Andy Slavitt Wants to Unite America on Health Care


Andy Slavitt

Galen Fletcher for The New York Times

In 2015, Barack Obama nominated you to run the Centers for Medicare and Medicaid Services. Are you surprised that health care isn’t more of a uniting issue? If you give me 15 minutes, I can create a common bond around a story of the health care system with almost any American.

Have you ever actually changed someone’s mind about health care? I was at a town hall in Ohio: There was a family with a child with a number of severe illnesses, and one of the attendees basically apologized for voting for Trump. I don’t think that’s the answer — I hope people who continue to support Trump find that they cannot see eye to eye on the political approach he has taken on health care — but I think people’s minds are changed not by fact but by something that they feel and discover themselves, and you have to allow that opportunity to happen. You can’t beat someone up with a baseball bat and tell them they’re wrong.

Why don’t you think it’s uniting people on Capitol Hill? Congress is thinking about health care as the issue that brought them into office, so they eat breakfast, lunch and dinner on health care. So many in Congress have chosen to avoid their constituents and town halls, and they’re able to keep themselves removed from reality.

What did you make of the most recent efforts to repeal or replace the Affordable Care Act? The Senate and the institution of Congress have become a runaway train. We have an administration and a majority party that were conspiring to try to pass a bill that even the people voting for it acknowledged they hoped would never become law, all through a process that only had two hours of review and no evaluation. Forty-­nine senators still voted for it. We are on the brink of allowing ourselves to make bad policy decisions based on obscure political pressures.

Many people outside the debate may not realize that the A.C.A. started out as a conservative solution to health care. Do you agree? It is. It’s hard for Republicans to figure out how to dramatically change this solution, since it’s something that’s fairly right of center. It’s free-­market driven, so a lot of things they come back with just sound like chintzier versions of the A.C.A. But now, Americans of all political stripes are getting exposed to both how challenging this is and how many layers of complexity the private-­sector solutions bring to this. There is a strong sentiment — even if it’s not a political one — to just simplify it.

What’s the most misunderstood aspect of the A.C.A.? Most people don’t pay the headline premiums that the Republicans have done a good job of defining in the media. But also: Whatever Obamacare has and hasn’t achieved, it’s had no support for the last seven years. Republicans need to understand: The things they did not only to not support the law but also to take actions that caused several million people not to get Medicaid — whether it was because those people lived in states where the government chose not to expand the program or because politicians took money out of the rate-­stabilization funds, which were intended to keep rates low — are things that could’ve played out very, very differently. We have to understand: We may not love every law we have on the books, but it’s still our patriotic obligation to support it if the American people have their lives at stake.

In a recent interview with The New York Times, President Trump alluded to young Americans having to pay $12 a year for insurance. Do you think he understands the difference between health insurance and life insurance? I doubt he is incapable of understanding these issues, but he has not persuaded the country that he’s approaching this with the seriousness required to get the right solutions. And that’s a shame.

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