Leslie Dach, a former Wal-Mart Stores Inc. executive, has been a senior counselor to Health and Human Services Secretary Sylvia Mathews Burwell for more than a year.
With the Affordable Care Act’s third open-enrollment season under way, Mr. Dach sat down with Wall Street Journal Assistant Managing Editor Laura Landro to discuss how health-care policy is evolving.
Edited excerpts follow.
MS. LANDRO: I think we can say that the Affordable Care Act is among the most controversial and sweeping pieces of legislation in recent memory. Five years in, with another enrollment period under way, how are you going to stabilize things in the coming year?
MR. DACH: As most people know, we’ve seen a historic reduction in the uninsured in this country since the law went into effect, 17.6 million people now with coverage, a 45% drop in the uninsured rate. When it comes to quality, we’ve seen everybody’s coverage really improve, whether you’re on the Affordable Care Act or not. People are no longer discriminated against for existing conditions. They keep their kids on until 26. There is much less chance of medical bankruptcy. From an affordability standpoint, not only can people on the marketplace get coverage, seven in 10 of them for less than $75 a month in premiums, we’ve seen hundreds of billions of dollars in savings in Medicare and reduction in annual growth of health care to a place we haven’t seen before.
We have more to do. In terms of enrollment, we’ve set a goal of 10 million, what’s called, effectuated enrollees, paying their premiums at the end of 2015. What’s important about that is that there are, we believe, about 10.5 million people who are uninsured and qualified for insurance. So to achieve that objective, we have to get one in four of those people to sign up, an ambitious goal.
MS. LANDRO: We’ve increased access. We’ve increased coverage. Yet millions remain uninsured, and those who do have coverage are still having a hard time finding quality care at an affordable cost because they’re up against deductibles of $3,000 in some cases. What about that aspect?
MR. DACH: Well, this is a difficult system and it’s going to take a lot of complex solutions working together.
We fully agree that it’s very important for people to have a full understanding of the cost of their health care before they pick coverage. Healthcare.gov this year has a lot of new tools to help people do that. We don’t want surprises. We want a satisfied customer.
In terms of quality and getting more bang for our health-care buck, both in quality and in cost savings, that’s really an important frontier. We’re working hard to move from the way we pay.
MS. LANDRO: Away from fee-for-service and toward quality rather than quantity?
MR. DACH: Correct.
MS. LANDRO: There are different approaches to that. You’ve got bundles of care and accountable care organizations. Tell us about the hip-and-knee replacement initiative.
MR. DACH: All of these various models have a common concept, which is we want to incentivize the system to pay for quality and not quantity. We want to incentivize care to be integrated and organized.
The hip-and-joint bundle is a perfect one announced in final form yesterday. Billions of dollars are spent every year in America under Medicare and private insurance on hip and joint [replacement]. These are operations that can be quite painful. Recovery takes time. Under the old system, we would reimburse for the operation. The concept here is to ask the provider to be responsible for a 90-day period, an episode of care, so that they integrate the care down through rehab. If they do that well, they make more money. If they don’t do it as well, they have an economic risk. And that’s been welcome, frankly, by the hospital system and others.
Date: November 23, 2015