White Coat Notes

Kingsdale on why he declined 2010 offer to help with federal health law

One of the many differences between the implementation of the 2006 Massachusetts health care law and the rollout of the Affordable Care Act was that the state created an independent agency headed by former insurance executive Jon Kingsdale to oversee the new insurance marketplace. Meanwhile, the national implementation has been managed from inside the Obama administration.

The Washington Post in a detailed narrative highlighted this decision not to appoint an outside health care czar, who could have hired staff and managed the federal health insurance exchange like a startup, as one of the main failures of the troubled rollout.

The story notes that the administration tried to hire Kingsdale to help Obama’s top health care advisors, but he wouldn’t take the job. In an interview Tuesday, I asked him why.

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“I was just finishing up at the state after four pretty intensive years of public service,” he said. “To tell you the truth, it looked like it wasn’t clear where and what I was supposed to be doing, but it was clear that I would be down under ... in the bureaucracy.”

At the Massachusetts Health Connector, “I was running something,” he said. The federal job “looked much more like a staff role, one in which it would be very intense, a lot of work, a lot of commitment, but not necessarily a lot of authority.”

Kingsdale said he had conversations with the administration in the spring and summer of 2010. That fall, he joined Wakely Consulting Group as a director in the Boston office.

In a prior interview, Kingsdale had said he had a sense that there was “a fairly deep distrust or disdain for health insurers” among some members of the Obama administration. But he said Tuesday that was not a factor in his decision at that time.

It wasn’t the right role or the right time for him, he said. Now, if the government came asking, he said, he might have a different answer.

“I think they need somebody to run something now,” he said.

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