Ex-Health Chiefs: Don't Make it Worse 08/20 11:42
That's the advice of former U.S. health secretaries of both parties to
President Donald Trump and the GOP-led Congress, now that "Obamacare" seems
here for the foreseeable future. The 2018 sign-up season for subsidized private
health plans starts Nov. 1, with about 10 million people currently served
through HealthCare.gov and its state counterparts.
Stability should be the immediate goal, said former Health and Human
Services secretaries Kathleen Sebelius, Mike Leavitt and Tommy Thompson. At
minimum: Dispel the political and legal uncertainty --- fueled by presidential
tweets --- around billions in subsidies for consumers' insurance copays and
deductibles. The three former officials shared their views with The Associated
Beyond the urgent need to calm markets by providing clarity on subsidies,
Democrat Sebelius and Republicans Leavitt and Thompson differ on the direction
Trump and Congress should take. They agree that Republicans still have an
opportunity to put their stamp on the Affordable Care Act, even if the drive to
"repeal and replace" former President Barack Obama's legacy program appears to
have hit a dead end.
"They can make changes that signal a new ideological direction without
generating a logistical and political mess," said Leavitt, who led HHS during
former President George W. Bush's second term. "They won the right to make
changes. However, they should do it in a skillful way." Leavitt shepherded the
Medicare prescription drug benefit through its rocky rollout in 2006.
"Stabilizing the current situation can only --- I think --- be to their
benefit," Sebelius said of the Trump administration. "In an environment in
which (insurance) companies are enrolling customers, they've got a lot of time
to actually go back to the drawing board and figure this out. The worst of all
worlds for them would be to have the current situation unravel because of
decisions by this administration."
Sebelius helped steer Obama's law through Congress and later oversaw the
troubled launch of HealthCare.gov, when the computer system locked up on the
first day of sign-up season, frustrating millions of consumers and embarrassing
the White House. She took the heat, but Sebelius stayed on task and ultimately
helped deliver a successful open enrollment.
"It would be a mistake to further destabilize the (insurance) market," said
Thompson, who served during Bush's first term and led HHS preparations to meet
the bioterrorism threat after the deadly anthrax mailings that followed closely
the Sept. 11 attacks.
Thompson urged a health care summit between Trump and congressional leaders
of both parties, followed by a period of intensive legislative work under a
deadline to reach a truce in the political battle over health care.
Trump and top lieutenants like HHS Secretary Tom Price have sent mixed
Leading congressional Republicans want to try to move limited legislation
after lawmakers return next month, worried they'll suffer consequences in next
year's midterm elections.
At the very least such legislation would provide clear legal authority for
the ACA's cost-sharing subsidies, which reduce copays and deductibles for
people with modest incomes. Stopping the payments would lead to a spike in
premiums, more insurers leaving the markets and increased federal deficits, the
Congressional Budget Office warned last week. The markets already saw steep
premium increases this year, and more insurers have since bailed out, citing
The administration has continued to make monthly subsidy payments to
insurers, as recently as last week. But Trump on Twitter and in interviews has
repeatedly threatened to pull the plug. Sebelius has been sharply critical of
the Trump administration's stewardship of the ACA.
Two of the former health secretaries --- Leavitt and Sebelius --- said
states are now likely to assume a bigger role in shaping the future of Obama's
law. A waiver pathway for states was built into the law, and Republicans want
to make it less restrictive. That's a key focus for Senate Health, Education,
Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., as he plans
bipartisan hearings this fall with Democratic counterpart Patty Murray of
Leavitt sees waivers as a way to provide states more flexibility to tailor
their insurance market rules to local needs and preferences.
Sebelius says that should not be done in a way that undermines federal
consumer protections like standard benefits. She'd like to see states use
waivers to help offset the cost of care for the sickest patients.
Thompson says he believes a bigger deal, at the federal level, is still
possible if Trump plays his cards right with Congress.
Former HHS Secretary Sylvia Burwell, who served during most of Obama's
second term, declined interview requests.