Obama Health Team Turns to Carrying Out Law/Doctors Hear Many Questions About Health Law

Obama Health Team Turns to Carrying Out Law
By ROBERT PEAR
Copyright by The New York Times
Published: April 18, 2010
http://www.nytimes.com/2010/04/19/health/policy/19health.html?th&emc=th


WASHINGTON — The success of the new health care law depends to a large degree on a handful of Obama administration officials, who are scrambling to make the transition from waging political war on Capitol Hill to managing one of the most profound changes in social policy in generations.

For these officials, the task of carrying out the law may be as much of a challenge as getting it enacted.

Jay Angoff, a longtime consumer advocate and nemesis of the insurance industry, will lead efforts to regulate insurers and insurance markets.

Jeanne M. Lambrew, an idealistic veteran of the Clinton White House, is carrying out provisions of the law aimed at expanding coverage.

And Phyllis C. Borzi, a top Labor Department official, will police the conduct of employers, who provide health benefits to more than 150 million Americans.

Their task is to translate the promise of the law into reality, with help from the private sector, if possible.

Joseph R. Antos, an economist at the American Enterprise Institute, asked: “After spending so many months trashing the health insurance industry, will officials be able to calm down enough to be able to talk to the industry and the experts who will be running the new system? You need their input. It’s essential to get technical insights from people in the industry who were largely ignored in the political process.”

Here are profiles of three top members of the Obama team.

Jay Angoff

After graduating from Oberlin College in 1973 and Vanderbilt Law School in 1978, Mr. Angoff began his career as an antitrust lawyer at the Federal Trade Commission and then worked as a lobbyist at Congress Watch, a Ralph Nader organization.

Michael Pertschuk, a former chairman of the trade commission, wrote admiringly of Mr. Angoff in “Giant Killers,” his 1986 book about public interest lobbyists. He described Mr. Angoff as “tough, prickly, righteous, slow to compromise.”

Mr. Angoff worked for a nonprofit group, the National Insurance Consumer Organization, before moving to New Jersey, where he was a deputy insurance commissioner and health policy adviser to Gov. Jim Florio, a Democrat.

As director of the Missouri Insurance Department from 1993 to 1998, Mr. Angoff got to know Kathleen Sebelius, who was the insurance commissioner and then the governor of Kansas.

Ms. Sebelius, now the secretary of health and human services, recruited him to be director of a new Office of Consumer Information and Insurance Oversight.

Mr. Angoff said effective regulation of insurers “could have a greater impact on costs and coverage” than the public insurance option liberals championed unsuccessfully.

And Mr. Angoff has made it clear that he means to be aggressive in setting “marketplace rules.” He will enforce a section of the law that requires insurers to file detailed justifications for any “unreasonable increases in premiums.” One of his first tasks is to define “unreasonable.”

A former law partner, Cyrus Mehri, said: “Having been a state insurance commissioner, Jay can see through the games insurance companies play. He will put teeth into the law. He will create a whole new federal regulatory regime to rein in the abuses and excesses of the industry.”

As a Missouri official, Mr. Angoff won a legal battle with the state’s Blue Cross and Blue Shield plan, which agreed to help set up an independent charitable foundation after it switched from nonprofit to for-profit status. As a lawyer in private practice, he secured tens of millions of dollars for consumers in class-action lawsuits against insurers.

Calvin W. Call, executive director of the Missouri Insurance Coalition, a trade association, said Mr. Angoff’s appointment did not bode well for health insurers.

“The industry’s survival is probably limited in time, and Jay will be right there to watch it perish,” Mr. Call said. “Here in Missouri, Jay seemed to be a proponent of confrontation and almost invited litigation to decide issues that could have been resolved in the General Assembly or through compromise.”

On the other hand, Mr. Call said: “Jay kept us challenged every day. He may have made the industry better, more attuned to detail.”

Jeanne M. Lambrew

When President Bill Clinton’s plan for universal health insurance collapsed in 1994, many Democrats, exhausted and disillusioned, turned to other issues. Ms. Lambrew never wavered. She kept plugging away at efforts to expand coverage.

In Mr. Clinton’s second term, she worked at the White House, as senior health analyst at the National Economic Council and as an associate director of the Office of Management and Budget. In those roles, she was an architect of the Children’s Health Insurance Program.

During the Bush administration, Ms. Lambrew refined her ideas as a senior fellow at the Center for American Progress, a sort of government in exile for liberal policy experts. She became an associate professor at the University of Texas and collaborated with former Senator Tom Daschle on a book that laid out many ideas incorporated in the new health care law.

Ms. Lambrew is leading efforts to expand coverage as director of the Office of Health Reform established by Ms. Sebelius. Ms. Lambrew is racing to meet a deadline set by the new law: Within 90 days, every state must have an insurance pool where uninsured people with medical problems can buy coverage at reduced rates.

Even people who disagree with her politics say Ms. Lambrew is a pragmatist, focused on results, not ideological purity.

Ms. Lambrew picked up her interest in health care from her father, Dr. Costas T. Lambrew, a cardiologist in Maine; her mother, Patricia, a nurse; and her maternal grandfather, Dr. James Travers, a family doctor in New York.

While working at academic medical centers, her father said, “I ran clinics for people who could not afford private care.”

In 2003, Ms. Lambrew helped local officials overhaul the health care system in Maine, her home state. “Jeanne has a passion for the uninsured,” said Trish Riley, director of the Office of Health Policy and Finance in Maine.

