Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Tuesday and Thursday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.
About two months ago, the federal agency overseeing Obamacare said it would name its first-ever chief executive for HealthCare.gov, an acknowledgement that the enrollment Web site didn't have a true leader before its faulty launch last fall. On Tuesday, the Obama administration announced that new role will be filled by Kevin Counihan, the chief executive of Connecticut's health insurance exchange, which is thought to be one of the best state-run insurance marketplaces in the country.
The idea of a single point person to oversee the law's implementation originally generated interest among some of the law's advocates in early 2010 and top administration officials. More talk resurfaced after the failed launch of HealthCare.gov last year, when it became clear there was a management problem at the Centers for Medicare and Medicaid Services, the agency overseeing the law's implementation.
It's easy to see why CMS saw Counihan as the right person to run the enrollment Web site serving 36 states. Counihan, also a former executive with the Massachusetts exchange that was a model for the Affordable Care Act, ran the Connecticut exchange, which managed to avoid major tech glitches while reportedly cutting the state's uninsured rate in half this year. Maryland is planning to use Connecticut's technology for the upcoming enrollment period, and other states have looked at using the Connecticut platform. Connecticut also did some unique things to boost enrollment, like setting up a handful of storefronts across the state that were modeled after Apple's retail locations.
How else did Connecticut avoid the pitfalls that other states equally enthusiastic about embracing Obamacare ran into? As Counihan told The Post in July 2013, the Connecticut exchange intentionally scaled back some of its Web site's more ambitious features to make sure it would be ready on time for the first enrollment period.
“This is a two- to three-year implementation we’re doing in 10 months,” Counihan said at the time. “I wish we had one more year.”
That's not to say, though, that Connecticut's exchange hasn't been without its problems. As the CT Mirror recounts today:
A programming flaw led 903 Access Health customers to lose their insurance coverage this year. In June, a data breach occurred when an employee of the vendor that operates Access Health’s call center left a backpack containing notebooks with customer information on a Hartford street. And federal auditors raised concerns about the internal controls used at Access Health, as well as the exchanges run by California and the federal government.
CMS didn't say which other candidates might have been considered for the chief executive job, and the agency is still looking to permanently fill a new chief technology officer position announced almost two months ago.
Counihan will be heading up an operation that still faces some major challenges for the next enrollment period. The back-end systems with insurers still need to be finished, about 300,000 people need to provide proof of citizenship to avoid losing coverage next month, and re-enrollment of this year's customers could provide its own headaches. As new CMS principal deputy administrator Andy Slavitt, who helped repair HealthCare.gov last fall, acknowledged in July, there will be "some bumps" when enrollment opens again Nov. 15 — now less than three months away.
Top health policy reads from around the Web:
New birth control rules follow SCOTUS recommendation. "Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month. The unsigned order agreed to by six of the nine justices said Wheaton College need not fill out and send to its insurance company a form opting out of offering the coverage. Instead, it could merely inform the government of its objections. The new rules unveiled Friday require those with religious objections to providing some or all FDA-approved contraceptives to do exactly that." Julie Rovner for Kaiser Health News.
Overruns for one-third of HealthCare.gov contracts. "The federal government is due to pay at least 20 contractors more than their original estimates for work on HealthCare.gov and the rollout of ObamaCare, according to an official review released Tuesday. Seven companies are due to receive more than double their initial estimates, the IG report stated. The government was obligated to pay nearly $800 million for 60 contracts related to the federal marketplace as of February 2014. By that time, it had spent nearly $500 million." Elise Viebeck in The Hill.
One state re-opens ACA enrollment. "Responding to ongoing problems at the Washington Healthplanfinder insurance exchange, state Insurance Commissioner Mike Kreidler on Monday instituted a limited special enrollment period for consumers who want to obtain coverage outside the exchange. From Aug. 27 to Nov. 14, those who have had problems with enrolling or making payments through Healthplanfinder can enroll in coverage outside the exchange either by selecting a different plan with the same carrier or by changing carriers. It’s not clear how many people are eligible for the special enrollment." Patrick Marshall in the Seattle Times.