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Ex-Health Chiefs: Don't Make it Worse  08/20 11:42

   That's the advice of former U.S. health secretaries of both parties to 
President Donald Trump and the GOP-led Congress, now that "Obamacare" seems 
here for the foreseeable future. The 2018 sign-up season for subsidized private 
health plans starts Nov. 1, with about 10 million people currently served 
through and its state counterparts.

   Stability should be the immediate goal, said former Health and Human 
Services secretaries Kathleen Sebelius, Mike Leavitt and Tommy Thompson. At 
minimum: Dispel the political and legal uncertainty --- fueled by presidential 
tweets --- around billions in subsidies for consumers' insurance copays and 
deductibles. The three former officials shared their views with The Associated 

   Beyond the urgent need to calm markets by providing clarity on subsidies, 
Democrat Sebelius and Republicans Leavitt and Thompson differ on the direction 
Trump and Congress should take. They agree that Republicans still have an 
opportunity to put their stamp on the Affordable Care Act, even if the drive to 
"repeal and replace" former President Barack Obama's legacy program appears to 
have hit a dead end.

   "They can make changes that signal a new ideological direction without 
generating a logistical and political mess," said Leavitt, who led HHS during 
former President George W. Bush's second term. "They won the right to make 
changes. However, they should do it in a skillful way." Leavitt shepherded the 
Medicare prescription drug benefit through its rocky rollout in 2006.

   "Stabilizing the current situation can only --- I think --- be to their 
benefit," Sebelius said of the Trump administration. "In an environment in 
which (insurance) companies are enrolling customers, they've got a lot of time 
to actually go back to the drawing board and figure this out. The worst of all 
worlds for them would be to have the current situation unravel because of 
decisions by this administration."

   Sebelius helped steer Obama's law through Congress and later oversaw the 
troubled launch of, when the computer system locked up on the 
first day of sign-up season, frustrating millions of consumers and embarrassing 
the White House. She took the heat, but Sebelius stayed on task and ultimately 
helped deliver a successful open enrollment.

   "It would be a mistake to further destabilize the (insurance) market," said 
Thompson, who served during Bush's first term and led HHS preparations to meet 
the bioterrorism threat after the deadly anthrax mailings that followed closely 
the Sept. 11 attacks.

   Thompson urged a health care summit between Trump and congressional leaders 
of both parties, followed by a period of intensive legislative work under a 
deadline to reach a truce in the political battle over health care.

   Trump and top lieutenants like HHS Secretary Tom Price have sent mixed 

   Leading congressional Republicans want to try to move limited legislation 
after lawmakers return next month, worried they'll suffer consequences in next 
year's midterm elections.

   At the very least such legislation would provide clear legal authority for 
the ACA's cost-sharing subsidies, which reduce copays and deductibles for 
people with modest incomes. Stopping the payments would lead to a spike in 
premiums, more insurers leaving the markets and increased federal deficits, the 
Congressional Budget Office warned last week. The markets already saw steep 
premium increases this year, and more insurers have since bailed out, citing 
financial losses.

   The administration has continued to make monthly subsidy payments to 
insurers, as recently as last week. But Trump on Twitter and in interviews has 
repeatedly threatened to pull the plug. Sebelius has been sharply critical of 
the Trump administration's stewardship of the ACA.

   Two of the former health secretaries --- Leavitt and Sebelius --- said 
states are now likely to assume a bigger role in shaping the future of Obama's 
law. A waiver pathway for states was built into the law, and Republicans want 
to make it less restrictive. That's a key focus for Senate Health, Education, 
Labor and Pensions Committee Chairman Lamar Alexander, R-Tenn., as he plans 
bipartisan hearings this fall with Democratic counterpart Patty Murray of 

   Leavitt sees waivers as a way to provide states more flexibility to tailor 
their insurance market rules to local needs and preferences.

   Sebelius says that should not be done in a way that undermines federal 
consumer protections like standard benefits. She'd like to see states use 
waivers to help offset the cost of care for the sickest patients.

   Thompson says he believes a bigger deal, at the federal level, is still 
possible if Trump plays his cards right with Congress.

   Former HHS Secretary Sylvia Burwell, who served during most of Obama's 
second term, declined interview requests.


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