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White House Aims For 'Senior-Level Focus' in Health Law Rollout

By John Reichard, CQ HealthBeat Editor

May 19, 2014 -- The turnaround of the troubled federal health exchange website proved that focused CEO-type attention could fix tough, complex problems.

But with reports surfacing over the weekend that problems persist, it's doubtful the Obama administration fully absorbed that lesson. And its appointment of Kristie Canegallo as deputy chief of staff for policy implementation may only be a partial move to limit the damage.

The Washington Post reported last week that the Department of Health and Human Services is months away from having an efficient system in place to verify the incomes of people seeking insurance subsidies and to resolve questions about the immigration status of applicants.

Many other implementation challenges remain, such as assuring that people who applied months ago for enrollment in the expanded Medicaid program are actually getting coverage.

The White House portrayed Canegallo's appointment as evidence it had learned lessons from the federal website fiasco.

"The President has directed that whenever we go through a major event, we capture the lessons learned so that we don't repeat them, and that we adapt," White House Chief of Staff Denis McDonough said in announcing Canegallo's new post.

"Given our experience with, we have determined we need more senior-level focus on implementation and execution. I have worked with Kristie since October 2010 and have found her to always be the most prepared person in the room."

Canegallo is no stranger to White House background materials say she spearheaded implementation work after the failed Oct. 1 launch, synthesizing technical, operational and policy work.

She earned the respect of her peers, "no matter the complexity of the task at hand," McDonough said. But she'll have more on her plate than the health law (PL 111-148, PL 111-152) in her new job. She'll also help overhaul information technology, implement education policy and have some responsibilities in the area of national security.

That job description is at odds with the recommendations of a new report by the Center for American Progress.

It suggests a management structure to oversee health law implementation "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."

The report from the left-leaning think tank recommends 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 praised the work of the crisis management team led first by Jeffrey Zients and then former Microsoft exec Kurt DelBene, whose appointment could end in June. But "it is unclear whether decision-making authority resides with the White House, the Centers for Medicare and Medicaid Services, or the secretary of Health and Human Services," the report says.

It also noted that all state exchanges empower a CEO or executive director accountable for their management. This structure doesn't by itself assure success "but it is a necessary condition for success," the report adds.

Such a structure could yet materialize in the federal government. But Canegallo's appointment does not by itself put in place the structure and focus required for a smoothly functioning health law. And with continuing and complex implementation challenges ahead for months if not years to come, a higher powered approach may be need to fully absorb the lessons learned.

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