WASHINGTON -- The Obama White House is painting a rosier picture of the Affordable Care Act after a surge of sign-ups in December and a calm first day of coverage on Jan. 1. But one of the top officials working on the law's implementation cautioned that the coming week would be critical in determining its political and administrative viability.
In an interview with The Huffington Post, Phil Schiliro, the president's former director of legislative affairs turned health care point man, said the administration was "preparing for the worst case" scenario for the next few days, as patients head to hospitals and pharmacies with new insurance coverage in hand. There's a clear possibility that some of those patients will not have the coverage they assume because of website glitches, Schiliro said. But the White House will be working around the clock to make sure that any potential fire is put out quickly.
"If we can get through this phase without the hiccups we had with the website, that will put us in a much better position to be aggressive in getting people to sign up," Schiliro said. "We have been very fortunate in that insurers, hospitals, pharmacies and doctors go through this every year because people switch plans every year. They have dealt with it. What they haven't had in the past, except for the year of Medicare Part D, is a spotlight where everybody is looking to see what happens."
"Once you are through that first week, almost anything that's out there we will have dealt with, and it's always easier to do it the second, third and fourth times," he added.
Coverage began Jan. 1 for the 2.1 million people so far who have picked a plan through the federal and state exchanges and the additional 3.9 million people who enrolled in Medicaid, and the administration feels good about how things have gone so far. There have been notably few public anecdotes from consumers who found out that the coverage they thought they had bought never went through. But that could change at any moment. Pharmacies, for instance, expect a big rush of customers to come on the 6th or the 7th of the month, after they go see their doctors this Thursday and Friday.
According to Schiliro, the White House has a process in place to deal with worst-case scenarios. The administration has reached out at least twice to each person who submitted applications that may contain erroneous information or could be missing a page, and private insurance companies have done the same. In addition, a 24-hour call center is available to help people sort through the confusion and "a team of caseworkers who will work to try and resolve [problems] within 24 hours," Schiliro said. Many pharmacies are adopting flexible policies for newly covered people buying prescriptions, and Medicaid has assumed enrollment for new patients.
But that probably won't be enough to stamp out potential political issues, Schiliro conceded.
"We can't solve newspaper stories cropping up around the country saying, this person thought they had insurance and they didn't," said Schiliro. "In most cases, there won't be validity to them, and we will try to fix it after the fact. But that is just what we have to live with."
Discussing the larger state of the health care law, Schiliro said that White House felt buoyed by "the trajectory we are on," noting that the number of enrollees in federal exchanges had spiked to nearly one million in December after poor showings in October and November. While tracking polls show more people have had a negative experience with the law than a positive one, the numbers are moving in the administration's favor.
Schiliro declined to discuss the composition of the enrollees -- which will go a long way towards determining the stability of the exchanges, as they rely on the participation of younger, generally healthy consumers to keep costs down -- but said that he hopes the data will be available "within the next couple of weeks."
He also said it was "ludicrous" to think that more Americans ended up losing health care coverage than receiving it because of policy cancellations, calling the number of people whose existing plans were canceled "a number without meaning."
"Those are people who received notices," he said. "That is like saying that if you received a notice from the DMV that you had to renew your license, that meant your license wasn't renewed. All it is, is telling you that something is happening and you have to act on it."
Schiliro defended the administration's series of executive changes to the law, arguing that they were "common sense" reforms that helped with a naturally rocky transition. The White House has delayed the employer mandate and cuts to Medicare, in addition to allowing insurers to grandfather in more consumers and allowing consumers to re-up catastrophic insurance plans that were cancell=ed. All of this was done without congressional approval, prompting howls from Republicans and some agitation from Democrats.
"It is always an option," Schiliro said, when asked why the White House didn't ask for lawmakers to legislate these reforms. "I don’t think there is an exemplary record right now of getting changes past on any issue in Congress this past year. There are obviously differences up there. A lot of them are legitimate differences in philosophy.
"But the president has said this throughout," he said. "He is willing to work with anybody to make the law better. A lot of what we have done ... was people really acting in a common sense way."
As an example of what he called "overwrought criticism" of executive action, Schiliro highlighted the looser standards imposed on catastrophic plans. The only change the administration made, he said, was to simply grant a hardship exemption to a small group of individuals who want health care and are eager to find a better plan, but would benefit from a fallback option if the alternatives are too costly.
"I don’t even know if [a reform like that] would pass or not," he said. "But it wasn't going to happen in December. That’s why I say most of this is just common sense adaptation to what circumstances are."
Going forward, Schiliro said that the White House would be ramping up its outreach campaign for the Affordable Care Act. He declined to discuss whether the administration was now more focused on individuals who had never purchased insurance versus those who were picking new plans. Nor did he preview any particularly new wrinkle in advertising strategy.
Outreach will be more robust, he said, in part because when there were problems with the federal website in October and November, the White House could not do a PR blitz.
"We had a really bad beginning, we had a really good December," he said. "December doesn't mean we will have a really good January, February or March. So that's why nobody here is complacent."
Disclosure: This reporter's wife works for the administration on matters of congressional oversight, including on the topic of health care reform.