Republicans have not been eager lately to associate themselves with President George W. Bush. But the team advising GOP presidential hopeful Mitt Romney on health issues draws heavily from the Health and Human Services Department in the Bush era.
Romney’s health advisers haven’t been frequent speakers on the D.C. health policy circuit. And they aren’t the people House Republicans summon to Capitol Hill to excoriate Democrats’ health care law. What they share is a connection to Mike Leavitt, the man who will lead transition planning if Romney wins the White House.
The former Utah governor is mild mannered and not known for partisan rancor. A fellow Mormon and onetime head of the Environmental Protection Agency, Leavitt combines policy wonkiness with the political deftness he acquired during his gubernatorial tenure.
If Romney wins, Leavitt would have a big role in implementing the health reforms the campaign is proposing. In the Bush years, he led the rollout of the Medicare prescription drug plan known as Part D.
Despite initial confusion among seniors, the plan eventually attracted millions of enrollees and is now one of the most popular pieces of Medicare.
That plan reflects the Republican philosophy that increasing competition among private insurers for consumers’ health care dollars will lower health care costs. That theory underpins Romney’s arguments that seniors should be able to choose among private insurance companies offering Medicare plans.
Leavitt’s involvement with Part D means that his team has experience tackling a major Medicare overhaul, an issue that the campaign has been pushing hard. It’s also something near and dear to Leavitt’s heart: In an old biography from the HHS website, he warned of disaster in both Medicare and Medicaid and said it was crucial to put them on a more sustainable path.
The Romney health advisers include Tevi Troy, Leavitt’s former deputy at HHS, and Tom Barker, now a partner at Foley Hoag, who also worked for Leavitt at HHS. Another adviser is Scott Gottlieb, now with the American Enterprise Institute. Gottlieb served in the Bush years as a senior adviser at the Centers for Medicare and Medicaid Services and became a deputy commissioner at the Food and Drug Administration.
Troy said that Leavitt “rolled up his sleeves” in the prescription drug program’s implementation, even dropping in one Saturday at HHS’s Baltimore office to work with the staff on it. Drawing on his political experience, he focused during the rollout on making sure that seniors understood their choices.
“The only way it was going to work was if people really understood their choices,” Troy said.
Douglas Holtz-Eakin, architect of Sen. John McCain’s 2008 health care platform, said the experience with Part D’s implementation would be a plus for Romney’s health team.
“They had to really think hard about the rollout, the presentation on websites, and just had to get it done in time with a short lead time,” Holtz-Eakin said. And that experience could be useful in transitioning the entire Medicare program to private insurance plans. Of course, Holtz-Eakin said, the scale is “enormously larger.”
Gail Wilensky, a former McCain campaign health adviser, said the advisers were “capable, competent individuals” whose political savvy would be helpful in guiding Romney’s efforts.
The goal to overhaul Medicare was sealed when Romney chose as his running mate Rep. Paul Ryan, the architect of a premium support Medicare plan approved twice by the Republican-controlled House. Before the Ryan pick was even announced, former aides to the congressman such as Matt Hoffmann and Jonathan Burks had left their jobs on the House Budget Committee to work on the Romney campaign.
Another person Romney may turn to for advice is Robert Moffit, a Medicare expert at the Heritage Foundation. Moffit hired Romney Policy Director Lanhee Chen, who worked for Troy and Leavitt at HHS.
As for repealing Obama’s health care law, Romney would need a legislative strategy to make that happen. If the Senate Republicans have fewer than 60 votes, the effort would require reconciliation, a complex procedural tactic, to undo as many parts of the law as possible. Such know-how could come from the staff of Senate Minority Leader Mitch McConnell and Budget Committee ranking member Jeff Sessions.
Should Romney succeed in repealing the Affordable Care Act, he would have help resurrecting insurance exchanges and shaping them into the Republican visions of a competitive marketplace from Leavitt, who ran a consulting firm focused on insurance exchanges in his post-government days. Romney could also lean on the expertise of Cindy Gillespie, who worked for Romney in Massachusetts during the state’s health reform and has been helping states prepare for and build exchanges in her position at the law firm McKenna Long and Aldridge.