Health Care Reform Implementation (Part 2)

A series of presentations at the annual conference of the National Academy of Public Administration focused on the complicated management challenges all levels of government will be facing upon the passage of any health care reform legislation. As one participant noted: “There’s too much of a view that programs are self-executing and you just need more inspectors general and audits. . . that happened with the Recovery Act.” The consensus seemed to be that this assumption clearly won't work for health care reform!

Federal challenges. As Congress debates the shape of the health care reform legislation, there are a number of administrative management issues where seasoned executives in federal agencies might want to begin thinking through. The Department of Health and Human Services might be a logical home for such a task force, but other agencies, like Labor, Treasury, Veterans Affairs, and Defense might play important roles as well. And someone would need to represent agencies that don’t exist yet, like the proposed Medical Choices Administration.

Even if specific policy provisions are not yet defined for the health care initiative, certain tasks can be undertaken right away, for example:

• identifying a team of top career talent that have the experience of implementing big programs,
• defining competencies and skills needed to staff potential programs,
• creating expedited hiring and procurement authorities,
• gaining authority to operate streamlined regulatory and advisory processes, and
• developing the infrastructure for collaborative cross-agency networks.
• (feel free to add to this list!)

State-local challenges. As health care coverage is expanded for low income citizens, state governments will be challenged in ramping up their existing programs. Depending on the legislation enacted, the enrollment in state Medicaid programs could increase by about 12 million. This will place a huge burden on state enrollment and administrative processes. Likely concerns about potential program abuses may increase oversight costs, or at least complicate implementation efforts.

Likewise, if the proposals to create health insurance exchanges are enacted, creating new administrative structures in each state will be challenging. The Senate bill delays implementation until 2014, but even then it would be challenging to design them, enact the regulations, educate the state providers, hire the needed staff, educate the new enrollees, and conduct the enrollment process. Any implementation strategy would involve federal, state, local, non-profit, and for-profit stakeholders.

At the state level, fortunately, some are already thinking about implementation challenges. For example, Alan Weil of the National Academy for State Health Policy, has developed several guides that lay out both strategic and topic-specific steps that need to be considered. One report, “Supporting State Policymakers’ Implementation of Federal Health Reform,” could serve as a useful checklist for federal implementers!

NOTE: A subsequent Gov Exec article on concerns about implementing health care reform cites a NAPA report issued July 2009 recommending quick action on putting attention on seven specific administrative areas important to implementing any health care reform. That report is titled "Administrative Solutions in Health Reform."