Obama Administration Puts Executive Focus on — Surprise! — Execution
In Washington we say that where a President puts his prize staffers is the best indicator of his priorities. That being the case, two of POTUS’ recent staffing moves paint a picture: Obama’s #1 domestic priority is smoothing out ObamaCare before the next enrollment period this fall and solidifying the experience of the millions who gained coverage this year.
In the surprise of the year so far, it appears that Sylvia Mathews Burwell will cruise to confirmation as Secretary of Health and Human Services as early as this week. Burwell is a longtime Obama confidant from the White House Office of Management and Budget and known as a strong manager of minutiae. Like Mark McClellan did as CMS Administrator in the Bush Administration for the launch of Medicare Part D, she is a skilled bureaucrat with a mind for process, and with her budget background, certainly knows which cushions to find coins under. As a veteran administrator, her job is high cover and finding the money her department needs to see the ObamaCare launch through as appropriations play out on the Hill.
Over the weekend, the White House elevated longtime aide Kristie Canegallo to the new position of deputy chief of staff for policy implementation, a role that will include keeping tabs on the ACA. The move, which coincides with the expected departure of healthcare adviser Phil Schiliro (a legislative wizard but not an operator), highlights the administration’s intent to maintain focus on ObamaCare implementation after last fall’s goat rodeo of a launch. Her task will be hovering over Burwell and CMS Administrator Marilyn Tavenner and whipping the process along.
We know the biggest vulnerabilities that remain for ObamaCare are fixing the back end of CMS’ systems that interact with insurers on their membership coming through the health insurance exchanges — this will be Canegallo’s focus — and securing funding for the “3 R’s” — risk adjustment, reinsurance, and risk corridors, which will be Burwell’s job. Due to a drafting error in the ACA, nobody identified funding for exchange risk corridors; on Friday in the final exchange rule, HHS clarified that if risk corridor funds are insufficient the government will be required to step in and make issuers whole, and would find that money elsewhere in HHS if needed. Nobody better for that than the former budget chief.
The challenge for these two exceptional women — and even for Tavenner, a former hospital administrator — is that none are particularly well-known or regarded in the insurance industry — their partners in this next phase of implementation and wrinkle-smoothing. They will need to build that trust in a charged environment of preparing for the next open enrollment and possibly a Republican takeover of the Senate. Expect to see this triumvirate doing some serious outreach in the weeks and months ahead, and many White House meetings for AHIP’s Karen Ignani and other industry reps.
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