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1:14 am
Tue October 22, 2013

How Politics Set The Stage For The Obamacare Website Meltdown

Originally published on Wed October 23, 2013 10:23 am

Since the Affordable Care Act's health care exchanges launched to a long series of error messages Oct. 1, most of the "what went wrong" fingers have been pointing at software developers.

But some say there's more to it than that — that politics has played a role as well.

"It is a mess and there's no sugarcoating it, and people shouldn't sugarcoat that," says Jay Angoff, who formerly ran the health exchange program for the Department of Health and Human Services. "On the other hand, people should remember that those who are in charge of the money HHS needs to implement the federal exchange are dedicated to the destruction of the federal exchange, and the destruction of the Affordable Care Act."

Which led to the first big problem — money. When it became clear that HHS would need more money to build the federal exchange than had been allocated in the original law, Republicans in Congress refused to provide it.

As a result, says Angoff, officials "had to scrape together money from various offices within HHS to build the federal exchange."

Then there was the timing issue. Technically, department officials have had 3 1/2 years since the law passed. But much of that time was spent in limbo. First there was waiting to see if the Supreme Court would overturn the law in the summer of 2012. (It didn't.) Then there was waiting to see if Mitt Romney and a Republican Senate would be elected that November to repeal it. (They weren't.)

Then it was another month waiting for states to decide if they wanted to build their own health exchanges or let the federal government do it for them.

"The administration bent over backward to accommodate the states; the administration begged states to cooperate," Angoff says.

And in the end, the administration made a major miscalculation. Officials figured that even Republican states would both create their own exchanges and expand their Medicaid programs because both came with so much federal money attached.

"The thought was that ultimately money trumps everything," says Angoff. "And that no matter what the rhetoric was of some of the elected officials against the Affordable Care Act, ultimately they would take the money. And I think what surprised most people was that in this case, money didn't trump everything."

So what now? Even some of the administration's strongest backers think it needs to change course. Ezekiel Emanuel, brother of former Obama chief of staff Rahm Emanuel and himself an architect of the health law, took the administration to task on Monday for not being more forthcoming about the website's problems and how it's fixing them.

"I think they need to have daily briefings, and they need to give us milestones over the next four weeks as to what we should look for improvement," he said Monday on MSNBC. "Reassurance verbally is not worth much at this point, and we need to see weekly what's improved; but we need a daily briefing."

So far, though, that's not happening. And no timetables are being given for any final fix.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

This is MORNING EDITION, from NPR News. Good morning. I'm David Greene.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep.

It's fair to say that no presidential speech has gone exactly like the one President Obama delivered yesterday in the White House Rose Garden. The president defended the Affordable Care Act.

GREENE: He talked about health care with people standing behind him, and turned at one point to help a woman who fainted. Obama insisted the private insurance plans available through the new law are a good deal, even if people are having trouble signing up. He urged people to phone if they couldn't use a website, which he acknowledged is frustrating many customers.

(SOUNDBITE OF SPEECH)

PRESIDENT BARACK OBAMA: Nobody is madder than me about the fact that the website isn't working as well as it should, which means it's going to get fixed.

INSKEEP: The government's technological problems have drawn sharp criticism, as we'll hear in a moment. The new law also faces political problems, as NPR's Julie Rovner reports.

JULIE ROVNER, BYLINE: Just 10 days before the exchanges opened, it fell to a high-level bureaucrat from the Department of Health and Human Services named Gary Cohen to assure the House Energy and Commerce Committee that, yes, the websites were ready to launch.

GARY COHEN: We may encounter some bumps when open enrollment begins, but we'll solve them, because it's what we do. We're here to help people get health insurance, and we at CMS take this responsibility very seriously.

ROVNER: CMS being the Center for Medicare and Medicaid Services, where Cohen is head of the office overseeing the health exchanges. Officials had been warning for months that, as Cohen said, things might be a little rocky at the start. But no one expected the major meltdown that occurred October 1st, when the website went live.

Republicans, have been in full I-told-you-so mode ever since. Here's Senate Minority Leader Mitch McConnell on CBS' "Face the Nation" on Sunday.

(SOUNDBITE OF TV SHOW, "FACE THE NATION")

SENATOR MITCH MCCONNELL: They've had three or four years here to get this ready. God only knows how much money they've spent. And it's a failure. You know, the government simply isn't going to be able to get this job done correctly.

ROVNER: But while many of the what-went-wrong fingers have been pointing at software developers, some say there's more to it than that. Jay Angoff is a lawyer in Washington, D.C. who used to run the health exchange program for the administration.

JAY ANGOFF: It is a mess, and there's no sugarcoating that. People shouldn't sugarcoat that. On the other hand, people should remember that those who are in charge of the money HHS needs to implement the federal exchange are dedicated to the destruction of the federal exchange and the destruction of the Affordable Care Act.

ROVNER: Which led to the first big problem: money. When it became clear that HHS would need more money to build the federal exchange than had been allocated in the original law, Republicans in Congress refused to provide it. As a result, said Angoff...

ANGOFF: HHS had to scrape together money from various offices within HHS to build a federal exchange.

ROVNER: Then there was the timing issue. Technically, department officials have had three-and-a-half years since the law passed. But much of that time was spent in limbo. First, there was waiting to see if the Supreme Court would overturn the law in the summer of 2012.

Then there was waiting to see if Mitt Romney and a Republican Senate would be elected that November to repeal it. Then it was another month waiting for states to decide if they wanted to build their own health exchanges or let the federal government do it for them.

ANGOFF: The administration bent over backwards to accommodate the states. The administration begged states to cooperate.

ROVNER: And in the end, they made a major miscalculation. They figured that even Republican states would both create their own exchanges and expand their Medicaid programs because both came with so much federal money attached.

ANGOFF: And that no matter what the rhetoric of some of the elected officials was against the Affordable Care Act, ultimately, they would take the money. And what I think surprised most people is, in this case, money didn't trump everything.

ROVNER: A big mistake. So what now? Even some of the administration's strongest backers think it needs to change course. On MSNBC, Zeke Emanuel, brother of former Obama Chief of Staff Rahm Emanuel and himself an architect of the health law, took the administration to task for not being more forthcoming about the website's problems and how it's fixing them.

ZEKE EMANUEL: I think they need to have daily briefings, and they need to give us milestones over the next four weeks as to what we should look for for improvement. Reassurance verbally is not worth much at this point, and we need to see weekly what's improved, but we need a daily briefing.

ROVNER: So far, though, that's not happening, and no timetables are being given for any final fix.

Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.