Health and Human Services Secretary Michael Leavitt, left, and President… (PAUL J. RICHARDS/AFP/GETTY…)
Michael O. Leavitt served as secretary of health and human services under President George W. Bush. He is the founder and chairman of Leavitt Partners, which advises and invests in health-care organizations and consults with state governments on the implementation of the Affordable Care Act.
This past spring, Sen. Max Baucus (D-Mont.) called the impending implementation of the Affordable Care Act “a huge train wreck.” His words caught my attention because the last time the federal government delivered a new health-care benefit to more than 40 million people, I drove the train.
As secretary of health and human services during President George W. Bush’s second term, I faced the daunting task of rolling out Medicare’s new prescription drug benefit. Commonly referred to as “Part D,” the program is considered a tremendous success: Premiums have remained low, the program operates well under its projected budget and 90 percent of seniors are satisfied with their plan.
But in early 2006, there were days when I thought we could crash at any moment. For several weeks, the rollout of Medicare Part D felt like a runaway train — bumpy, uncomfortable, unnerving. Fortunately, the ride ended safely.
I opposed the Affordable Care Act, and I still believe that big changes to the law are necessary. But I’m not hoping for a wreck. That outcome would hurt ordinary people, not just politicians. Avoiding a calamity will be a major test for the Obama administration. To succeed, it should learn from our experiences with Part D — what we did well and where we fell short.
Part D and the Affordable Care Act resulted from contentious negotiations and fierce legislative battles. Both charged the Department of Health and Human Services with creating an insurance marketplace where people could choose among competing private plans. Both involved new regulations and information-technology systems, approval of insurer bids and plans, coordination with federal departments and state governments, and the education of millions of Americans. However, the ACA’s challenges are even greater than those we faced, given the law’s complexity, size and scope.
The Obama administration assures us that it will be ready, but independent analyses and recent delays signal potential trouble. In particular, I see four risks that could cause this train to jump the tracks:
With the ACA’s initial enrollment period three months away, 78 percent of Americans lack awareness about the law and the changes it will bring. Four in 10 don’t even know the law is set to take effect. So it’s not surprising that 58 percent of the uninsured report that they don’t have enough information to answer the important question: What will the ACA mean for me?
With Part D, the education hurdles were also high. Before the program was implemented, only 21 percent of seniors had a favorable opinion of it, and 66 percent didn’t understand what the reform would mean for them.
So we spent 18 months devising and implementing a campaign to explain the prescription drug benefit, prepare seniors as well as partners — such as community groups, churches, pharmacies, insurance plans and state and local governments — and then sign people up. A national bus tour supported each phase. The summer before enrollment (the same period that the ACA is in now) we logged more than 600,000 miles and visited 48 states. As secretary, I made 119 stops in 98 cities. I learned that with a program like the ACA, you can’t count on Washington to sell it. You have to reach people where they live, work, pray and play.
Compared with Part D, ACA implementation is behind schedule. The administration and its allies have waited until this summer to begin an education campaign, to explain how fine print becomes lived experience.
To close the awareness gap, HHS leaders need to hit the road and prepare those seeking coverage for inevitable technical glitches and delays. They must also remember that the biggest political risk isn’t unhappiness among the tens of millions who don’t have insurance — it’s sticker shock among the hundreds of millions who do, and whose premiums are likely to rise. The administration needs a narrow message for the uninsured and must have a more persuasive message for everybody else.
When the ACA starts delivering benefits in January, its success will depend in part on the technical infrastructure the government has built. The centerpiece is a hub that will connect and transfer data between the in-house systems of various government agencies and private entities.
Imagine an uninsured 27-year-old man living in Texas — a key demographic in one of the administration’s target states.