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 The recommendation, in a report due to be released by the
Washington-based Center for American Progress think tank, calls for
a major shakeup within the U.S. Department of Health and Human
Services, which presided over last year's disastrous rollout of the
federal market portal, HealthCare.gov.
The idea would be to take the exchanges out of the current
bureaucracy and put them in the hands of a CEO with private-sector
experience who could run them as true e-commerce sites. The CEO
would answer only to President Barack Obama and his intended new
health secretary, Sylvia Mathews Burwell.
CAP's plan would have the CEO assume full oversight of both federal
and state exchanges, as well as insurers and market regulations, but
not Medicare or Medicaid.
The White House said in a statement it had not reviewed the CAP
recommendation, but was open to considering "all ideas" that might
improve the law's implementation after the botched October rollout
and subsequent recovery.
The report's co-authors, including former White House healthcare
adviser Dr. Ezekiel Emanuel, say the change should be made soon to
address challenges that include the completion of automated "back
end" systems needed to carry out vital functions with insurers,
state Medicaid agencies and other entities.
"An absolutely essential element of achieving these goals is having
the exchange run by a CEO who is both given the resources and made
accountable for the exchange's performance," Emanuel, who teaches at
the University of Pennsylvania, told Reuters in an email from
Switzerland.
The idea is not new. Reform advocates, including CAP pressed the
same idea on the White House after HealthCare.gov's October crash,
the first in a series of setbacks that posed a political challenge
for Obama and his Democratic allies. The administration opted
instead for a more narrowly defined health technology czar to rescue
the site.
The report's authors believe the administration could be more open
to the idea now that last year's crisis is history and Burwell,
known for her managerial skills, is poised for Senate confirmation
and expected to bring her own team to HHS.
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Several senior HHS officials have also departed, potentially
clearing the way for changes. The current tech czar, former
Microsoft executive Kurt DelBene, could leave his post next month.
The administration is already looking at leadership options within
the Centers for Medicare and Medicaid Services (CMS), the HHS agency
largely responsible for the implementation of the Affordable Care
Act, popularly known as Obamacare.
"There are different management leadership models under
consideration right now," CMS Chief Operating Officer Tim Love said
on May 7 in testimony before a Senate Appropriations subcommittee.
He was referring to the CMS Center for Consumer Information and
Insurance Oversight (CCIIO), which oversees Obamacare exchange
regulations.
"I know the (CMS) administrator is consulting with the department
and the White House on what the most rigorous leadership model for
the CCIIO front office would be," Love added.
(Editing by Caren Bohan and Andre Grenon)
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