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A Director’s Musings on the Nevada Health Exchange



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Jon Hager, the Nevada health-exchange executive director who resigned in February, wrote a strangely poetic set of notes for his keynote speech at the Nevada Health Link Summit in June. A few excerpts:

I told the board 773 days to go; when I started, I realized that I was using January 1, 2014 as the end date instead of October 1 2013 and immediately lost 90 days  and thus began a string of errors and mistakes that is Nevada Health Link

So what is Nevada Health Link? It’s a time machine.

What other job can you have where you lose 90 days in the blink of an eye?

When you come back from a week long vacation and, since you were gone, five new 100 page regulations have been published and everything you once held near and dear to you has changed?

733 days to go… Now there are only 110!

Actually, Nevada Health Link is a sleep deprivation chamber.

My son was five months old when I started – he would wake up in the middle of the night – which ended up to be a perfect time to catch up on email.

He is now 22 months old and sleeping through the night – I am not.

How many others out there have lost sleep over the Exchange?

He continues:

Nevada Health Link is a new government agency – which by the way is a government bureaucrats dream… Design the program, hire your own staff, don’t inherit any problems…

(controllers office)

Step out of your box. step away from the box

Great things about being a state agency, as opposed to a non-profit: there are already rules in place that don’t have to be created – accounting, purchasing, HR…

Rules that are required by the grant funding – we had them so that we could concentrate on more important things – like figuring out what the hell we were doing!

And then there’s this quote:

You certainly need to hire good people that know the rules – to keep you out of trouble.

But what you really need are brilliant people that know the rules to get around the rules that keep you out of trouble.

And finally, you need visionaries that are willing to change the rules when the rules just don’t make sense!

National Review Online obtained these rough speech notes from a public-records request, and we were pleasantly surprised and pleased with the Nevada health exchange’s transparency, which has been far superior to that of the Nevada Division of Insurance. But perhaps it’s gotten a bit too transparent. From Hager’s notes:

We are one of the most transparent exchanges in the country.

Nearly every one of our documents, board reports, contracts, deliverables is up on that web page.

You want to see what we wrote to the legislature it’s there

You want to read the transcripts of our board meetings, its there

You want to watch our board meeting – check out our youtube channel

You want to see me in a zebra costume with a circus Afro – see our Facebook page.

You want it, it’s there – warts and all

We did, and it’s true:

Finally, there’s this:

SB440 – state legislation that created the Exchange was enrolled two years ago today; signed by the governor 2 years ago this Sunday – what have we done what have we built?

Nothing but ones and zeros.

- Nothing to see but policy papers; deliverables; a draft web portal demo; billions of ones and zeros in the cloud

It’s a little terrifying

A terrifying roller coaster with lots of ups and lots of downs;

It’s been fantastic; fascinating; fun;

I have been told that I’m not using the correct F word.

To be fair, Hager did include many more serious matters in his speech notes. Then again, many a truth is said in jest.



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