Obama camp, industry shift from political battle to implementation focus

President Barack Obama's administration is shifting its focus from the politics of the health overhaul to the work of implementing it, which officials may pursue even more quickly than required by the law, The New York Times reports. Top health officials, including Health and Human Services Secretary Kathleen Sebelius, White House adviser Pete Rouse, and Obama's health care lobbyist Nancy-Ann DeParle will all play central roles in implementing the law. Sebelius has already taken on a higher profile even as she begins to write new regulation for health insurers and government health programs and craft a new innovation center within the agency that runs Medicare. DeParle will set in motion policies meant to expand coverage to 30 million uninsured and Rouse will manage an "elaborate implementation plan" (Calmes, 4/17).

For another set of officials, "the task of carrying out the law may be as much of a challenge as getting it enacted," The New York Times reports separately. "Jay Angoff, a longtime consumer advocate and nemesis of the insurance industry, will lead efforts to regulate insurers and insurance markets. Jeanne M. Lambrew, a Clinton White House veteran, 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" (Pear, 4/18).

Health insurers are also moving to get ready for the overhaul, The Washington Post reports. Lawmakers will require health plans to spend 80 percent of their revenue on patient care. Plans that cover large groups would have to spend 85 percent. To prepare for those requirements, some insurers may "redefine" what patient care means on their balance sheets. "In January, WellPoint began including under medical benefits such costs as nurse hotlines, 'medical management,' and 'clinical health policy,' a WellPoint executive said in a March briefing for investors." They could pursue other means to mitigate the effects of the overhaul, such as boosting rates, too (Hilzenrath, 4/18).

Indeed, The Associated Press notes, "All sorts of special interests — business, labor, medical, consumer and ideological — are now focused on how the new law shaping the nation's health care system will be carried out. They're also turning lawmakers' votes into ammunition for this year's congressional campaigns and beyond. It all shows how lobbying grinds on, well after Congress has spoken on an issue" (Fram, 4/17).