Crisis management and Obamacare

Lanny Davis Former Special Counsel to President Bill Clinton
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As a supporter of the Affordable Care Act, also known as “Obamacare,” I want the problems to be fixed and for the program to succeed. After all, we are the only Western democracy that does not provide some form of national health insurance or guaranteed access to healthcare to all citizens.

But the failure of the federal and state websites’ marketplaces or “exchanges” to be entirely operable by Oct. 1, as well as the increasing number of individuals who have lost their health insurance or are getting hit by unexpected substantial increases in premiums, has created a political crisis for the president and Democrats seeking reelection to Congress in 2014.

In such a situation, the White House should be following the time-tested rules of crisis management. First, get all the facts out. Second, take responsibility and apologize for the problems. And third, fix the problems.

Last Friday, the president followed the second rule, saying “I’m sorry” that some people lost their policies despite promises to the contrary when the legislation was passed in 2010 and during the 2012 presidential campaign.

But the White House has somewhat failed to follow the first rule of crisis management: to get all the facts out. For example, the president is permitting federal and state officials to refuse to publicize the actual number of individuals who have obtained new private insurance policies vs. Medicaid. Why? If the reason is to avoid admitting that the numbers of Medicaid enrollees are much greater than the uninsured who have obtained new private insurance, that violates a fundamental crisis management goal — get the bad news out entirely, early and yourself.

The administration might also have done a more thorough job following the third rule — reassuring the American people that he can fix the problems beyond simply spending more money on the government exchanges.

For example, an option still available to the president is to accept help from existing private sector health insurance websites, which have been enrolling individuals in affordable health plans for years, using the power of the Internet to force insurance companies to be competitive. (Full disclosure — one of the leading health insurance websites, eHealth.com, is a client of mine.)

Health and Human Secretary Kathleen Sebelius, to her credit, issued a regulation in March 2012 allowing these private insurance websites to co-exist side by side the federal and state exchanges, requiring them to display all plans and data found on the government exchanges with the same plans, same premiums and same benefits — meaning no “adverse selection” would be possible.

Yet, to date, neither the federal exchange, representing 36 states, nor any of the 14 states and the District of Columbia with their own exchanges have allowed these highly regulated private sector exchanges to assist the government exchanges. Why? If the goal is 100 percent enrollment of the uninsured, you would think welcoming help from experienced private sector websites would make sense.

The president could also reduce the number of requirements for coverage under various regulations that added to the costs of insurance and were a major reason why so many millions of Americans received notice that they couldn’t continue with their current policies at the same costs. While the goal of those writing the ACA and the regulations was laudatory — increasing coverage in a variety of areas not uniformly insured by most insurance companies — this might be a good example of where the perfect is the enemy of the good.

Instead, President Obama might be well advised to admit to trying to do too much too soon in a 1,000+ page Obamacare bill, passed by an almost entirely partisan vote in 2010 — and revert back to a step-by-step approach to increase required coverage over a longer period of time, in effect reinstating the guarantee that if you have insurance, you can keep your policies.

Now more than ever it may be time to encourage public-private partnerships rather than complicated all-government solutions. Such a mid-course correction could be a compromise worth trying — saving not only public support for Obamacare but perhaps the Democratic control of the U.S. Senate in the 2014 elections as well.

Davis served as special counsel to former President Clinton and is principal in the Washington D.C. law firm of Lanny J. Davis & Associates, in which he specializes in crisis management. He is special counsel to Dilworth Paxson of Philadelphia and the author of a recently published book, Crisis Tales: Five Rules for Coping with Crises in Business, Politics, and Life