Andy Slavitt already saved Obamacare once. Can he do it again?

Every week for nearly three years, Andy Slavitt flew from Minneapolis to the nation’s capital to go to work. In the final quarter of Barack Obama’s administration, the 50-year-old Edina native and former UnitedHealth Group executive ran the federal agency that administers Medicare and Medicaid, and implements the Affordable Care Act.

Slavitt was one of a select few officials granted broad authority to make Obama’s health care vision — which aimed to insure more people at lower prices through the ACA and expansions to Medicaid — a reality. Before that, Slavitt helped overhaul Healthcare.gov, the federal government’s insurance marketplace, after its botched roll-out threatened the entire system.

On November 9, however, Slavitt and other champions of Obama’s health care agenda were confronted with a stark new reality: the election of a president and a Congress itching to undo close to everything they’d worked for.

When Donald Trump took the oath of office, Slavitt, like thousands of others, was instantly out of a job. But that hasn’t stopped him from continuing to fly back to Washington each week for work — though his job description is a little different now.

In the first months of the Trump era, Slavitt has emerged as a top defender of Obamacare, Medicare, and Medicaid, and a lead critic of the GOP’s plans to overhaul the U.S. health care system.

Ubiquitous on cable news, Capitol Hill, and particularly, Twitter, Slavitt has thrown himself full-speed at a daunting task: stopping the destruction of Obama’s health care vision — and his own.

A history in health care policy

When in D.C., Slavitt keeps the schedule of a man possessed. On a recent weekday, he shuttled from a breakfast health care forum in downtown D.C. to a hearing on Capitol Hill to meetings with lawmakers. His wife, Lana, serves as his unofficial scheduler. (“He doesn’t make time for lunch,” she lamented.)

Slavitt did hold court in a Capitol Hill restaurant for a few hours one afternoon in March, sitting at a corner table while various Washington types filed in to meet with him for 30 minutes at a time. These days, he’s a highly sought-after commodity: Slavitt has perhaps the most knowledge of anyone in the country the health care programs that are at the center of the national debate right now.

He’s originally from Chicago — “I don’t have a Minnesota accent, I don’t think,” he said — and went on to the University of Pennsylvania, where he studied business at the Wharton School, and then Harvard Business School. He put in time at Goldman Sachs and the consulting firm McKinsey and Company.

Slavitt founded his own company, Health Allies, which he sold to Hopkins-based UnitedHealth Group in 2003. He moved from California to Minnesota in 2004 and entered the UnitedHealth ecosystem of companies, eventually rising to run Optum, a subsidiary that operates a variety of UnitedHealth’s patient services, like health savings accounts, as well as its data and information technology operations.

The Obama administration contracted with Optum to help fix a major problem: Healthcare.gov, the website where people could buy insurance through the federal government, was plagued with technical problems after its launch in 2013. Slavitt was part of the team that helped make major improvements to Healthcare.gov in time for a crucial open enrollment date in 2014, helping save Obama, and Obamacare, from continued dysfunction and embarrassment. He also helped with the online insurance exchanges of Minnesota and other states.

That work got him on the cover of TIME magazine, and on the president’s radar. In 2014, Slavitt left his lucrative post at Optum to become deputy administrator of the Centers for Medicare and Medicaid, or CMS, the Baltimore-based federal agency that operates the trillion-dollar programs that provide health care to seniors, the disabled and the poor. CMS was also tasked with implementing parts of Obamacare.

By March 2015, Slavitt was named acting head of CMS, and was formally nominated by Obama in July. The position requires confirmation in the Senate, but Republicans never brought him up for a vote, so he served as acting administrator through the end of Obama’s presidency.

When he was nominated, top Senate Republicans voiced concern over Slavitt’s close ties with the health care industry, and suggested that conflict of interest issues could preclude his ability to do the job well. Conservative media jumped on his nomination as a sign of lax ethics in the White House.

Slavitt says that he followed all ethical guidelines, divested completely from UnitedHealth, and didn’t talk to company officials while at CMS. (His sale of UnitedHealth stock after leaving Optum netted him nearly $2 million, reported the conservative Daily Caller.)

The tweeting bureaucrat

By most accounts, Slavitt wielded his considerable authority at CMS fairly. He recalled that he was hard on the industries that he came from. “I have friends all across the health care industry but I was a public servant, that’s my job,” he said. “There were people I dealt with that I know that I had to have very tough conversations, and do very difficult things.”

Under Slavitt, CMS did not renew its contract with Optum for the online exchanges, instead bringing in Booz Allen Hamilton to do the job. (CMS did continue to work with Optum companies on other projects.)

