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On the Third Hand: California

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From some really carefully thought-out strategic perspective, the Obama administration’s careful, low-detail approach to Patient Protection and Affordable Care Act (PPACA) implementation must make great sense.

Maybe, based on focus group research, the fact that the White House usually has talked about sad or happy patients, while the Republicans at least occasionally have relented from equating PPACA with the imposition of a Marxist Leninist dictatorship long enough to complain about specific PPACA implementation problems, has made political sense.

Maybe defending against implementation gripes with human interest anecdotes has helped guard the ability of the U.S. Department of Health and Human Services (HHS), and HHS’ Centers for Medicare & Medicaid Services (CMS), and CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) to keep on plugging away at setting up the exchange program.

The affairs have, to be fair, posted many, many documents on the CCIIO website.

But what’s really noteworthy is that CCIIO has never posted as many updates in as systematic a fashion as the managers of Covered California, let alone, say, the managers of Nevada’s Silver State Health Insurance Exchange.

The Nevada exchange, for example, may have had some technical glitches, but it also started posting detailed exchange activity data within a few days of the Oct. 1 enrollment system start.

Similarly, the Washington Health Benefit Exchange — the parent of the Washington Healthplanfinder system — has been posting activity data, and early attempts at analyzing what went right and went wrong with its enrollment system start, on its site.

Those are fairly small states. Maybe people there are really nice and it’s easier for exchange builders there to post detailed information without getting savaged by political opponents.

New York is a big state, and managers of the NY State of Health exchange have not exactly been fountains of clear, warts-and-all status information.

But think about California. California is a big state. The Covered California site has worked in some ways but also had problems. Brokers from there are sending us lots of letters full of angst about exchange broker certification, for example. And California has Republicans.

Rep. Darrell Issa, R-Calif., the chairman of the House Committee for Tormenting Exchange Builders, is from California.

But, whatever else Peter Lee, the executive director of Covered California, and other managers there do right or wrong, at least they regularly post a fair amount of detailed information about what’s going right and what’s going wrong in the board meeting files on their website.

They have what some might think is a glut of information about Chinese-language outreach and the like, but the California exchange at least conveys the impression that bright people are making systematic efforts to get their exchange going and keep it going.

On the one hand, maybe that kind of information flow doesn’t really affect how exchange enrollment sites work or what total enrollment turns out to be.

On the other hand, at least it feels better to know what goes on and not feel as if folks are trying to hide something from us.

On the third hand, maybe our government in Washington is officially now so dysfunctional that all the officials there can really do is sit in a corner muttering about how they could’ve been contenders if that stupid government shutdown hadn’t happened.

Maybe, at this point, the documents that have been on the HHS, CMS and CCIIO sites are the best anyone can do…

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