Health 202: Meet the Affordable Care Act’s biggest Twitter defender

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If you could slay the GOP health-care bill with words, Andy Slavitt would have done it by now. Until four months ago, Slavitt oversaw Obamacare for Obama. Since then, he’s been carving out a niche as a top, vocal critic of Republicans and their one-sided effort to overturn big parts of the Affordable Care Act.

Slavitt was always refreshingly talkative, even during his two years as head of the Centers for Medicare and Medicaid Services, the agency that also runs most of the ACA’s biggest components. And now that he’s out from under agency shackles, Slavitt prides himself on being candid — and highly snarky, at times. His Twitter feed has become a must-read for those following the Republican effort to repeal and replace some of the ACA. Here are some choice examples:

Over the weekend, Slavitt appeared to criticize the news website Axios, for describing Pence’s health-care promises as creating “trouble” for the Senate – instead of calling them outright falsehoods:

“We’re still referring to bold-faced lies as ‘trouble,’ ” he tweeted.

A few weeks ago, Slavitt tweeted that House Speaker Paul Ryan, R-Wis., was “just saying goodbye” to young cancer patients Ryan was photographed with during a visit to a Texas children’s hospital – insinuating that Ryan’s health-care bill would lead to their fatal demise due to its Medicaid cuts:

“Just saying goodbye,” he posted.

“What I meant by that tweet is you can’t cut the program that takes care of half the children in this country and not hurt children’s hospitals,” Slavitt explained to me last week over drinks at a Capitol Hill restaurant.

“So when someone wants to get pictures taken in children’s hospitals [while] at the same time cutting a dramatic amount of resources to those hospitals, it’s not really right, and I was just trying to call that out,” he said.

Slavitt’s son told him no one would listen to him any longer once he left CMS. But Slavitt found his Twitter following grew rapidly in the days after his departure, from 17,000 to more than 70,000 today.

“I don’t know that I can understand it other than people care about health-care — they want someone to just be straight about what’s going on,” Slavitt told me.

Many ACA foes wouldn’t agree that Slavitt always gives an entirely fair assessment of efforts to replace it, but few would disagree that he’s straight about his feelings on the matter. Check out his other recent tweets:

“Most everyone in hc now thinks the Admin strategy is to hurt people to force AHCA on people.”

And:

“Sadly, purposely screwing up the lives of millions of Americans may not be the Trump Administration’s worst policy. But it gets my vote. ”

Plus:

“We spent years trying to bring health care access & dignity to people’s lives. Trump & Ryan are now investing weeks to try to take it away.”

Slavitt first came to Washington as part of a rescue team to fix Healthcare.gov back in 2013 while it was floundering in the first enrollment season. President Barack Obama appointed him to lead CMS in March 2015 — he served until Trump was installed in January. Now, Slavitt is juggling several roles, advising the Bipartisan Policy Center and traveling around the country to speak out against the GOP efforts to dismantle the law he fought to improve.

He chatted recently with The Post (until Rep. Joe Kennedy, D-Mass., interrupted us) about his growing Twitter presence, what he’d like to change about the ACA and what frustrates him the most about how thing are going under President Donald Trump:

The Health 202: There’s been some pretty bad news about rate hikes and insurer exits from the ACA marketplace for next year. Does that discourage you?

Slavitt: What’s discouraging is it’s a far easier year to keep insurers in the market than it was last year.

We would have killed [last year] for the circumstances we have this year: the insurers are making money, they’re solid. So watching the administration basically cause the markets to self-destruct by not paying [cost-sharing reductions], by saying they’re not going to enforce the individual mandate. . .I sit here and go ‘if we were still here we would be having a very good year.'”

Slavitt: He’s got to commit to paying them for 2018. I guarantee you in 30 days if he said he was paying cost-sharing reductions, he’d have full markets. And if he then said he was going to enforce the individual mandate, you’d see rate increase that are in the mid-single digits.

Q: How much better would the marketplaces be had Hillary Clinton won instead of Trump?

Slavitt: I think there are probably five states that have real challenges, like the risk pools are too small — like Alaska, like Minnesota. These are mostly states that had real competitive problems before the ACA. They didn’t get fixed with the ACA and they require some surgical solutions.

