New health-care rules multiply man-hours for policymakers, bureaucrats

By N.C. Aizenman
Thursday, June 3, 2010

At the Department of Health and Human Services, the team charged with writing new health insurance rules has ditched the fridge and microwave in their break room so they can have more work space.

At the Labor Department, a clue to the hours staff members are keeping is offered by the motion-activated lights in the hallways. They are on by 6 a.m. and don't flicker off until long after dark.

The health-care overhaul may have slipped from the headlines since President Obama signed the bill into law in March. But the gargantuan chore of putting the statute's more than 2,000 pages of provisions into practice is keeping Washington's policymakers and bureaucrats busier than ever.

"As soon as the bill passed, I sent an e-mail to congratulate a friend of mine at HHS who was heavily involved working with Congress," recalled Assistant Secretary of Labor Phyllis C. Borzi. "She sent me an e-mail right back that said, 'Roll up your sleeves, my friend. Now the hard work begins.' "

The White House largely remains in the driver's seat.

Most Mondays and Thursdays, Nancy-Ann DeParle, director of the White House Office of Health Reform, meets with several dozen top officials to weigh in on the myriad sensitive decisions required to translate the law's mandates into fine print covering one-sixth of the economy.

According to administration sources, key participants include Jeanne Lambrew, director of the Office of Health Reform at HHS, and Mark Childress, the agency's acting general counsel. Also present are officials from Treasury and Labor, where Borzi oversees implementation as head of the Employee Benefits Security Administration.

White House regulars include veterans of the effort to craft the law, such as health policy expert Ezekiel Emanuel of the Office of Management and Budget, as well as newcomers to the team, such as Democratic communications specialist Stephanie Cutter, brought on to launch a major public outreach campaign.

DeParle recently briefed Senate Democrats on a slew of provisions set to begin this year that will offer relief to vulnerable groups until the law takes full effect in the years ahead, and provide Congress members with achievements to point to before November's midterm elections.

The measures include sending $250 checks to seniors to offset the coverage gap in Medicare's drug benefit, giving tax breaks to small businesses that cover employees, prohibiting many insurers from denying coverage to children with preexisting conditions and requiring insurers to let parents keep adult children on their policies.

"They're rolling this stuff out very smartly, every week or 10 days coming out with another positive thing about the bill that makes it appealing to a particular constituency," said Senate Finance Committee spokesman Scott Mulhauser.

The extent of White House involvement is a measure of the law's potential impact on Obama's presidency. But it also reflects the degree to which the law leaves fundamental decisions to the administration's discretion.

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