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Burwell Meets The Press: Managing Expectations On Ebola,, ACA Year 2

We’re working on it.

No matter what the topic – from improving consumers’ experience with, the health law’s Medicaid expansion, narrow networks and even Ebola — Department of Health and Human Services Secretary Sylvia Mathews Burwell told reporters Thursday her agency is on it.

During a breakfast with reporters sponsored by Kaiser Health News and the health policy journal Health Affairs, Burwell tried to manage expectations about the health law’s next open enrollment season and declined to make a prediction about how many people would enroll this time around. She also cautioned that we are likely to see the number of Ebola cases rise before the crisis subsides.

A year ago Thursday, then Office of Management and Budget chief Burwell was in the middle of a government shutdown caused by a battle with Republicans over funding for the very health care law she’s now charged with implementing.  Her success — or failure — over the next year in fixing problems with and shaping public perception of the law may define its role in the 2016 presidential elections and well beyond.

The themes Burwell expressed during her question-and-answer session with reporters were familiar to those who have followed the secretary, who just passed her first 100 days in office. Expect improvement – but not perfection – when enrollment on begins again Nov. 15. HHS officials are working with insurers, consumer groups, state officials and others to find out what’s right and what’s wrong with the website to make the user experience faster and simpler.

Ongoing testing of the site should mean it can handle increased traffic far better than the debacle of a year ago where numerous outages infuriated millions and gave the GOP even more fodder in their campaign to defund or repeal the entire law.  Work continues on the “back end” of the site, which deals with communications between the government and insurers.

Burwell took questions on a wide range of topics and her answers were careful and measured:

— When asked if she was taking a “back seat” on the administration’s response to the Ebola crisis, Burwell made it clear she’s on top of it — she’s often conducting three meetings a day on the issue. But she’s comfortable to let colleagues who are experts, Thomas Frieden, chief of the Centers for Disease Control and Prevention, Anthony Fauci,  director of the National Institute of Health’s infectious disease institute, get more time at the microphone during press briefings.  Burwell didn’t mince words when it came to estimating the number of cases ahead.  “The numbers are going to increase before we get to a leveling off point,” she said. On Wednesday, the first person diagnosed with the disease in the U.S. died in a Dallas hospital and thousands have died in West African countries.

— Burwell acknowledged that the data on the Centers for Medicare & Medicaid Services’ Open Payments website “wasn’t perfect” but said HHS went forward with its release in an effort to improve government transparency.

— In response to a question about a recent Government Accountability Office report that found some insurers were not properly ensuring that federal subsidies to help pay for health coverage were not being used to fund abortion, Burwell said that no federal funds were being spent on abortion except in cases of rape, incest or to protect the life of the mother, consistent with current law. She also said HHS is working with states and insurers to make sure they understand what the law requires. She added that the GAO report was based on last year’s plans – not those offered for 2015.

— HHS is working with governors who have yet to expand their Medicaid programs – a provision of the health care law the Supreme Court made optional for states – and to clear backlogs in other states where people who have signed up for Medicaid coverage have yet to receive it. She mentioned Indiana, Tennessee and Utah as states that she is in active discussions with about expansion. “We have to think about what flexibility they need and what is the best approach for their state,” she said.

— Burwell declined to give a target health law enrollment figure for 2015, pointing instead to a Congressional Budget Office estimate that exchange enrollment is projected to hit 13 million next year and climb to 25 million by 2017. “Now we actually have information about what happened in the first open enrollment period….We want to try and to build that number, bottom up, based on what we know [about] those who did enroll,” she said.