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Who knows what the next four years will hold, but I think one of the great things about the Trump transition team is that it seems to include some people with very direct experience with the Affordable Care Act, ACA Medicaid expansion programs, federal health privacy rules, and other federal health laws and programs.

Related: Trump picks ACA foe as HHS chief, adds Pence associate 

Whether because of concerns about ethics or concerns about brutal nomination processes, the Obama administration has seemed to stick mainly with health policy shapers and implementers who have spent most, or all, of their lives working for the government, universities, think tanks and big law firms.

Originally, the ACA implementation team included some high-level officials who at least had experience with hands-on state insurance regulation, but the two prominent former insurance commissioners on the team left by 2013.

The Trump team recently brought Dr. Jerome Adams, an Indiana health commissioner who has a brother with opioid abuse problems, to the White House to talk about health policy.

Seema Verma, Trump’s pick for Centers for Medicare & Medicaid Services administrator, runs a company that used to make videos that helped explain the ACA public health insurance exchange system to the nonprofit exchange system helpers. She also helped revamp Medicaid in Indiana.

Marie Meszaros, a lawyer on the “landing team” for the U.S. Department of Health and Human Services, or entity that will help the Trump administration take charge of HHS, has worked in a medical practice as the privacy. She was responsible for deciding what to release, what not to release, and what to strike out when insurers and others asked for medical records. She also worked in a pharmacy and helped provided translation help for customers who spoke Spanish.

One great thing about the Trump administration getting advice from people who’ve been out working in the real, ACA-governed world is that it might hear some reality-tested ideas about what’s worth saving, or even expanding, as well as about what needs to be killed as quickly as possible.

But, at this point, what I haven’t noticed is people associated with insurance companies, insurance agencies, benefits consulting firms or actuarial firms. I’m not at all an outsider, and I may have missed an announcement about that, but, if I’m correct, and the transition team does not yet including people with experience in the insurance industry, I think that would be a gap worth filling.

Of course, people from the insurance community will look at health policy through insurance community lenses.

But I think one important thing that people from the insurance community, and especially from the actuarial community, could bring to the table would be the idea that proposals that sound small and nice can lead to financial disasters and unmet promises. The people in the new administration (and on the congressional teams that may very well be clashing with the new administration) need to combine loving hearts with cold, calculating, mathematical minds.

A “generous health care program” is only a generous program if it actually works for at least long enough for computer screens in the main offices to get smudged. Offering an unrealistic, dramatically unsustainable program is worse than offering no program and openly admitting that people are on their own.

Allison Bell is health channel editor for


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