I talked exclusively with the secretary about her day-to-day work implementing the Affordable Care Act and what she worries about as the Oct. 1 opening of the health insurance marketplaces approaches. What follows is a transcript of the conversation, lightly edited for clarity:
Sandhya Somashekhar: How is it going to go on Oct. 1?
Sec. Kathleen Sebelius: Well, we are testing all of the data systems like crazy to try and make sure that information can flow easily through the system. I’m sure there will be operational challenges in the opening of the markets, but I think we’re trying to build in redundancies and be able to respond very rapidly. And really we see Oct. 1 as the beginning of the campaign that really lasts for six months.
SS: We keep hearing it’s a tight but doable deadline.
KS: It is very tight…Ideally what you would do if you were building a data hub that needs this kind of information, you’d put a piece together and test that. You test it, if you will, sequentially. We have to build and test simultaneously…it’s a big operational issue but all systems are a go for the first of October.
SS: How involved are you in the day-to-day work on the ACA?
KS: The good news is we have spectacular people who are doing the operations piece of this 24/7. And I am personally engaged a minimum of a couple of days a week around operational issues, getting all the regulations out, making sure all the information is correct, getting regular updates on the states, what our progress is on the national level. So there’s a pretty roll-up your-sleeves element that this isn’t a hands-off operation for me.
SS: Is that what you’d say you do all the time? ACA?
KS: I do some ACA, but with a department as large and diverse as ours, I don’t have the luxury to just do this every day.
SS: How are you going to measure success on March 31?
KS: Our target for this first open enrollment period is to have 7 million newly enrolled individuals throughout the country. We’ll have the ability to, on a very real-time basis, know who is signing up, who’s enrolling, who’s got coverage and whether or not we’re on target to meet those goals.
The opportunity in a six-month enrollment is to know what’s working in what areas, what isn’t working, look at best practices. Be able to shift around, figure out why in Des Moines they seem to be having great success, what are they doing, move that to another market area and try to replicate it. So we’re really trying to make sure we have the ability to be pretty nimble on the ground.
SS: You’ve said many times that the marketplaces will be open in every state and every person in America will have quality choices when they do sign up. But what about the enrollment experience? Do you think that will be different in a place where a state has gotten a grant and they’ve already been printing out these promotional materials and they’re plotting all these strategies, and a state where there’s not really that level of buy-in from the leadership?
KS: Well, I don’t really think the enrollment experience will be different per se, because, ideally, either on the Web site, on the telephone or in person, they’ll be walking through the same steps and have a very similar set of choices.
What I think is different is the education and outreach leading up to enrollment. Certainly it is much more robust in some areas than others. Having consumers be able to get information easy to read, easy to understand, answer questions, pull together their financial information and then get ready, may be more challenging in states where there isn’t a really robust outreach effort. Particularly in communities where people are going to need a lot of in-person assistance, somebody who has never had insurance before who doesn’t even know how to think about terminology – what’s a deductible, what’s a copay, how do I measure that, how do I make a choice about services. That level of consumer dialogue, we’re trying to make sure occurs everywhere in the country, but certainly if there is a lot of help and support from locals it might be easier to put together than in other areas.
SS: Are you worried about that? Do you worry that people aren’t going to understand in those states either what their obligations are or how they can benefit?
KS: Yeah, I worry that people have no idea the opportunities that they’re going to have and the benefits they are going to receive. We always knew that the federal government clearly cannot do this alone. We never anticipated that we would. So building a wide network of stakeholders, health-care providers, people from the faith community, a lot of the health related groups, community outreach groups, a number of the people who actually were involved in passing the legislation in the first place, we’re trying to reengage and involve in making sure we can complete this circle…We have a lots of eager folks who, they worked hard for this president, they helped him get elected, helped him get reelected, and the notion now they can help people get health insurance, it’s like, this is really cool and amazing.