Policy Implementation, Before and After

Last week, Secretary Sebelius announced that HHS is halting the implementation of the CLASS Act. The CLASS Act passed as part of the Affordable Care Act, and would have established a voluntary government-administered long-term care insurance plan. People who could not qualify for or afford commercial long-term care services could buy into the CLASS program. It would have been funded solely by premiums, not tax dollars. HHS could not find way to make the program financially solvent for 75 years, as the law requires.

Politco summaries Assistant Secretary for Aging Kathy Greenlee's explanation of the agency's decision:

The department was ultimately stumped on how to stop the program from attracting a pool of beneficiaries that had unsustainably high needs, Greenlee wrote in a memo. Actuarial models showed that premiums could climb as high as $3,000 per month if adverse selection — in which the program would attract only the people with health problems — ”were particularly serious."

Such premiums would only cover the minimum benefit allowed in the statute — $50 per day. Such low benefits, Greenlee warned, could make the risk selection problem even worse.

I wrote a paper on oversight of ACA implementation last spring, and attended a House Subcommittee on Health hearing titled “Implementation and Sustainability of the New, Government-Administered Community Living Assistance Support (CLASS) Program." During the hearing Republican members expressed concern that CLASS would be a new entitlement program. Greenlee testified that the program may not be solvent as it was written in the ACA, but that her agency was making adjustments. After 19 months spent studying the program, I guess HHS concluded that adjustments wouldn't be enough.

The CLASS Act was disbanded before it could be implemented. On the other side of the policy process, government officials may solicit feedback on whether programs are being implemented efficiently. My mom recently attended a feedback "evening of discussions" with Sue Swenson from the Department of Education. Swenson is the Deputy Assistant Secretary of the Office of Special Education and Rehabilitation Services and came to Colorado to hear from parents of children with disabilities talk about their experience with pubic education, specifically inclusion.

While many of the parents wanted to talk about specific problems with how Denver Public Schools is implementing the Individuals with Disabilities Education Act's inclusion requirement (that children with disabilities be educated in the "least restrictive environment"), Swenson made it clear that her office was not able to help with specific cases. She told the two dozen parents in attendance to contact lawyers in ED's Office of Civil Rights if they thought the school district was violating their requirement to provide a "free and appropriate public education" in the "least restrictive environment." According to my mom, Swenson just wanted to listen and "absorb the hurt." While she did ask for policy suggestions, she mainly pushed for parents to organize at the grassroots to push for change.