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 Advocates have been quietly pushing the idea of a CEO who would
set marketplace rules, coordinate with insurers and state regulators
on the health plans offered for sale, supervise enrollment campaigns
and oversee technology, according to several sources familiar with
discussions between advocates and the Obama administration.
Supporters of the idea say it could help regain the trust of
insurers and others whose confidence in the healthcare overhaul has
been shaken by the technological woes that crippled the federal
HealthCare.gov insurance shopping website and the flurry of
sometimes-confusing administration rule changes that followed.
The advocates include former White House adviser Ezekiel Emanuel,
the brother of President Barack Obama's former chief of staff Rahm
Emanuel, and the Center for American Progress, the Washington think
tank founded by John Podesta, the president's newly appointed senior
counselor.
The White House is not embracing the idea of creating a CEO,
administration officials said.
"This isn't happening. It's not being considered," a senior
administration official told Reuters.
Some healthcare reform allies say the complexity of the federal
marketplace requires a CEO-type figure with clear authority and
knowledge of how insurance markets work.
Obama's healthcare overhaul aims to provide health coverage to
millions of uninsured or under-insured Americans by offering private
insurance at federally subsidized rates through new online health
insurance marketplaces in all 50 states and in Washington, D.C.
Only 14 states opted to create and operate their own exchanges,
leaving the Obama administration to operate a federal marketplace
for the remaining 36 states that can be accessed through
HealthCare.gov.
The marketplace is now officially the responsibility of the U.S.
Centers for Medicare and Medicaid Services (CMS) and its
administrator, Marilyn Tavenner. Healthcare experts say there is no
specific official dedicated to running the operation.
A CMS spokesman said exchange functions overlap across different
groups within the agency's Center for Consumer Information and
Insurance Oversight.
The lack of a clear decision-making hierarchy was identified as a
liability months before the disastrous October 1 launch of
HealthCare.gov by the consulting firm McKinsey & Co.
Obama adviser Jeffrey Zients, who rescued the website from crippling
technical glitches last month, also identified the lack of effective
management as a problem.
POTENTIAL CEO CANDIDATES
Former Microsoft executive Kurt DelBene has replaced Zients as
website manager, at least through the first half of 2014.
"We're fortunate that Kurt DelBene is now part of the administration — there's no one better able to help us keep moving forward to make
affordable, quality health insurance available to as many Americans
as possible," Obama healthcare adviser Phil Schiliro said in a
statement to Reuters.
The White House appears, for now, to be concentrating on ironing out
the remaining glitches in HealthCare.gov to ensure millions more
people are able to sign up for coverage in 2014. Good enrollment
numbers are seen by both critics and supporters of Obamacare as a
key measure of the program's success.
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"So my sense is that they're not thinking about appointing a CEO in
the short term," said Topher Spiro, a healthcare analyst with the
Center for American Progress.
The CEO proposal calls for removing day-to-day control of the
marketplace from the CMS bureaucracy and placing it under a
leadership structure like those used in some of the more successful
state-run marketplaces, including California.
The new team would be managed by a CEO, or an executive director,
who would run the marketplace like a business and answer directly to
the White House, sources familiar with the discussions say.
They point to insurance industry and healthcare veterans as
potential candidates, including former Aetna CEO Ronald Williams,
former Kaiser Permanente CEO George Halvorson and Jon Kingsdale, who
ran the Massachusetts health exchange established under former
Governor Mitt Romney's 2006 healthcare reforms. None of the three
was available for comment.
Healthcare experts say the idea should have been taken up by the
administration years ago.
"It's the right thing to do. It's just two years late," said Mike
Leavitt, the Republican former Utah governor who oversaw the rollout
of the prescription drug program known as Medicare Part D as U.S.
health and human services secretary under President George W. Bush.
"The administration is confronted by a series of problems they
cannot solve on their own. They do not possess internally the
competencies or the exposure or the information," he told Reuters.
Emanuel, one of the administration's longest-standing allies on
healthcare reform, recommended a marketplace CEO in an October 22
Op-Ed article in the New York Times, calling it one of five things
the White House could do to fix Obamacare.
"The candidate should have management experience, knowledge of how
both the government and health insurance industry work, and at least
some familiarity with IT (information technology) systems. Obviously
this is a tall order, but there are such people. And the
administration needs to hire one immediately," he wrote.
The administration has adopted Emanuel's four other recommendations:
better window-shopping features for HealthCare.gov; a concerted
effort to win back public trust; a focus on the customer shopping
experience; and a public outreach campaign to engage young adults.
(Reporting by David Morgan in Washington;
editing by Karey Van Hall,
Michele Gershberg, Ross Colvin and Will Dunham)
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