(2013-11-02) Healthcaregov Dragged By Political Games

In May 2010, two months after the Affordable Care Act (ObamaCare) squeaked through Congress, President Obama’s top economic aides were getting worried. Larry Summers, director of the White House’s National Economic Council, and Peter Orszag, head of the Office of Management and Budget, had just received a pointed four-page memo from a trusted outside health adviser (David Cutler). It warned that no one in the administration was “up to the task” of overseeing the construction of an Insurance Exchange (HealthcareGov) and other intricacies of translating the 2,000-page statute into reality.

In the end, the economic team never had a chance: The president had already made up his mind, according to a White House official who spoke on the condition of anonymity in order to be candid. Obama wanted his health policy team — led by NancyAnn De­Parle, director of the White House Office of Health Reform — to be in charge of the law’s arduous implementation.

Based on interviews with more than two dozen current and former administration officials and outsiders who worked alongside them, the project was hampered by the White House’s political sensitivity to Republican hatred of the law — sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition. Inside the Department of Health and Human Services’ Centers for Medicare and Medicaid, the main agency responsible for the exchanges, there was no single administrator whose full-time job was to manage the project.

According to two former officials, CMS staff members struggled at “multiple meetings” during the spring of 2011 to persuade White House officials for permission to publish diagrams known as “concepts of operation,” which they believed were necessary to show states what a federal exchange would look like. The two officials said the White House was reluctant because the diagrams were complex, and they feared that the Republicans might reprise a tactic from the 1990s of then-Sen. Bob Dole (R-Kan.), who mockingly brandished intricate charts created by a task force led by first lady Hillary Clinton.

That spring, CMS had begun writing specifications for the IT contracts to build the federal exchange, but the White House again insisted on caution. A larger number of states than expected were signaling that, under Republican pressure, they would refuse to build their own online insurance marketplaces and would rely on the federal one. The more states in the federal exchange, the more complex the task of building it.

After the contract was awarded to CGI Federal, the administration kept giving states more and more time to decide whether to build their own exchanges; White House officials hoped that more would become willing after the 2012 election. So the technical work was held up.

Meanwhile, the White House also slowed down important regulations that had been drafted within CMS months earlier, appearing to wait until just after Obama’s reelection.

After the election, David Cutler, the Harvard professor, renewed his warnings that the White House had not put the right people in charge. “I said, ‘You have another chance to get a team in place,’ ” he recalled.

Inside CMS, meanwhile, some staffers were aware by late 2012 that the work of building the federal exchange was lagging, according to a former HHS official — a much earlier timeline than has been previously disclosed. Some employees in the main office involved with building the exchange repeatedly warned at meetings late last year and in January that so many things were behind schedule that there would be no time for adequate “end to end” testing of how the moving parts worked together, the former HHS official said.

On Sept. 5, White House officials visited CMS for a final demonstration of HealthcareGov. Some staff members worried that it would fail right in front of the president’s aides. A few secretly rooted for it to fail so that perhaps the White House would wait to open the exchange until it was ready. Yet on that day, using a simplified demonstration application, the Web site appeared to work just fine.