Nonprofit, nonpartisan journalism. Supported by readers.


Just like Medicare expansion, bipartisan efforts needed to fix Obamacare, says former Bush official

Larry Kocot noted that the rollout of Medicare Part D benefits had problems similar to those with the Affordable Care Act’s health insurance exchanges.

Larry Kocot: “This is a lot more than a website. This is an enrollment process for millions of people, with robust subsidies and a lot of money involved.”
MinnPost photo by James Nord

Politicians and officials need to come together to fix the implementation of the Affordable Care Act, like they did after the last major Medicare expansion in the mid-2000s.

That’s the view of a former Bush administration expert who worked on Medicare’s rocky rollout of the prescription drug benefit.

Larry Kocot, now an expert at the Brookings Institution, acknowledged the early problems with both the Medicare Part D benefit and the Affordable Care Act’s health insurance exchanges.

But, he said, past lawmakers came together to fix the problems, which seems much less likely now, given the climate in Washington.

“We’re going to need for us to come together as a country in a bipartisan way to solve some of the problems for what will be a foundational benefit in the future – all politics aside,” Kocot said during a talk Tuesday at the Humphrey School of Public Affairs at the University of Minnesota.

“I really do believe this will succeed,” he said, “but we’re going to go through a little bit more of a rough patch before we see that sun through the clouds.”

Article continues after advertisement

Kocot offered a frank but optimistic assessment of the strengths and failings of both major public program expansions.

The Affordable Care Act goes into full effect on Jan. 1. The added Medicare benefit, passed in 2003 under then-President George W. Bush, was implemented in late 2005.

After Part D’s rocky start-up, though, professor Larry Jacobs, who moderated the discussion, said he remembers Democrats jumping in to make the law work. He credited that in part to liberals supporting expanded government programs.

“When Medicare Part D faced early troubles, many blue states came to its rescue,” according to a mid-November Politifact analysis comparing the two programs.

“The New York Times reported in 2006 that ‘about 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England, have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program.'”

“It was hard to see partisanship in this,” Jacobs said. “It had kind of shifted from a partisan matter into a lot of Democrats saying … “How can we get this to work better?”

“I’ve never seen it this bad in Washington in terms of the partisanship,” Kocot said, agreeing with Jacob’s point. “It’s just a whole different environment.”

Under the Affordable Care Act rollout, Kocot said, President Barack Obama’s administration has focused too much on looking at the success of a website — — and not enough on enrolling consumers.

“This is a lot more than a website,” he said. “This is an enrollment process for millions of people, with robust subsidies and a lot of money involved.”

During the Medicare prescription drug benefit expansion, he said, navigators, brokers and pharmacists were much more involved in helping consumers. He said there was also a significant number of alternatives to enrolling online, such as going through the insurance companies.

At least one of the web portals for Medicare Part D arrived much later than expected, and there were IT troubles similar to the current ones.

But, that’s to be expected with massive public program expansions, Kocot said.

“These are things that happen in every rollout,” he said. “People do get missed, they get dropped. The systems don’t work the way they’re intended.”

But, he said, some problems won’t even be known until Jan. 1, when coverage is supposed to start for those who purchase insurance through the health exchanges or sign up for public programs.

For example, some consumers may not get the coverage they signed up for if the government is unable to transfer accurate information to the insurance carriers, he said.

Minnesota’s health insurance exchange officials, who also provided an update on the marketplace at Tuesday’s event, assured Minnesotans they would receive the coverage they’ve chosen beginning on Jan. 1.

Human Services Commissioner Lucinda Jesson, who is also a MNsure board member, said that all public program enrollees would be covered on that date.

“I know if someone went on MNsure and they did everything they needed to do to apply, and they’re eligible for a public program, we’ll make sure they have coverage one way or the other on Jan. 1,” she said.