The White House is coming under pressure from some of its closest allies on health care reform to name a chief executive to run its federal health insurance marketplace and allay the concerns of insurers after the rocky rollout of Obamacare.
Advocates have been quietly pushing the idea of a CEO who would set marketplace rules, coordinate with insurers and state regulators on the health plans offered for sale, supervise enrollment campaigns and oversee technology, according to several sources familiar with discussions between advocates and the Obama administration.
Supporters of the idea say it could help regain the trust of insurers and others whose confidence in the healthcare overhaul has been shaken by the technological woes that crippled the federal HealthCare.gov insurance shopping website and the flurry of sometimes-confusing administration rule changes that followed.
The advocates include former White House adviser Ezekiel Emanuel, the brother of President Obama's former chief of staff Rahm Emanuel, and the Center for American Progress, the Washington think tank founded by John Podesta, the president's newly appointed senior counselor.
The White House is not embracing the idea of creating a CEO, administration officials said.
"This isn't happening. It's not being considered," a senior administration official told Reuters.
Right now, the administration is focused on assuring the functionality of HealthCare.gov, which launched on Oct. 1 with significant technical problems. The website is now vastly improved, and the administration said over the weekend that more than 1 million people have enrolled in an insurance planthrough the federal website that serves 36 states. More have signed up on through state-run Obamacare sites in the remaining 14 states.
The president appointed Jeffrey Zients to oversee the website’s repair, and he was recently replaced by former Microsoft executive Kurt DelBene.
While serving the administration, Zients identified the lack of effective management over the new marketplace as a problem. The lack of a clear decision-making hierarchy was identified as a liability months before the disastrous Oct. 1 launch of HealthCare.gov by the consulting firm McKinsey & Co.
However, DelBene is only slated to oversee the marketplace through the first half of 2014.
"We're fortunate that Kurt DelBene is now part of the administration - there's no one better able to help us keep moving forward to make affordable, quality health insurance available to as many Americans as possible," Obama health care adviser Phil Schiliro said in a statement to Reuters.
Some health care reform allies say the complexity of the federal marketplace requires a CEO-type figure with clear authority and knowledge of how insurance markets work. Mr. Obama's health care overhaul aims to provide health coverage to millions of uninsured or under-insured Americans by offering private insurance at federally subsidized rates through the new online health insurance marketplaces.
The marketplace is now officially the responsibility of the U.S. Centers for Medicare and Medicaid Services (CMS) and its administrator, Marilyn Tavenner. Health care experts say there is no specific official dedicated to running the operation.
A CMS spokesman said exchange functions overlap across different groups within the agency's Center for Consumer Information and Insurance Oversight.
The CEO proposal calls for removing day-to-day control of the marketplace from the CMS bureaucracy and placing it under a leadership structure like those used in some of the more successful state-run marketplaces, including California.
The new team would be managed by a CEO, or an executive director, who would run the marketplace like a business and answer directly to the White House, sources familiar with the discussions say.
They point to insurance industry and health care veterans as potential candidates, including former Aetna CEO Ronald Williams, former Kaiser Permanente CEO George Halvorson and Jon Kingsdale, who ran the Massachusetts health exchange established under former Governor Mitt Romney's 2006 health care reforms. None of the three was available for comment.
Health care experts say the idea should have been taken up by the administration years ago.
"It's the right thing to do. It's just two years late," said Mike Leavitt, the Republican former Utah governor who oversaw the rollout of the prescription drug program known as Medicare Part D as U.S. health and human services secretary under President George W. Bush.
"The administration is confronted by a series of problems they cannot solve on their own. They do not possess internally the competencies or the exposure or the information," he told Reuters.
Emanuel, one of the administration's longest-standing allies on health care reform, recommended a marketplace CEO in an Oct. 22 Op-Ed article in the New York Times, calling it one of five things the White House could do to fix Obamacare.
"The candidate should have management experience, knowledge of how both the government and health insurance industry work, and at least some familiarity with IT (information technology) systems. Obviously this is a tall order, but there are such people. And the administration needs to hire one immediately," he wrote.The administration has adopted Emanuel's four other recommendations: better window-shopping features for HealthCare.gov; a concerted effort to win back public trust; a focus on the customer shopping experience; and a public outreach campaign to engage young adults.