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New Medicare No. 2 Official May Help Dismantle Obamacare

Aug. 21, 2018, 11:09 AM

A new high-ranking member of the Trump administration’s health-care team brings expertise in the health field as well as a stated opposition to the Obamacare law he’ll be responsible for implementing.

Paul Mango is the new No. 2 official at the Centers for Medicare & Medicaid Services, which is responsible for Medicare, Medicaid, and the Affordable Care Act. He was named the chief of staff and chief principal deputy administrator to CMS Administrator Seema Verma July 24, after working as a senior partner in health-care policy at consulting firm McKinsey & Co. for more than two decades and losing a bid for the Republican nomination for governor in Pennsylvania in 2018.

Mango’s appointment adds another industry veteran to the table to help implement health-care policy for President Donald Trump, joining Health and Human Services Secretary Alex Azar, Verma, and Adam Boehler, director of the agency’s Center for Medicare and Medicaid Innovation.

Mango did not respond to multiple requests for comment, but Bloomberg Law spoke with his former colleagues and campaign staff to get a picture of Mango’s health-care experience and views.

“I have known Paul for more than 10 years and look forward to having his support as we deliver on President Trump’s agenda and execute on our strategy on behalf of the American people,” Verma said in a statement July 24.

The Centers for Medicare & Medicaid Services would be “hard-pressed to find somebody in this country who is more qualified to be doing what he’s doing” than Mango, John Brabender, chief strategist and creative officer at Washington-based BrabenderCox, a political consulting and advertising firm, told Bloomberg Law Aug. 17. Brabender was the senior strategist for Mango’s gubernatorial campaign.

Anti-Obamacare and Opioids

Mango was endorsed by Sen. Tom Cotton (R-Ark.) in his gubernatorial run and lost the primary to Scott Wagner in May. Cotton was one of 13 Republican senators who drafted the American Health Care Act of 2017, a bill that attempted to repeal the ACA.

Mango was a vocal critic during the gubernatorial race of the ACA, which he called a disaster in an October 2017 op-ed. Mango wants to end the ACA and will “continue to work toward a Free-Market Healthcare system,” he said in a Facebook post in April.

Mango’s policy agenda while running for governor included a proposal to raise premiums on individuals who sign up for insurance after letting coverage lapse, although Mango opposed the ACA’s requirement to purchase health insurance or face a tax penalty, according to the Pittsburgh Post-Gazette.

Mango cared about nuanced policy plans that weren’t the same ideas as other politicians, Brabender said. Mango was more concerned with the details of plans and making sure he understood them than moving the polling numbers, Brabender said.

Mango was particularly passionate about improving health care for veterans and helping people affected by the opioid epidemic during his campaign, Brabender said.

Mango talked with families who were affected by the opioid crisis and looked at different approaches to rehabilitation instead of putting people with addictions in jail, Brabender said.

Understanding Insurers and Hospitals

Mango worked with insurance companies and hospitals at McKinsey, which helped him empathize with different health-care stakeholders, Tim Chapman, a former McKinsey colleague who is now retired, told Bloomberg Law. Mango’s encyclopedic knowledge of health-care policy also meant he could help both sides innovate to help patients.

Mango was “at his best when it came to thinking about strategy in what health systems need to do to work more effectively,” Chapman said.

Mango developed strategies for helping hospitals decide if they wanted to acquire physician practices or other hospitals and defining how to improve core processes to increase productivity, Chapman said.

Mango built the health-care reform center at McKinsey, working on accountable care organizations, among other reform efforts, Chapman said. Mango was focused on impact for patients and providers and his “proclivity to act was based on fact.”

Mango and Chapman suggested that a large client hire someone from General Motors to run their supply chain. This was before hiring people into health care from other industries was common, but Chapman said Mango knew the experience that person had would improve the client’s supply chain.

Strong Work Ethic

Mango graduated from the U.S. Military Academy at West Point and Harvard Business School, which Chapman and David Urban, president at Washington-based American Continental Group Inc.---a government affairs and consulting firm---cited as making Mango an effective leader. Mango is also a veteran of the 82nd Airborne Division and a graduate of U.S. Army Ranger School.

Mango was the hardest worker on his gubernatorial campaign, Urban told Bloomberg Law. Urban was a senior political adviser on Mango’s campaign and a senior adviser on Trump’s campaign.

Mango “wasn’t afraid to listen” to differing viewpoints and spent a lot of time on his campaign talking with seniors and working families, Brabender said.

To contact the reporter on this story: Shira Stein in Washington at

To contact the editor responsible for this story: Brian Broderick at