Uh oh: Obamacare author warns implementation could be a “train wreck”

posted at 4:01 pm on April 17, 2013 by Mary Katharine Ham

Sen. Max Baucus (D-MT), who helped write Obamacare and is up for reelection in 2014:

Senate Finance Committee Chairman Max Baucus, one of the health reform law’s chief authors, says he’s worried about a “huge train wreck coming down” if the Obama administration doesn’t improve its public outreach about the legislation.

Baucus, a Montana Democrat who is up for reelection in 2014, sharply criticized the administration’s outreach efforts in a budget hearing on Wednesday. He told Health and Human Services Secretary Kathleen Sebelius that people and businesses “have no idea what to do, what to expect” from the law.

“If the administration implements it correctly, millions more Americans will gain access to health care next year,” Baucus said. “I am concerned that not every state, including Montana, will have an insurance marketplace established in time.”

After the hearing, Baucus explained that the train wreck is “that consumers and businesses will just not have enough information. That it will be too confusing.”

He also expressed frustration that the White House and HHS are not providing details of its outreach efforts.

Baucus is actually addressing three separate problems in his criticism—a messaging problem and two logistics problems— but making it sound in his clarification as if he only means there’s a messaging problem, which is the Obama administration’s standard line for most of its failures.

This is more than a messaging problem, as Baucus himself clearly indicates. He has concerns that Montana and other states will not have an insurance exchange in place by October, when the public is supposed to begin open enrollment.

As HotAir pointed out in November, the danger of delay stems from the fact that the administration foolishly assumed every state would build their own exchanges, though it had not given states requisite incentive, information or regulations around which to build these complex systems. The reason the Obama administration did not roll out most of the exchange regulations until late 2012 is because being explicit about the bill’s new requirements would have been unhelpful to the president’s reelection. Baucus and Co. leaving most of the regulations blank for Sebelius’ regulators to fill in had the same political calculus behind it. But the administration’s delay, as even Joe Klein concedes, was irresponsible and may spell big trouble for exchanges.
Another complaint also goes beyond messaging and outreach. He asked Sebelius about the system’s “Navigators”—a customer service army meant to smoothly and competently guide citizens through the process of applying for Obamacare and buying health care through exchanges. Now, even if you set aside the federal government’s reputation for customer service, it would take a tremendous amount of time and savvy to train all these employees in the intricacies of the federal data hub, the complicated formula for determining subsidies, and the technological interface for exchanges, most of which does not yet exist.

“My main concern is that when I ask them for information about the navigators … that I don’t get anything back,” Baucus told reporters.

Sebelius defended the administration’s efforts, arguing that there will be navigators — guides to help consumers through the exchanges — ahead of the Oct. 1 enrollment date. Sebelius also said that people will be in the states this summer to inform people about the law. She said HHS officials and the Small Business Administration are holding webinars and seminars and will be holding more through the summer.

But when Baucus asked for the number of people and which states, Sebelius declined to reveal specifics.

“We need data,” Baucus said. “You never give me any data. You give me concepts, frankly.”

Emphasis mine. Here’s a bit of data I have from Maryland. Baucus is right. Continued promises and concepts, no matter how good they sound, don’t help us determine whether this thing can get off the ground.

I like to use Maryland as a benchmark for how exchange implementation is going. In order to be fair, I’ve picked the state with arguably the highest health-care-bureaucrat-to-citizen ratio and a lot of experience heavily regulating health care. Maryland was also politically gung-ho from day one to implement Obamacare. When I tell you where Maryland is in the process, you can safely assume almost every other state is behind it.

Maryland announced in early April that it is going to hire 70 employees to work in the exchanges, and “expects to have most, if not all, the positions filled by the exchange’s opening day.” The state has been hiring for a while, but many unfilled job listings are on its website.

In addition, the state is hiring companies that will create and/or manage parts of the exchange. When their contracts are finalized, the companies will do their own hiring for a so-far undetermined number of jobs.

“A lot of our resources will be through vendors,” says Leslie Lyles Smith, the exchange’s director of operations, of the companies to which the exchange will subcontract various responsibilities.

Smith says that most of the future employees, both those hired by the exchange and by vendor/subcontractors, will be in operations and IT. She divided the job areas into the following categories:

IT;
marketing and communications outreach;
planning and partner management, specifically liaison with brokers, third-party administrators and insurance companies;
operations and consumer assistance, specifically the call center and navigator program;
internal operations;
budget and finance;
human resources;
general services;
policy and government relations; and,
appeals/grievances.

Emphasis mine again. At meetings of the Maryland Health Benefit Exchange board, state officials have indicated training for Navigators would take several months. So, Baucus is not just encountering a problem of Navigators who are not getting the word out, but Navigators who do not yet exist.

“Sebelius said there will be no polling, testing or benchmarks to measure how much people know about the law,” Politico notes. If you’re wondering whether smaller, state-level reforms in health care generally have polling, testing, pilot programs, and benchmarks for this kind of thing, yes they do. The administration’s messaging strategy is no doubt hampered by the fact that it must solve pretty serious technical and logistical problems before it can tell anyone anything. Both the magnitude of the program and the administration’s own foot-dragging have exacerbated the problem. Pretending it’s one that can be fixed with mere better messaging will not help fix it. You can repeat, “It’s like a Travelocity for health care” as many times as you like. That won’t build a Travelocity for health care.

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