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On the Third Hand: Tavenner

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The Centers for Medicare & Medicaid Services (CMS) effort to implement Patient Protection and Affordable Care Act (PPACA) programs was about as open as the federal underground laboratories that allegedly store dead space aliens.

In early 2013, I could do search for “federal UFO alien labs” and get (literally) about 50 million results.

The managers of the state-based exchanges in Nevada and Minnesota seemed to be posting just about everything up to and including what their board members ate as children.

If I wanted to know who was really in charge of computers or broker relations at the Center for Consumer Information and Insurance Oversight (CCIIO), that was harder than getting a map of the tunnels that supposedly connect the U.S. military’s alien autopsy sites.

Steven Brill reports in his book about U.S. health reform and PPACA implementation, America’s Bitter Pill, that the lack of communications was evident inside CMS and CMS’s parent department, the U.S. Department of Health and Human Services (HHS).

CMS wasn’t sharing much information with the public, and, according to Brill, it and HHS weren’t sharing much information with each other, either.

Marilyn Tavenner, the outgoing CMS administrator, might be a great person in many ways, and she might have had valid tactical and strategic reasons to avoid saying much about PPACA implementation in general, or about the PPACA exchange system in particular, but she did not make any visible effort to update the public on PPACA implementation.

The heart of the PPACA exchange system and the PPACA commercial health insurance rules is the PPACA “three R’s” risk-management programs, and it’s still not at all clear how those programs will work.

All I can tell about how CCIIO will administer the three R’s system is that CCIIO says, on its website, that Lateefah Hughes is the director of the Division of Risk Adjustment Operations. There are certainly documents about risk-management programs on the CMS website, but it’s hard to find any other information about Hughes or Hughes’ division, or even any clear indication about whether the division still exists.

On the one hand, it could be that the risk adjustment division has a small footprint on the Web because, in normal times, who but an insurance company actuary or regulator really cares about insurance risk adjustment?

On the other hand, it’s scary to think that the fate of the PPACA exchange system and the U.S. commercial health insurance system may depend on what amounts to a message from CMS stating, “Trust us. We’re cool.”

On the third hand, wouldn’t it be great if HHS Secretary Sylvia Mathews Burwell and Andy Slavitt, the new acting CMS administrator, could open enough windows onto CCIIO’s operations to show us whether or not the risk adjustment division actually exists, and whether its staff is ready to run the three R’s? 

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