Clearance

clearance, n

1. The action or process of removing or getting rid of something
2. Official authorization for something to proceed or take place.
3. Clear space allowed for a thing to move past or under another.

You probably think of clearance the way i used to, when I was told to turn off my personal device, or when I was installing some bookshelves. Or when a bookstore files for Capter 11.

Clearance has taken on much more importance for me since I joined the executive branch. It's the process for getting approval to release something in writing to the public: it could be a regulation, to be published in the Federal Register, explaining what we think Congress meant and how we're going to implement it, some sub-regulatory guidance explaining what we meant by the regulation, or it could be just a letter.

Clearance involves some list of people being given some amount of time to make comments on whatever I and my team have written. Some of the people on the list are up the chain of command, so that makes perfect sense. And the lawyers in the General Counsel's Office. And if it's a regulation, the Office of Management and Budget, part of the White House, that must approve all regulations.

Some of these reviewers are other people in the agency, some may be in other agencies. Many of them I've never heard of, and they've never heard of me; some likely know little to anything about the subject the're reviewing.

It's easy to chalk this up just to bureaucracy, and it's also easy to chafe at the delay it causes. But I have come to appreciate the fact that something I do might have an unexpected impact on something that others in the Federal government are doing, and that of course I know nothing about. So we understand why the process is needed. And when we can, we plan our work with a timeline that takes account of the additional time that will be needed. And the system works pretty well. Which doesn't mean we can't grumble a bit now and then.

Traveling south

With apologies to Tony Hurwitz and Sarah Vowell . . .

We went down to Fredericksburg on Saturday. There's some colonial history, George Washington's mother was born there, and his boyhood home, Ferry Farm, is nearby. And beautiful homes, some ante, most postbellum. Apart from some cute shops, for tourists its' mostly The War Between the States.

We had Zorro with us, and folks down there sure love dogs, so we got lots of smiles and he was much admired and petted. One gentleman came over and ended up with Zorro licking his whole face (as he will do, if you let him), after he left Liz said that at first she thought he was speaking another language, but no, it was just the combination of a drawl and maybe a few less than a full complement of teeth. Nice fella.

So we walked around the town, did some window shopping and spent just enough time retracing the battles of Fredericksburg (December 1862, Confederate victory, due mainly to bureaucratic hangups that delayed the arrival of pontoon bridges needed to cross the Rappahannock--I guess the federal government hasn't changed all that much) and Chancellorsville (May 1863, Confederate victory, due mainly to "Fighting Joe" Hooker's failure to live up to his nickname; known best as the battle in which Stonewall Jackson fell to friendly fire). We left the battles of the Wilderness and Spotsylvania Courthouse (Grant v. Lee in 1864, bloody but inconclusive) for another day. The National Park Service does a good job of helping you to imagine what it must have been like to fight over that ground, where so many gave their last true measure of devotion or were maimed for live. There's a genuine Confederate uniform with the leg cut off due to the amputation the man who wore it endured.

All very interesting and noble, but I can't help but wonder why one of the main roads is called the Jefferson Davis Highway, and why the Park Service memorializes Lee and Jackson, both of whom went to West Point, wore the uniform of the United States and fought for their country before raising arms against it. The guy who leaked information to Wikileaks is called a traitor, some are calling for him to be executed, and he will undoubtedly spend some years in prison. Somehow I don't think they'll be naming state highways after him. So why do we have statues honoring Confederate generals? Why wasn't Lee taken out and shot as a traitor?

Liz says that this reconciliation is part of what preserved the Union and is a testament to America's strength. But didn't it also help preserve a Jim Crow way of life that persisted into the 1960s? Maybe a little more shock and awe after the Civil War was over would have been a good thing. Of course I know my history, Lincoln was assassinated, Andrew Johnson became President and radical reconstruction came to an end. But that still doesn't explain why we continue to glorify a society that was built on the idea that one person can own another. I'm not sure why my tax dollars are going to honor those who fought to continue that barbarism and cruelty.

My wife Liz has the most wonderful laugh. When something strikes her as really funny -- and you never can be quite sure why or when that will be -- she loses control completely. Her eyes close, she whoops, she screams, she roars. One of my favorite things is to render her helpless in that way.

She has recently taken laughter to another level, as a certified laughter yoga leader. Check out laughteryoga.org, it's good for you.

New Title, New Duties, redux

I posted here a week ago about my new position as Acting Director, Oversight, in the Center for Consumer Information and Insurance Oversight (CCIIO) within the Center for Medicare and Medicaid Servics (CMS). I took the post down because I heard some mindless chatter that some folks out there--you know who you are, I don't--thought I'd jumped the gun because they hadnt seen a press release from CMS announcing my appointment. As if. For the record, there has been and there will be no press release about this--I am not all that (yet, anyway). And of course I had approval from the right people to share the news, as it was official and all the people who needed to know had been informed. 'Nuff said.

I've been in the job just short of two weeks and things are going just great. There's a lt going on and quite a few plates to keep spinning on those long sticks, but I wouldn't have it any other way. This is what I came to Washington to do; I'm happy and grateful that I'm having the chance to do it.

If you go to our new website, cciio.cms.gov/cciio, you can see lots of info about what we do. One day we may have an organization chart on there, but for now I can tell you that there are four Offices below the level of Center Director. The website describes our duties this way:

The Office of Oversight
This office will implement, monitor compliance with, and enforce the new rules governing the insurance market and the new rules regarding medical loss ratios. It will also be responsible for rate review at the federal level, and for providing rate review grants to states.

So that's what we're going to do.

More reorganization

My boss Steve Larsen, head of the Office of Oversight in OCIIO, announced this week that we are combining two divisions to create a Division of Compliance and Enforcement. You may already be wondering why in the world you should care about this piece of Tricia, and there is no particular reason other than the fact that I am the head of the Division, and now have about half of the staff in the Office of Oversight reporting up to me. So to the extent one measures success in a bureaucratic organization by an increase in span of control, this would be an indication of success.

There will be lots of changes in the days to come, which I will try to keep my faithful readers up to date on, to the extent I can speak publicly.

Beginning of a New Year of Change

I can make no comment on the accuracy of the story I have provided a link to on the right, although I will say that it is odd to assert that Secretary of Health and Human Services Kathleen Sebelius has relinquished control over the office responsible for implementing health care reform by moving it into the Center for Medicare and Medicaid Services (CMS), since CMS is part of the Department of Health and Human Services.

I will also say that I can now state without any fear of contradiction that I am a federal bureaucrat.

End of a year of change

This has been a year of change, in many unexpected ways. For me, it meant a move to DC, first to work for Congressman Garamendi as his Chief of Staff, and then in the Office of Oversight in OCIIO at HHS. By now you know that Dave has decided to keep Adam on as GC. I hadn't wanted to say anything until he made the announcement.  I'm disappointed, but I've also got plenty more to do at my job in DC.  

All the best for a happy and healthy New Year.  That job has brought some unexpected changes as well; I never imagined that I would be managing the teams responsible for drafting two sets of regulations implementing major parts of health care reform; one on how the requirement that health plans spend 80 or 85% of premium dollars on clinical care or activities that improve health care quality, the other establishing a process for review of "unreasonable" increases in health care premiums.

The process was long and exhausting, including working late into the night. I think that any reasonably objective view would be that we did an excellent job of staying true to the language of the statute (sometimes rather opaque), giving deference to the States as much as possible, while providing a federal "floor" that will protect consumers.

Next year will bring it's challenges, as the political environmental will be, shall we say, less friendly to our efforts. We will persevere.

Happy New Year to you all, I hope that 2011 brings you all the happiness that life can offer.