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Thursday, October 18, 2018

by Charles Ornstein ProPublica.

Less than a month after President Obama signed the Affordable Care Act into law, he nominated Dr. Donald Berwick to lead its implementation as administrator of the Centers for Medicare and Medicaid Services. Months later, when Congress failed to act on the nomination, the president used a recess appointment to install Berwick in the post. Berwick resigned in late 2011 and is now running for governor of Massachusetts.

Berwick has positioned himself as a leader in the health reform effort, but he has tried to distance himself from the problem-plagued rollout of, the federal health insurance exchange. “Those were staff level functions,” he said in an interview last month with the Boston Globe. “My leadership investment was in the vision of CMS as a major force of improvement of care for the nation.”

I caught up with Berwick Friday as he was heading to the airport.

For many in the public, the disastrous rollout of has come to define the law itself. But Berwick emphasized — as other defenders of the law have — that its features extend well beyond the health insurance marketplaces.

Among other things, he said, the law provides free preventive care benefits to millions of Americans, allows young adults up to age 26 to remain on their parents’ health insurance policies, gives additional assistance to seniors with high medication bills, and improves oversight of insurance companies. He said the law also has many provisions to improve the quality of patient care and cited a recent drop in hospital readmissions.

Berwick said he hasn’t had much interaction with those responsible for the rollout because presidential appointees are barred from having substantive interactions with their former agencies for two years after they leave office.

The interview has been edited for clarity and length.

Q. How do you think things are going with the rollout?

A. I guess I answer in two tiers. I think for the law as a whole, things are going well. This implementation has after all been going on really since the law was passed. And there are many, many benefits that are in place — things that are much better for millions of people. The discussion of the exchange rollout tends to dominate the visual field when there’s so much else that’s going on under the law that I’m very familiar with, because that happened when I was there — much of it.

In terms of the rollout [of], it’s unfortunate for sure. Nobody’s happy with this. I don’t have much more information than an average newspaper reader has. But my general view is that this is a significant technical problem. It’s reminiscent of some of the Part D [prescription drug program] implementation problems, but it’s big and it’s unfortunate. I think it’s technical and therefore can be solved technically, and I assume will be. I can only guess the amount of resources that are now being put into an understanding of what’s wrong and fixing it. I’m confident that this is going to be behind us, but like everyone in the country, I’m sorry that it hasn’t gone well so far.

If we weren’t so polarized, if there weren’t people trying to shoot down the Affordable Care Act going way back to 2010, I think we’d have a different kind of national attitude, which would be, “Oh my goodness, that’s a problem. Let’s fix it.” Instead of “Oh this is proof this law doesn’t work and the government can’t do anything.” I mean, that comes out of the political rhetoric, not out of the facts.

Q. How long do you think the administration has to fix the problems before it actually begins undercutting the law?

A. I don’t know. I think that the facts on the ground should favor the administration in some important ways because the benefit structure of the law as a whole is so widespread. Actually I don’t really think you could stop this law because the minute you tried to take it down, millions and millions of people would realize that they’re losing something right now, let alone in the future. Pre-existing conditions applying to kids again, prevention benefits lost, drug access down. That should help. I’m not an actuary, and I don’t know how to calculate the actuarial consequences of the delay. I can make arguments on either side of the case. I will say that given the intensity of the commitment that I’m sure exists in the administration and the enormous technical competence of the nation, I think it will be fixed. I think it will be fixed in good enough time.