Dr. Shantanu Agrawal served for two and a half years as the director for program integrity at CMS, the division tasked with tackling waste, fraud, and abuse in the Medicare and Medicaid systems, and reported directly to Slavitt when he was acting administrator.

Agrawal had nothing but good things to say about his former boss. “I think he really had the reputation of being —  he still has the reputation of being — really innovative,” he said. “He came in having been on the cover of TIME magazine. That’s not an everyday event for a CMS administrator, or for us to expect as the incoming person.”

“So many stakeholders had a very positive view of him externally and internally, he was viewed as an innovator and a fixer,” Agrawal said. “The way he conducted himself bolstered those viewpoints.”

At CMS, he presided over projects designed to drag the federal agency into the latest technological age, like contracting with a start-up to put state-level Medicaid information in a cloud database. He also oversaw changes to the way the agency’s roll-out of rules and regulations, and released a key Medicare rule with a complement of online resources, including a separate website designed to help physicians understand changes.

One innovation Slavitt looked to was more personal: he was the rare bureaucrat at home on social media — particularly, on Twitter. Over time, Slavitt’s prolific use of that social media platform has become a professional hallmark of his.

Social media communication is, generally, tightly controlled in the federal bureaucracy. But in his travels around the country as CMS administrator, Slavitt saw an opportunity to share to a wider audience how federal health care programs were affecting people.

He took to broadcasting visits to hospitals and nursing homes on Twitter, telling stories and sharing details, like what conditions caregivers treat and what languages they speak. He’d also freely share more mundane details, like what his agency’s priorities for a given week were.

“My aim when I started using Twitter when I was in the administration, I felt very much like in order to have a more open government, a more transparent government, you really had to put a face and a personality on it,” he says. “So I started communicating the things I was seeing and the things we were doing, and also telling people why.”

That approach was not something the Obama administration intuitively understood. It largely struggled to connect the benefits of its health care reforms to people’s everyday lives, and Obamacare’s Democratic advocates got punished for it across several election cycles in which many lost their seats. 

“Obviously we didn’t do a great job of making people understand what the ACA meant to their lives over the last number of years,” Slavitt says. “And that’s a failing of ours.”

In Slavitt’s view, Twitter could help mitigate that failing. Befitting his background, he largely shies from partisan sniping, and prefers to approach the health care debate with a mountain of data and a large dose of wonkish sincerity. It’s earned him 50,000 followers, but he has said his candidness on Twitter has “scared the crap” out of his colleagues in the federal bureaucracy.

But after November 9, fear in the Obama administration shifted elsewhere. During the Trump transition, Slavitt went into high gear on Twitter with his warnings about what might happen should the new GOP regime move to dismantle the ACA, and his sharing of stories of those afraid of losing coverage they obtained under the law.

Taking on the AHCA

When House Republicans rolled out their Obamacare replacement, titled the American Health Care Act, Slavitt’s initial predictions were backed up. The Congressional Budget Office estimated the AHCA would lead to 24 million people losing their insurance coverage.

On Twitter, Slavitt was one of the first people breaking down what the bill meant, issuing a string of 25 messages just hours after it was introduced that explained what he saw in the legislation. (One observation: “It basically takes all the things Rs complained about & makes them worse.”)

Slavitt was one of many Obama allies and administration alums who panned the GOP’s long-awaited health care plan. But like his former boss, Slavitt says he is open to any proposals, from either side of the aisle, that would make the health care system better.

“I’m awfully proud of what we did on the ACA,” he said, “but I’m not anti-one thing or pro another thing as much as I want to see us continue to make progress.”

Obamacare was far from perfect, he says, “but what that means is we should be surgically fixing it and making it better and better in whatever form we do, and that’s in the country’s interest.”

On Capitol Hill, Democratic Rep. Tim Walz, who is a critic of the GOP’s plans to replace Obamacare, saw Slavitt testify recently and called him a useful resource for policymakers.

“He’s a smart guy and he gets it,” Walz said. “I suppose there are some that’ll make it political, but I never got that feeling from him. I think it was a good resource for us to say, well, what happens if this piece of Medicaid is pulled back? He has a better understanding of that.”

Slavitt’s own congressman, 3rd District Rep. Erik Paulsen, has the most influence of any Minnesotan lawmaker over health care proceedings on the Hill. Paulsen sits in the GOP majority on the tax-writing Ways and Means Committee, where he voted to advance the AHCA.