The majority of the rest of the states, I think, are competitive, so I think this would have been a transitional year, but it would have been a very successful year. That’s not to say there wouldn’t have been problems with the ACA — I’m not saying that — but the insurers, they just can’t expand in this environment.

Q: What do you think of Seema Verma, your successor picked by Trump to lead CMS?

Slavitt: So you’re going to uncharacteristically find me restraining myself from being critical. I think there’s a lot of policy things that we clearly aren’t going to see eye-to-eye on, but I really hope she does that job the way I did, which is feeling the weight of 130 million Americans — delivering their care and their services.

Q: So was there mass panic inside CMS last year when insurers were proposing double-digit rate hikes and some GOP criticisms of Obamacare appeared to be coming true?

Slavitt: In the sane world you would take that fact and you would adjust, you’d say the risk pool is a little sicker and you’d increase subsidies. Unfortunately, there was no chance of any cooperation from Congress. That was just the reality we lived in. It didn’t have to be this bad, but prices did need to adjust and that was just something that needed to happen.

Q: If you could change one thing about the ACA, what would it be?

Slavitt:Subsidies for higher-income people.

Q: Was it hard to implement the ACA amid all the partisanship?

Slavitt: Let me give you an example. If there was a problem with Medicare, I could pick up the phone and I could call a Republican committee chair and talk to them about an issue. Even if we didn’t see eye to eye on the solution, I knew for sure I was talking to someone who was as committed to the Medicare program as I was.

Whereas if it was the marketplace. . .someone had a pizza party for their staff who was an enroller and we got a congressional letter. This was a role where we had I think I had 170 audits from the [Government Accountability Office] or [Office of Inspector General] at any one time on the marketplace. It was insanity. It was insanity.

Q: So tell me, do you think Republicans will actually pass an Obamacare overhaul?

Slavitt:I think you always have to give the odds to the majority. I think we now are in an environment where people just want a victory and don’t care that much about the content and will stampeded anyone who gets in the way of overturning the ACA. I think Trump has put the equivalent of a gun to the head of the American public by the steps he’s taken to blow up the ACA.

Q: What do you see as your role in all this?

Slavitt:As someone who believes in bipartisanship, I also believe you have to kill rancid, acidic, horrid partisanship when it exerts itself. And that’s what this bill is. People kind of say ‘Well gee, Andy, how can you call yourself bipartisan and speak out so against this bill?’ That’s because this bill and the process by which it’s being played out is one of the most partisan processes imaginable.

Here’s what I really believe. At the end of the day, if this bill passes, it will hurt a lot of people and people will wait for redress and the next administration and hope for a new administration, and back and forth we’ll go.As long as one party holds full responsibility, good and bad, for what happens to the health-care system and the other party gets to point the finger and says anything wrong I get free rein to criticize, we’re not going to be able to do anything to induce advancement.”

Q: How else are you speaking out against repeal-and-replace efforts?

A:I’ve been going to all these town halls where I basically challenge representatives who won’t hold a town hall. We’ve talked to over 32,000 people now, so it’s like an extension of Twitter. Obviously people are very engaged in these town halls — they feel threatened about what’s going on in health care and they can relate to it.

Q: Speaking of Twitter, like you’re having a lot of fun with social media these days.

A: It started when I was [at CMS]. I was way out there relative to the administration on Twitter. . .I felt like CMS was really opaque and very hard to understand and such an important partner for everyone in health care.

Q: So your approach is to be more open and less guarded online?

A: I believe all of our problems in health care are everyone’s fault — it’s one of my core beliefs. And I think one of the things people in health care are so good at doing is explaining in really clear terms why things aren’t their fault. When you’re CMS administrator, they come in and tell you all the reasons why everyone is wrong but we’re entitled to your money. You can only listen to that for so long, so what I started to do is. . .I basically tried to be very clear when CMS was at fault or when we could have done something better.

I made a comment in January of 2016 that I think we’ve ‘lost the hearts and minds of physicians.’ That was quoted thousands of times and I was like why is that a big deal — it’s true. There were probably people inside the administration who weren’t all that happy about all of that, but I think I got credit for trying to be open and transparent.

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