HHS’s Burwell makes management changes


The Senate confirmed Sylvia Mathews Burwell as secretary of the Department of Health and Human Services on June 5, 2014. (Jonathan Ernst/Reuters)

Health and Human Services Secretary Sylvia Mathews Burwell announced a series of management changes Friday that are intended to put a single administrator in charge of the federal health insurance marketplace — something both critics and allies of the Obama administration have urged since the troubled rollout of HealthCare.gov last year.

Burwell announced that she plans to hire a chief executive officer to oversee the insurance exchange — an idea that some in the White House had advocated without success when the Affordable Care Act was enacted in 2010.

In addition, Burwell has appointed a second-in-command within HHS’s Centers for Medicare and Medicaid Services (CMS) — Andy Slavitt, group executive vice president of Optum, the main contractor that has been coordinating the work of fixing and creating parts of HealthCare.gov, the federal insurance exchange’s Web site.

The changes are Burwell’s first visible efforts to improve the functioning of CMS since she was sworn in less than two weeks ago, succeeding Kathleen Sebelius. While the moves sound bureaucratic, they represent a swift attempt to avoid a repeat of what President Obama called a “disastrous” beginning of the launch of HealthCare.gov.

By spring, 8 million Americans had signed up for coverage, but the first few months were marred by serious online sign-up problems that frustrated people trying to buy a new health plan. Though the issues had several causes, they stemmed in part from responsibilities that were too diffused among those creating rules for the marketplace and those building a highly complex computer system, with no one person in charge.

Meet Sylvia Mathews Burwell: Here's everything you need about her career in less than a minute. (Jackie Kucinich, Theresa Poulson and Jeff Simon/The Washington Post)

“These actions will bolster our team and further instill ongoing accountability for reaching milestones, measuring results and delivering results for the American people,” Burwell said in a statement accompanying the announcement. “Under this new structure, we bring additional operational and technological fire power and have a clear single point of contact in the Marketplace CEO to streamline decision-making.”

Burwell also announced that Kurt DelBene, a retired Microsoft executive assigned by the White House at the end of last year to help oversee work at HHS on the insurance exchange, will leave the department at the end of this month. His appointment had been considered temporary.

Senior health officials, speaking about internal deliberations on the condition of anonymity, said that the secretary intends to “actively recruit” for both the marketplace CEO and another new position — chief technology officer for the marketplace, and plans to have filled those positions in time to prepare for the second sign-up period that is scheduled to begin in November.
One health official said the shifts were “really taking into account the lessons learned” from the implementation of the health-care law. “It’s important to have in place a management structure that will have responsibility and accountability for the work that needs to be done,” the official said.

The initial computer defects that thwarted many people’s ability to sign up for coverage have largely been resolved. But other significant problems linger, with some parts of the system still not working. They include the ability to readily trade information with insurers about their new customers, automated enrollment of people whose incomes are low enough that they qualify for Medicaid, and untangling the cases of a few million people whose reported incomes or citizenship are inconsistent with federal records.

Amy Goldstein is a national reporter for The Washington Post, focus on health-care policy.
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