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By Cheryl and Ferd Mitchell
On October 1, the Health Exchanges for the Affordable Care Act (ACA) began operations. This start-up effort promises to provide many insights into the administrative strategies that are being attempted.
The start-up is taking place at the end of a long evolutionary period of development (2010-2013); in a political setting of intense partisanship and uncertainty over ACA activities by the public; and in the midst of innovative technical and marketing efforts that have yet to demonstrate success or failure.
Implementation of the Exchanges has presented major technical challenges for the development of software and hardware for the Exchanges (to receive and process applications for assistance). Similar challenges have been presented by preparation of the Data Services Hub (to act as a switchboard linking Exchanges and federal agencies) and revisions to computer systems by federal agencies (required to determine eligibility and confirm the amounts of premium subsidies available for all applicants).
A somewhat fragile marketing campaign has been fired up to promote the Exchanges—while anti-Exchange marketing campaigns have also been launched. In this environment, much can be learned by watching the administrative strategies that are being applied.
Those responsible for technical implementation of the Exchanges are operating with an inwardly-oriented developmental focus that is largely invisible to the public. At the same time, outreach to the public largely avoids direct engagement with critics.
Administrative strategies for implementation of the Exchanges are thus being driven by political polarization rather than problem-solving techniques. Technical development has been almost completely hidden except for limited status reports. There has been no time for a public demonstration of operations.
Marketing efforts on behalf of the Exchanges have been largely directed toward selected segments of the population. Counter-marketing efforts have tended to be directed toward the same public groups.
Administration of the Exchanges has been inwardly directed for development, and directed toward certain segments of the public for outreach. Critics of the Plan have largely directed their efforts toward the public.
Advocates and critics are not seeking a mutual resolution of issues. Rather, they are seeking to force-feed the public with their own points of view.
The administrative strategies for both sides are to “run for election” with the public as the final audience. The success or failure of the Exchange operations will thus feed into the ACA “election process” that is under way.
The result is “administration by election.” Typical program management concepts are being replaced by internal efforts that are largely unseen by the public, combined with the intensive marketing of clashing perspectives. Lessons can now be learned by watching how well this approach is able to play out, and by identifying the strengths and weaknesses of the efforts.