Slavitt says that he and Paulsen have talked before, and that he’d love the chance to have a “friendly debate” with him on health care in front of CD3 constituents. (When asked what he thinks about Slavitt by MinnPost, Paulsen only said they have chatted on the plane to D.C.)

Skin in the game

Though he sings the virtues of bipartisanship, Slavitt isn’t under any illusions that Washington is even close to crafting a compromise on health care. “It’s like, when you’re in a maze and walk around three corners and you don’t see the endpoint until you’ve walked around those three corners?” he said. “We’re at least three corners away from bipartisanship where we are today.”

Though he wants to work with Republicans, Slavitt — like many Obama allies — has not entirely moved on from how mercilessly the GOP attacked the ACA. He said he didn’t expect the law to be accepted immediately, but added that Democrats believed, naively, that “people wouldn’t spend every waking minute trying to tear the thing down after it was set up… That there would be some measure of patriotism to say, didn’t love it, didn’t vote for it, but we’ll do our best to make it work.”

In Slavitt’s telling, the Republicans took steps to make the ACA fail, and then used the ensuing fallout as a data point to convince the public the ACA was failing.

That’s part of why Slavitt is doing what he is doing. He could go back to the private sector and make a fortune, or take a cushy post at some prestigious nonprofit or university. His friends say his frantic lobbying is born out of a desire for public service, but it’s also clear that Slavitt doesn’t want to see his hard work dismembered so quickly after leaving office.

Jim Meffert, a former Democratic candidate for Congress in the 3rd District and a friend of Slavitt’s — their kids played on the same Little League team — says he’s seen Slavitt’s investment in the issue evolve over time.

“You see where it all came from when he was brought in to fix the exchanges, Optum became a little more engaged in what were perceived as partisan solutions,” Meffert said. “You watch that evolution and watch him get to a place where he has a little more personal skin in the game in solutions being worked out.”

Meffert says he reads some frustration that “the work he was doing, the work they were doing to fix things is completely getting dismantled. I sensed that energy from the Twitter and the speeches — a little bit of personal pride. He’s unbridled a bit to speak to those dynamics in a way he didn’t because he was behind the scenes fixing it.”

Behind the scenes for long?

Slavitt embraces this notion of himself as the behind-the-scenes guy, despite his increasingly public profile. He says his immediate plans are to continue to advise lawmakers in D.C., as well as governors and state legislators around the country.

Last week, Slavitt also accepted a post at the Bipartisan Policy Center, a nonpartisan D.C. think tank, to work on bipartisan solutions to health care issues.

Back home, Slavitt is sometimes discussed as a potential candidate for political office. He and his wife, Lana, have been active in Minnesota politics: federal records show tens of thousands of dollars of contributions in Slavitt’s name to candidates, including Klobuchar, Walz, Meffert, and former GOP Rep. Mark Kennedy. (Most of the money he contributed went to UnitedHealth’s political action committee, which tends to give to both parties evenly.) Lana has worked with several DFL campaigns, most recently as the treasurer for Terri Bonoff’s campaign against Paulsen last year.

He is well-connected in the highest echelon of Minnesota political and business leaders, having once worked for the Itasca Project, the influential group of public officials and philanthropists who work together — behind the scenes — to achieve certain public policy goals. (Slavitt served on the group’s higher education team.)

Slavitt says he doesn’t want to run for anything right now. “I’m not sure I’d be the best run for office person,” he said. “Maybe I’m better off helping really good candidates with their policy direction.”

But he left the door open to some public post, elected or not: “If I can be of service in some capacity, it’s certainly a thing I think about.” (His Twitter bio lists his old job, his current post at the Bipartisan Policy Center, and, winkingly, “more to come.”)

For now, there are more pressing concerns: the House of Representatives is expected to vote on its health care bill, which dismantles Obamacare and includes steep cuts to Medicaid, today. People will be looking to Slavitt to help make sense of the aftermath, whether the bill passes or fails.

“Whatever change happens,” Meffert says, “we’re not even sure what it is, we’re going to need people like Andy who understand the dynamics that set this up to transition to whatever comes next.”

As he prepared to head to the airport for another flight back to MSP, as he has done most every week since 2014, Slavitt took a stab at answering why he’s still doing all this — the long commute, sure, but the shuffling around D.C., the slog of navigating an increasingly partisan, nasty debate.

“I think just the circumstances where we find ourselves, I still do have a purpose,” he said. “I still love — I still care about the same things I cared about before.”

Gathering his bags, Slavitt at least affirmed his plans for the near future. “I’ll be here next week.”