Kathleen Sebelius, secretary of Health and Human Services, sat down with Bloomberg News today while promoting the Affordable Care Act in Atlanta, Georgia.
On Oct. 1, Americans who lack insurance through their jobs can begin signing up for coverage through new government-run marketplaces called exchanges; the Obama administration hopes for at least 7 million people to have coverage by March 31 of next year.
See the story about Sebelius at Bloomberg.com. And read the highlights from her interview here:
Bloomberg News: The Affordable Care Act faces one of the strongest opposition movements we’ve seen for a law like this in recent history. Can you match the opponents dollar for dollar; can you match them message for message?
Sebelius: “They may be better resourced. But I think the Affordable Care Act is the law and we think it’s really important for people to understand what’s going to be available to them and how for the first time millions of Americans are going to look forward to health security that they’ve never had. Even in states where the leadership of the state may be hostile, there are active, engaged, well known supporters who are very involved. I’m going to sit down in a little bit with a meeting led by the chairman of the county commission here in Atlanta who’s gathered together a wide group of stakeholders. That kind of local support and effort will be huge in terms of outreach; I’ve been spending time in Texas, and the mayors of major Texas cities, members of Congress, state legislators are very engaged and involved. We have active, engaged, interested people who know this is a brand new day and they want to get the word out to folks who will benefit from the law.”
BN: How are you going to measure the success of the law?
S: “We’ll be looking at our own real-time examples of who’s signing up, where it’s going well, kind of lessons learned. In a six-month open-enrollment period we have opportunities to actually take best practices and replicate those in various parts of the country. We know there will be states where things will go very well because the states are all in. There’s a lot of not only federal effort but a lot of engaged state effort, a lot of state resources. Other states, as you say, where there will be a lot of resistance, and so the job is kind of made doubly difficult; there are lots of people who may want information, may want new insurance benefits, but getting correct facts to them, drilling down through the misinformation, is going to be more complicated. That’s where a lot of my time and effort is going to be spent: on the markets that are really federal markets.”
BN: Do you expect enrollment to be stronger in states that are building their own exchanges and that have embraced the law?
S: “Probably, at least at first. Although a number of the states where the federal marketplaces exist are some of the highest populations of uninsured. I think one of the big challenges is also, the Medicaid expansion effort is again mixed. Often the states who are resisting are also the states where the governor and legislature at least at this point is not choosing to move forward with medicaid expansion.
“So reaching consumers who may be desperate for health security, for health insurance, only to say to them if they’re below 100% of poverty, ‘you really don’t qualify for any financial help until the Medicaid expansion is adopted,’ is a very difficult message and I think will be hugely disappointing to a lot of people. And frankly, very economically damaging on an ongoing basis to that state where resources will continue be poured into uncompensated care, hospitals will continue to look at a situation where they’re on the verge — which a lot of community hospitals are right now — of very difficult financial times.
“We’re hoping that, again, this debate about Medicaid expansion stays front-and-center and remains active. The door is open, there is no timetable.”
BN: How often are you meeting or talking with the president about implementation of the law, or enrollment?
S: “Pretty often. He is very engaged. We have a minimum of once a month, very detailed, broad-based conversation. But I would say: he wants this to work. He undertands well that it will likely work better in some states than in others, in terms of how the launch goes; that there’ll be some problems and glitches.”
“One of the frustrating things is that there still is a dialogue being perpetuated by some opponents that this is going to go away, and that this is not the law. One of the messages that I’ve been trying to carry across the country is that the Affordable Care Act was signed in March of 2010, it was upheld by the Supreme Court a year ago, the president was re-elected and we will implement the law. This is the law; it’s not a debate anymore; it’s not a discussion; it is the law. And so we’re going to move forward.”
BN: There are Republicans right now who are threatening to go to a budget standoff with the president over the funding of Obamacare. You’ve asked for not only funding to continue but a billion and a half dollars next year to make sure implementation is smooth. Can the law be successful without that extra billion and a half that you’ve asked for?
S: “We will continue to use all the resources we can mobilize and rededicate resources to moving forward. The original estimate for implementation at the time the bill was passed was about $10 billion. $1 billion was part of the bill that was signed into law and that’s pretty much where we’ve been. (laughs) So, could more resources be helpful, particularly with education and outreach and mobilization? You bet. I mean we’re launching basically a new product. We’re trying to give people new information about health insurance — many of whom have never had insurance before, or who had a terrible experience with an insurance company so they haven’t tried in a while. Would it be more helpful to have the ability to really drill down into neighborhood levels and get to people one at a time? You bet.”
BN: After your administration service, what’s next for Kathleen Sebelius? Would you consider running for president?
S: “I … [pauses, laughs] … oh my Lord. I’ve never had a long term plan, strategy, I don’t right now. I just appreciate the opportunity to actually be here at this moment. I think a lot about my dad [John. J. Gilligan], who’s 92, who was in Congress when Medicare and Medicaid were passed; he was on the Energy and Commerce Committee. He now gets to enjoy the benefits of those great programs on the Medicare side. So it feels like the baton has been passed and I get to maybe help fill in the gap for a lot of people in terms of health coverage. That’s a pretty great place to be.
BN: He must be pretty proud of his daughter?
S: “You know, he thinks I’m doing okay. He’s got advice on a regular basis.”