Health Care Reform Implementation (Part 1)

Government Executive’s Alyssa Rosenberg hits the nail on the head in her Fed Blog today, “How Health Care Would Be Run.” Her piece looks at the increased role of the Secretary of Health and Human Services in the Senate version of the bill. The House version has significant roles for other agencies as well, and creates a new independent agency, the Health Choices Administration.

But the broader point Rosenberg raises is: Is anyone looking at how this legislation would be implemented? After all, the 2008 Obama presidential campaign quietly put in place a top-notch transition team in mid-2008 in anticipation that he would win the election. That team moved quickly once the election was won. Is there such a team in the wings in anticipation of the passage of a health care bill?

There are a number of implementation issues that do not depend on policy options (such as whether there is a public option, or state exchanges, etc). For example, it is not too soon to be thinking about things such as (a) identifying a small cadre of successful career civil servants who have the experience of leading large efforts, (b) creating expedited hiring authorities for new functions being created in legislation, or (c) developing new approaches to speed up regulatory development and implementation for statutory provisions to be "implemented immediately." As Rosenberg notes, there probably are lessons to be learned from the stand-up of TSA and the implementation of the Medicare Part D prescription drug benefit.

Interestingly, health care reform was the underlying theme of the recent annual meeting of the National Academy of Public Administration (NAPA), a congressionally-chartered good government non-profit. This was the first time NAPA devoted an entire annual conference to a single topic. Why would NAPA do this? Well, this will likely be the most significant public management challenge facing government in the next decade!

I’ll summarize some of the highlights from that conference over the next few days.

The NAPA conference also triggered some curiosity on my part as to what is actually in the health care reform bills, so I did some browsing. If you want to look at them also, here are the links:

• The House Bill is H.R. 3962 - “Affordable Health Care for America Act”
• The Senate Bill is technically an Amendment to H.R. 3590, an unrelated bill, but renamed - “Patient Protection and Affordable Care Act”

Have fun browsing; there’s lots there to ponder!