Writing of health law not over yet

Fine print is still being worked on

By N.C. Aizenman
Washington Post / June 6, 2010

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WASHINGTON — At the Department of Health and Human Services, the team charged with writing health insurance rules has ditched the fridge and microwave in their break room so they can have more work space.

At the Labor Department, a clue to the hours staff members are keeping is offered by the motion-activated lights in the halls. They are on by 6 a.m. and don’t flicker off until long after dark.

The health care overhaul may have slipped from the headlines since President Obama signed the bill into law in March. But the chore of putting the statute’s more than 2,000 pages of provisions into practice is keeping Washington’s policy makers and bureaucrats busier than ever.

“As soon as the bill passed, I sent an e-mail to congratulate a friend of mine at HHS who was heavily involved working with Congress,’’ recalled Assistant Secretary of Labor Phyllis Borzi. “She sent me an e-mail right back that said, ‘Roll up your sleeves, my friend. Now the hard work begins.’ ’’

The White House largely remains in the driver’s seat.

Most Mondays and Thursdays, Nancy-Ann DeParle, director of the White House Office of Health Reform, meets with top officials to weigh in on the decisions required to translate the law’s mandates into fine print.

According to administration sources, key participants include Jeanne Lambrew, director of the Office of Health Reform at Health and Human Services, and Mark Childress, the agency’s acting general counsel. Also present are officials from Treasury and Labor, where Borzi oversees implementation as head of the Employee Benefits Security Administration.

White House regulars include veterans of the effort to craft the law, such as health policy specialist Ezekiel Emanuel, of the Office of Management and Budget, as well as newcomers, such as Democratic communications specialist Stephanie Cutter, brought on to launch a major public outreach campaign.

DeParle recently briefed Senate Democrats on provisions set to begin this year that will offer relief to vulnerable groups until the law takes full effect in the years ahead. The provisions could provide Congress members with achievements to point to before November’s elections.

The measures include sending $250 checks to seniors to offset the coverage gap in Medicare’s drug benefit, giving tax breaks to small businesses that cover employees, prohibiting many insurers from denying coverage to children with preexisting conditions, and requiring insurers to let parents keep adult children on their policies.

The extent of White House involvement is a measure of the law’s potential impact on Obama’s presidency. But it also reflects the degree to which the law leaves fundamental decisions to the administration’s discretion.

For instance, insurers will ultimately be required to spend most of the premiums they collect to pay medical bills or otherwise improve members’ health. But what sort of activities should be counted?

“How these regulations get written can have a real impact on how much health care reform we actually end up getting — and a lot of them need to get written within weeks,’’ said Mark McClellan, of the Brookings Institution.

Insurers may have cause to be nervous about the hires for the Health and Human Services branch most responsible for regulating them. Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, took on Blue Cross of Missouri when he was that state’s insurance commissioner.

But Dean Rosen, who was a health care adviser to Bill Frist when the Republican was Senate majority leader, cautioned against assuming that Angoff’s team would be hostile to insurers.