As the senior vice president, general counsel, and secretary of Health Net, Angelee Bouchard is helping the health insurer—which provides health benefits to approximately 5.8 million individuals across the United States—navigate the changes and impact of the Affordable Care Act (ACA). She discusses the challenges of the transition, and how, in the face of them, Health Net developed an enterprise-wide, systematic approach to ensure that health-care reform was executed in a timely, organized, and efficient manner.
When did you first get wind of the Affordable Care Act? How did you begin preparing?
Angelee Bouchard: Health Net has always advocated for a reduction in the number of uninsured individuals in the United States, making health care more affordable, and improving quality of care accessible to patients. And health-care reform to that end in general was discussed for years before the enactment of the ACA. In California, where we’re based, there had been robust decisions about health-care reform at the state level as early as 2007. When all the House and Senate debates were taking place in 2009 and early 2010, we were in a state of flux. It was impossible to prepare specifically from a legal perspective, because the versions of the law being debated were so diverse we didn’t know what form it would eventually take. We had to understand the federal mandates being debated as well as how the states in which we do business could interpret those mandates. So in terms of preparation, we just stayed apprised of the debate. It wasn’t until the law was passed, that we, and the industry as a whole, had something to prepare for.
What first steps did you take after the enactment of the law?
Bouchard: Several provisions of the act came into effect immediately, such as the prohibition of lifetime limits on essential health benefits, mandatory coverage of preventative services for children, and requirement that health insurance be made available to any dependent child up to the age of twenty-six. So in March of 2010, we had to quickly put into place all things necessary to deal with those mandates. We also had to just read the actual law and try to understand the general framework.
What have been the challenges?
Bouchard: Our mandate was always to be in full compliance with the ACA, and when you think about the magnitude of law, the political debates that took place following its passage, and the way it fundamentally changed the way we do business, you realize what a monumental task we faced. We spent four years working on implementation. During that time, lawsuits were filed challenging the constitutionality of the law. There were different decisions in different courts around the country before the law made its way to the US Supreme Court. When the Supreme Court ultimately upheld the key provisions of the law, it eliminated an enormous amount of uncertainty around what was and was not going to be changing in the rule-making process. That enabled our team to have more clarity about the tasks to complete to prepare for final implementation.
What was your strategy?
Bouchard: If you’re a company facing something like this—a fundamental change to the way you do business that is mandated by law—you have to stay laser focused on what is required in complying with the law. You have to ignore public perception and political debates, and ensure that the business is guided to be compliant. You also have to be flexible, and able to pivot as necessary. That’s difficult for lawyers sometimes.
How do you manage a staff through such a challenging time?
Bouchard: I’m so blessed to have a seasoned team of lawyers working for me. Many of them have more than twenty years of experience, not just in the industry but at Health Net. All of my staff, but in particular the regulatory lawyers, had to understand what the law said, interpret it, and advise the business on all the fundamental changes that needed to be made to the way the business had historically been run. They relied heavily on outside counsel and our internal public policy and government-relations team.
My litigation team was key in helping both our legal department and business leaders identify and assess legal risk emanating from the implementation of the law, as well as responding to numerous inquiries by various congressional committees in both the House and Senate prior to and subsequent to the passage of the law. My enterprise risk-management team worked with senior management and our board of directors to identify, assess, mitigate, and monitor ACA-related implementation and execution risks. Even the corporate lawyers were involved. Because we’re a public company, we have disclosure obligations to our shareholders, and the corporate lawyers spent an enormous amount of time collaborating with our regulatory lawyers and outside counsel to understand what the law required and what risks our company faced following passage of the law and post-implementation.
What takeaways do you have from this experience?
Bouchard: At the end of the day, in-house lawyers are professional service providers. We have to understand our clients’ needs and provide legal advice that best helps the business achieve its goals while complying with law.
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