Wednesday, March 26, 2014

ACA enrollment: driving uphill in a snowstorm.

As George W. Bush's second-term HHS Secretary, Michael Leavitt knows something about rocky rollouts of new government health programs, having overseen the launch of the Medicare Part D prescription drug coverage program, now broadly regarded as a success (e.g., by Leavitt).  As chair of health consultancy Leavitt Partners, he's also contracted with several state governments to help set up their ACA exchanges -- a role that subjected him to fierce conservative fire when he was named head of  Mitt Romney's transition team.  In 2011, he urged Republican governors to be practical and take control of their own state exchanges rather than cede the effort to the federal government. Notwithstanding his many qualms about the Affordable Care Act (e.g., its funding mechanisms), he is a believer both in state exchanges and in extending coverage to uninsured Americans.

It is not surprising, then, that in a January interview with Julie Appleby of Kaiser Health News, Leavitt signaled considerable empathy for the besieged team trying to get the ACA launched. Asked about one of the administration's many adjustments to rules and deadlines -- the extension of catastrophic plan eligibility to those whose 2013 plans were canceled -- he offered a striking metaphor that captures the administration's mindset and m.o.:

They’re trying to find ways to keep enough momentum moving forward.  Think about it like a big snowstorm, and you’re trying to drive a car uphill. The most important thing is to keep momentum and keep it out of the ditch. You might swerve from side to side, or might even do a circle or two. But if you can keep the momentum going up the hill, then you can ultimately succeed. They’re driving on a slick road up a stormy hill. They will do some things they hadn’t anticipated. But forward momentum is their game. At the end of the day, we’ll find out. They may get there; they may end up in a ditch. They may have a collision. Who knows? 
That image seems particularly apt in the wake of the administration's latest swerve, the extension of "special enrollment periods" past March 31 to anyone who claims to have tried to enroll in a health plan through before that point. Equally apt is Leavitt's less metaphorical take on the imperative driving moves like this:

KHN: What is your take on enrollment so far?

Leavitt: It’s unlikely they will hit their targets.  It seemed unlikely to me they would hit targets at the beginning. But we’re seeing more disruption than anticipated occurring.  [If they don’t get the enrollment] needed to make it actuarially sound, we’re likely to see higher premiums.  The objective for the administration at a moment like this is to keep it going at whatever cost.  At some point in time, it will smooth it out. It’s a logical strategy; it’s what they have to do.
"What they have to do" indeed. Ignore the critics and get the uninsured enrolled.

1 comment:

  1. Andrew, I'm wondering about the wisdom of an enrollment period at all, at least in that first year. If it's the problem of people waiting until they get sick, there are ways around that (including back-dating the insurance and premiums/subsidies). From what I'm seeing amongst my 20-something children & their uninsured friends, they're JUST beginning to feel that hey, maybe this is something they should do, after all. They've certainly heard it's a monster before; I'm just beginning to hear them talk about friends who enrolled, and the potential benefits.

    You've been doing an incredible job with these posts, thank you.