November 6, 2013
This is installment #18 in a continuing series of Obamacare Reports.
Implementation of the Affordable Care Act (ACA) has provided several key opportunities to size up how effectively the Department of Health and Human Services (HHS) has been able to deal with the threat of program failures.
Communication problems were encountered throughout the first three years of implementation efforts, leading to public confusion about the program and “opening the door” to critical attacks.
HHS finally began to start outreach and education efforts in mid-2013, but immediately demonstrated a lack of adequate preparation or budgeting. The result was a flurry of activity but not much impact on public awareness.
In this situation, the management strategy that was demonstrated might be described as a “quick fix” approach, characterized by ad-hoc catch-up activities. It became clear that introduction of a program like this to the public-at-large required a higher-profile effort to reach all target groups from the start.
The lesson might be that expert leadership was needed early in the game to establish communication and “branding” activities for the ACA. Late “fix” efforts tended to reach only those already motivated to sign up for health insurance through the new Exchanges, and not those on the sidelines (including young adults) who are also of critical importance to program success.
The next major problem encountered has been dysfunctional technical operations noted when the federal Exchange was “turned on”. This has been a very visible failure, leading to a new round of critical attacks.
At first, HHS tended to follow the “quick fix” approach, denying the scope of the problem and pushing on contractors to make short-term corrections. Again, there was a flurry of activity but not much progress.
After about a month, this response became a clearly inadequate, and an alternative strategy was chosen. A well-known and respected technology “czar” was appointed to be the visible sign of corrective action, and experts from across the country were swept into a “working group” to supervise improvements. A target date was named for fixing of the Exchange (by the end of November).
This “bring in the outsiders” approach has provided a different strategy for dealing with potential failure, more attuned to technical and political reality.
There has been another interesting side-effect of the technical failures associated with Exchange operations. High-level publicity about the Exchange problems has brought increased levels of ACA awareness to the public at large. One failure (communications) may have been partially offset by publicity regarding another (technical) failure, creating a third concern (about the competency of the program).
There will no doubt be more ACA-related potential failures—and need for responses—in the near future. It will be interesting to see what coping mechanisms are applied by HHS in these cases, given the experiences to date.
Useful lessons can be picked up by attorneys from these examples, when there is a need to help clients prepare for and cope with potential failures associated with new public (and private) programs and program changes.
More on these and related ACA topics may be found in a recent book by the authors that describes implementation of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.