Learning From ACA Implementation Problems

By Ferd H. Mitchell and Cheryl C. Mitchell

Federal and state administrative strategies to cope with the implementation problems of the Affordable Care Act (ACA) are beginning to become more transparent to outside viewers.

The federal Health Exchange (at www.HealthCare.gov )  is mired in technical problems. The response has been to appeal to Healthcare .govenhanced “fix-it” procedures, “talk up” the fixes, try to maximize alternative strategies for enrollment (through call centers and navigators), maximize administrative ability to shift deadlines, and seek to “change the subject.”

All of these efforts represent strategies to buy time and hope for delayed success.

It may be assumed that administrators are now preparing messages to either “claim that the Exchange is fixed” (if at all possible), or to come up with alternative plans to explain and justify delays.

It is interesting to contrast this situation with some of the more notable successes by a few state-run Exchanges (including those in California, New York and Washington State). These Exchanges have been able to better handle technical issues and communications, and are being recognized as relative successes.

The performance of Exchanges may vary due to their organizational environments, strategies for coping with problems, differences in Exchange sizes, and contrasting political settings.

LessonsLearned_Rect1Further, the state Exchanges by themselves do not have the ability to make significant changes in program schedules. Perhaps knowing of this situation, state administrators have been able to focus more clearly on meeting target deadlines.

And perhaps—most importantly of all—state administrators have often had the benefit of more operational experience with the design and implementation of online technology, due to widespread previous efforts.

This experience may have been a critical difference.

A comparison among Exchanges suggests that the administration of new programs might well benefit from more-relevant direct program experiences, and from the recruitment of highly-capable teams at the start. Organizational assignments should likely be closely matched to the jobs at hand.

And it may be helpful to divide the large programs into smaller parts, to reduce the scale of demands on all administrators.

Deadlines should be taken seriously, and managed carefully.

Communications should be as open as possible, to develop outside support and encourage public acceptance.

It would be useful to be able to perform a detailed administrative comparison between the federal Exchange and several state Exchanges (which have ranged from highly successful to largely unsuccessful).

Important administrative lessons could be drawn from such comparisons to the benefit of the field of public administration.


This is installment #13 in the “Affordable Care Act and Public Administration” series.

Previous installments of this series have considered impact of the ACA on the field of public administration from a variety of perspectives. Refer to the archived postings for this blog to review all of these installments and obtain an overview of the combined commentary. (Or search for “health care”, “ACA” or “Mitchell” in the search box somewhat below the top of the home page).

More on these and related ACA topics, including coverage of how organizational reactions affect implementation efforts, may be found in a recent book by the authors that describes evolution of the ACA, and in a new Practice Guide by the authors that addresses funding and access issues in health care.


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