Washington, D.C. — With the Affordable Care Act’s first open enrollment period now over and the Senate now considering Sylvia Burwell, President Barack Obama’s nominee for the next Health and Human Services Secretary, there is an opportunity to look afresh at the decision-making process for the law’s implementation.
A new report from Center for American Progress President Neera Tanden, Senior Fellow Zeke Emanuel, and Vice President for Health Policy Topher Spiro suggests that the marketplace adopt a management structure similar to many major corporations with a chief executive officer overseeing the federal and state marketplaces and a board of directors holding the CEO accountable.
“One of the biggest challenges for the incoming secretary of Health and Human Services is to ensure the federal exchange—which now runs enrollment in more than two-thirds of states—improves its user experience and insurance offerings and keeps premiums affordable,” said Dr. Zeke Emanuel, CAP Senior Fellow and co-author of the report. “An absolutely essential element of achieving these goals is having the exchange run by a CEO who is both given the resources and made accountable for the exchange’s performance.”
The report titled “A New Management Structure for a New Phase of the Affordable Care Act” recommends that the next secretary of Health and Human Services put in place a management structure that empowers a single leader that is accountable for all of the implementation, not just the website. The structure should integrate technology, policy, and business decisions; coordinate seamlessly with states and insurers, as well as the many federal agencies involved in implementation; and foster transparency and accountability. The report suggests that a system with a CEO and a board of directors would provide the particular leadership and accountability required to meet these goals.