Inside the Beltway: Federal Policy and the Nonprofit Sector with M. Todd Tuten

UT alum and senior policy analyst at the law/lobbying firm of Patton Boggs in Washington, DC, M. Todd Tuten was at the LBJ School, October 21, 2013, to speak on federal spending and the Affordable Care Act (ACA). 

Tuten opened the talk with an outline of the federal budget agreement process, summarizing the events that led to the recent government shutdown with a look ahead to 2014. While it is a tough political environment to accomplish anything right now, he said, health care spending is a significant percentage of the national GDP, and recent trends are unsustainable if something is not done. 

In this context, despite the headlines and early technical challenges, implementation of the ACA is moving forward, Tuten said, but will take time. Exacerbating the partisan gridlock on the issue, the timeline for implementation was accelerated for political reasons, and the opportunities for problem-solving were compressed. As a result, in addition to the much-publicized technical problems with the federal exchanges and enrollment websites, some major provisions of the law have been delayed, and in some cases, shelved. 

Tuten focused a portion of the discussion on the implications of state-level opposition to expansion of Medicaid and the complexities of eligibility for Medicaid or subsidies for coverage. Arkansas has found a way to move forward, and the federal government has given it the go-ahead. Some others states are also looking for options to address opposition and expansion concerns. He said that analysis indicates that the states will ultimately benefit financially from participation in the ACA, but the discussion has largely defaulted to politics. Some early adopters of reforms and technologies such as Washington state and California have been successful operating state exchanges, but, at present, 36 states are relying on the federal government exchanges. 

The ACA is a work in progress, Tuten said, and myriad factors, such as if the markets don’t perform as predicted, or reactions when the small business provisions take effect, make it too early to forecast the ultimate success or failure of the law. However, he said, like other major successful social legislation of the past, there will be opposition at first, and implementation will be incremental. Asked to provide a long-term outlook, Tuten said that, barring major premium spikes or lawsuits that “gut” the legislation, the ACA in large part will likely survive, and he doesn’t see a viable option to replace it. Getting the public on board is key, he said, and nonprofits are critical as a partner in this public/private effort.

Todd Tuten’s extensive congressional and private-sector experience includes development and implementation of substantive policies and strategies on a broad range of legislative and regulatory matters, with a particular focus on health care. Mr. Tuten is actively engaged in the debate on proposals to strengthen Medicare, Medicaid, and the nation’s health care system. He works closely with congressional leaders, senior agency officials, and key advocates to advance clients’ objectives in the context of related legislation, including passage and implementation of the Affordable Care Act.