Phyllis C. Borzi

Ms. Borzi, an assistant secretary of labor, has been working on employee benefits for 35 years, since she answered a job advertisement on a bulletin board at Catholic University while attending law school.

For 16 years, from 1979 to 1995, she worked for House Democrats on the subcommittee responsible for pensions and employee health benefits. She was a research professor at George Washington University and has extensive practical experience as a lawyer advising multiemployer health benefit plans.

Ms. Borzi said her goal now was to write regulations that provide clear guidance to employers without being “overly prescriptive.”

“I am committed to preserving the employment-based system and encouraging employers to keep their health plans in place,” Ms. Borzi said.

Though she is a Democrat with pro-employee sympathies, Ms. Borzi is respected by Republicans and employer groups like the United States Chamber of Commerce. They describe her as one of the nation’s leading experts on the law that governs workplace benefits, the Employee Retirement Income Security Act of 1974, known as Erisa.

Mark J. Ugoretz, president of the Erisa Industry Committee, a trade association of big companies, said Ms. Borzi knew as much about employee health benefits as anyone in the field. But he said he worried that her agency would be tempted to over-regulate health plans.

“If the regulations become too stringent, too burdensome, too costly, it could strangle the system,” Mr. Ugoretz said. “Employers would retreat from providing innovative, comprehensive health benefits, just as many companies have dropped traditional pension plans in favor of 401(k) plans.”






Doctors Hear Many Questions About Health Law
By JOHN LELAND
Copyright by The New York Times
Published: April 18, 2010
http://www.nytimes.com/2010/04/19/health/policy/19doctors.html?th&emc=th


Dr. Roger W. Evans, a cardiologist in Wichita, Kan., is used to answering patients’ questions about their hearts. But lately, he said, he has spent half his time answering a succession of different questions — about the health care law.

Donald Moore, 75, one of those patients, expressed his uneasiness about the law recently: “The fact is that I don’t understand it, and no one else I talk to understands it. Every day, you read something different in the paper.”

Mr. Moore’s latest concern was a “rumor that the new health care procedures are going to be monitored and managed by the I.R.S.”

“That’s a turnoff right there,” he said. “How much is true, how much is fiction, out here no one knows.”

Most of the health care law, which President Obama signed last month, has yet to take effect, but for many doctors it is already having an impact.

“We’ve had to add an hour or two to the day because patients want to talk about it,” said Dr. Evans, who travels around the state and said questions often left him scratching his head. “I see 30 to 50 patients in a day, and it is the subject of conversation more than half the time.”

After months of public wrangling and brinkmanship in Washington, the nation’s doctors now find themselves having to answer questions about a 2,400-page law that many do not understand themselves, and which they may have opposed. “Not only is the public confused, but so are our members,” said Dr. Lori J. Heim, president of the American Academy of Family Physicians, which supported the bill. “There’s been a lot of misinformation out in the media. We’ve been trying to get to them simple answers — what does this mean for my practice, what does it mean for my patients, what does it mean for the future?”

Some doctors said their patients were pushing for surgery now, for fear that it will not be covered in the future or that they will end up on a waiting list. “It’s ludicrous to be coerced to perform surgery because of fear of noncoverage in the future,” said Dr. Eustaquio O. Abay II, a neurosurgeon in Wichita. “I refuse.”

Dr. Abay said he had tried to read the law, but gave up because it was all legal jargon to him. “They think we have all the answers, but we don’t,” he said of patients.

While many doctors say they are not besieged, the queries have been particularly robust in states where the plan was unpopular, Dr. Heim said.

Joseph R. Baker III, president of the Medicare Rights Center, a nonprofit organization that operates a hot line for patients with questions, characterized the volume of calls about the bill as moderate. But he said the level of confusion was high, comparable to that created when Medicare added prescription drug coverage in 2004.

Often, Mr. Baker said, callers have been getting their information from media commentators or doctors who opposed the legislation. “They’re being told by their providers, ‘Now I won’t be able to take Medicare patients,’ ” he said.

“People call us confused, panicked, anxious,” he said. “And in most instances, we say there are some benefits in the short term, like closing the doughnut hole,” as the gap in Medicare prescription drug coverage is known, “and that the things that might have a negative impact, like lower reimbursement to providers, will happen over a number of years. Usually that calms people down.”

The questions do not always reflect the actual provisions of the law. The major changes for this year, including coverage on their parents’ policies for adult children under age 26, rarely come up, said Dr. Melissa Gerdes, a family practitioner in Whitehouse, Tex., who said it was not unusual for her patients to discuss politics in the examining room. She said that only one patient had asked about the new law’s provisions on the doughnut hole, and that she could not recall any patient who had inquired about coverage for adult children.

“The big one I get is, ‘Are you going to be able to keep seeing me?’ ” Dr. Gerdes said. (She tells them she will.)

At Dr. Alieta Eck’s free clinic in Somerset, N.J., where all the doctors donate their time, Dr. Eck said many of her patients were excited about the new program. “People say, ‘I can’t wait for Obamacare,’ ” said Dr. Eck, who has been outspoken in her opposition to the program. “They’re already getting free care.”

Dr. Eck said that her office had not been overrun with questions about the bill, but that during visits at her paid practice, “most patients are fearing that everything’s going to cost them more.”

For many doctors, the big frustration comes when they do not know what to say to their patients.

“Quite honestly, I don’t know how to answer their concerns,” said Dr. Deborah A. Sutcliffe, a solo practitioner in Red Bluff, Calif. “Sometimes they’re more informed than I am, sometimes they’re not. I haven’t read the damn thing.”