Managers are unsure government can handle expanded health care role
Survey respondents expect legislation will mean increased responsibility, but aren’t confident federal agencies are up to the challenge.
Federal managers believe health care reform legislation -- in any form -- will mean increased responsibility for the federal government, according to a new survey. They also lack confidence agencies will be able to meet new responsibilities effectively.
The survey of more than 550 Government Executive readers, conducted in late November by The Government Business Council, the research arm of Government Executive Media Group, found managers expect health care reform will require the government to take on a range of new roles and responsibilities. Eighty-three percent of respondents said they believed the federal government will assume increased oversight and enforcement responsibilities with or without a public option. Almost three quarters believed it will take on more management and execution responsibilities, also regardless of the public option's legislative fate.
Despite the uncertainty over what a final health care bill might entail, survey respondents identified a number of specific tasks that are likely to fall to government. More than 80 percent predicted agencies will take on the enforcement of insurance practices such as cost, competition and the approval of those with pre-existing conditions. Many respondents -- more than 70 percent in each case -- said the government likely will provide subsidies for qualifying individuals, help establish universal electronic medical records and manage the standardization of health care transactions.
At the time of the survey, less than half of respondents expected the government to take on the operation of a health insurance exchange. That option now appears more likely given a proposal introduced during the weekend to create a national insurance plan modeled after the Federal Employees Health Benefits Program.
The proposal would draw on a program that is overwhelmingly popular with federal managers; 80 percent of respondents expressed a positive view of FEHBP. Ninety percent based this opinion on personal experience with the program.
Despite widespread satisfaction with FEHBP, almost half the respondents said they were not confident in the federal government's ability to operate a health insurance exchange. In fact, respondents did not express great confidence that the government could take on any of the new responsibilities identified. More than half said they were not confident that the government could successfully enforce penalties for the uninsured or monitor insurance practices.
Managers were most sure of the government's ability to establish universal electronic medical records and to provide health care subsidies for those who qualify.
Perhaps contributing to respondents' lack of confidence in the government's ability to manage new responsibilities was uncertainty over whether Congress would properly fund implementation of health care reform. Almost half (45 percent) the respondents said they were very unconfident the final legislation would include sufficient funding for administrative or structural changes the federal government must make. Another 24 percent said they were somewhat skeptical. Even with the necessary funding, managers would face a number of high-level challenges running or enforcing health care initiatives. Collaboration, both across agencies and with state governments, tops the list of challenges identified by federal managers. Significant majorities also identified building the necessary electronic data storage systems, hiring enough qualified employees, securing the influx of citizen data, and establishing new agencies or offices as challenges.
The National Academy of Public Administration has recommended that President Obama immediately designate an agency and an individual to direct the implementation of the health care overhaul, even though the legislation has yet to be finalized. But given the legislative uncertainty, the Government Executive readers were not sure which agency would be best suited to lead the effort. Almost half (46 percent) of respondents said the Health and Human Services Department would be the most appropriate agency to receive this designation. One-third responded that this is not the best course of action, 16 percent said a new agency should be formed and another third said "other." The "other" responses ranged from "it should be a joint effort" to "hopefully this bill will fail" to "the Office of Personnel Management." The new proposal would have OPM administer the FEHBP-based exchange.