Obamacare Is Getting a Management Overhaul

Burwell wants clearer accountability, but Republicans fear conflicts of interest.

WASHINGTON - AUGUST 16: The U.S. Department of Health and Human Services building is shown August 16, 2006 in Washington, DC. The HHS Building, also known as the Hubert H. Humphrey Building, is located at the foot of Capitol Hill and is named for Humphrey, who served as a U.S. senator from Minnesota and Vice President of the United States. (Photo by Mark Wilson/Getty Images)
National Journal
Sam Baker and Sophie Novack
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Sam Baker and Sophie Novack
June 20, 2014, 9:37 a.m.

Just two weeks in­to the job, Health and Hu­man Ser­vices Sec­ret­ary Sylvia Math­ews Bur­well is over­haul­ing the frac­tured man­age­ment struc­ture that led to the dis­astrous Health­Care.gov rol­lout.

Bur­well an­nounced a sig­ni­fic­ant re­or­gan­iz­a­tion on Fri­day, bring­ing Health­Care.gov‘s top private-sec­tor repair­man in­to the gov­ern­ment and cre­at­ing new po­s­i­tions to over­see the op­er­a­tion­al de­tails of Obama­care’s fed­er­ally run in­sur­ance mar­ket­places.

Andy Slavitt, who has been spear­head­ing the Health­Care.gov re­pair ef­fort for the con­sult­ing firm Optum, will join the Cen­ters for Medi­care and Medi­caid Ser­vices as prin­cip­al deputy ad­min­is­trat­or. His re­spons­ib­il­it­ies will in­clude the Obama­care ex­changes as well as Medi­care and Medi­caid.

HHS also an­nounced the cre­ation of two new po­s­i­tions — a CEO and a chief tech­no­logy of­ficer — spe­cific­ally for the in­sur­ance ex­changes.

Slavitt’s new role could prove con­tro­ver­sial: The day be­fore Bur­well an­nounced the re­or­gan­iz­a­tion, a pair of Re­pub­lic­an sen­at­ors ques­tioned Optum’s role in the Health­Care.gov re­pair ef­fort. Optum is a sub­si­di­ary of United­Health­care, one of the coun­try’s biggest in­sur­ance com­pan­ies, which is selling plans in 10 states’ in­sur­ance ex­changes and look­ing to ex­pand.

Sens. Or­rin Hatch and Chuck Grass­ley said they’re con­cerned about pos­sible con­flicts of in­terest between Optum and United­Health­care and the in­form­a­tion Optum has about the de­tails of the ex­changes. The sen­at­ors said “sev­er­al key per­son­nel” have moved re­cently from lead­er­ship po­s­i­tions at United­Health­care in­to top jobs at Optum.

More broadly, though, Bur­well’s quick re­or­gan­iz­a­tion makes sense. She’s known as a skilled man­ager, and that’s what in­siders said HHS needed the most from a new sec­ret­ary.

Former HHS Sec­ret­ary Mike Leav­itt noted in a re­cent in­ter­view that the de­part­ment has re­mark­ably few as­sist­ant sec­ret­ar­ies — and while the new roles an­nounced Fri­day aren’t tech­nic­ally as­sist­ant sec­ret­ar­ies, they’re still aimed at cre­at­ing a clear­er and more stream­lined sys­tem of ac­count­ab­il­ity.

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