I want to build on Tamara’s good post from this morning on how to organize and defend when forced to and advance when possible.
The federal bureaucracy will be our friend. Right now the Trump team is being staffed by incompetents, grifters and Brietbart comment section heroes in too many high level, high profile locations. That means the federal civil service bureaucracy will either be micromanaged to death or if the political appointees know that they don’t know anything, they’ll be given quite a bit of loose guidance and a lot of freedom of action. And this is an area where we can have some success.
In October, I submitted a long comment to CMS for the NBPP 2018 rule. The core of the comment is a call for greater meaningful difference:
This new rule solves the current problems that are created by the current Meaningful Difference rule. Buyers will have far clearer choices when they actively shop on Healthcare.gov. The number of plans that can be offered for a geographic region and metal band will most likely be reduced. The reduction in plans will come from the removal of plans that are extremely similar to plans that will still be offered on Exchange. Finally, the removal of isomorphic clones will lead to higher enrollment and improvement of the risk pools as more individuals will find the post-subsidy premiums to be a better deal than paying the individual responsibility fee (individual mandate) penalty.
CMS released the final rule last Friday. The only reference to this comment was on p.178 where CMS brushed the suggestion off.
So that was not a win for me.
However, it is a point of leverage and pressure. If we are going to see technical staff have some technical freedom because their management won’t know what they are looking at, we can minimize the dumb or spiteful while getting some wins in the rulemaking process.
I’m going to get on Tim F’s beat — if you see something that the Federal government is doing that either intrigues you, pisses you off or touches on an area of specialized knowledge that you have, comment on the rule making. This letter took me three or four hours to write and revise with the other signers. It will be read, and it will be remembered by CMS technical staff as it engages them and it is not a mindless screaming of rage (from what I’ve heard, the EPA gets the best rage-grams.) Thoughtful, relevant responses that point to possible ways of accomplishing the mission of the agency in question will be read and they will be remembered. So please, do so