Why Healthcare.gov Broke: Two Competing Story Lines

This week­end brought more than a mod­icum of clar­ity to what hap­pened behind the scenes in the run-up to the Oct. 1 launch of Healthcare.gov.

In a dev­as­tat­ing story, Amy Gold­stein and Juliet Eilperin of The Wash­ing­ton Post dis­sected how pol­i­tics trumped pol­icy when it came to the Afford­able Care Act. In two key para­graphs, they wrote:

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. Repub­li­cans also made clear they would block fund­ing, while some out­side IT com­pa­nies that were hired to build the Web site, HealthCare.gov, per­formed poorly.

These inter­wo­ven strands ulti­mately caused the exchange not to be ready by its Oct. 1 start date. It was not ready even though, on the balmy Sun­day evening of March 21, 2010, hours after the bill had been enacted, the pres­i­dent had stood on the Tru­man Bal­cony for a cham­pagne toast with his weary staff and put them on notice: They needed to get started on car­ry­ing out the law the very next morn­ing. It was not ready even though, for months begin­ning last spring, the pres­i­dent empha­sized the exchange’s cen­tral impor­tance dur­ing reg­u­lar staff meet­ings to mon­i­tor progress. No mat­ter which aspects of the sprawl­ing law had been that day’s focus, the offi­cial said, Obama invari­ably ended the meet­ing the same way: “All of that is well and good, but if the Web site doesn’t work, noth­ing else matters.”

The Post also posted online a May 2010 let­ter writ­ten by David Cut­ler, a Har­vard pro­fes­sor and health adviser to Obama’s 2008 cam­paign, to Larry Sum­mers, direc­tor of the White House’s National Eco­nomic Coun­cil. In it, Cut­ler wrote:

My gen­eral view is that the early imple­men­ta­tion efforts are far short of what it will take to imple­ment reform suc­cess­fully. For health reform to be suc­cess­ful, the rel­e­vant peo­ple need a vision about health sys­tem trans­for­ma­tion and the man­age­r­ial abil­ity to carry out that vision. The Pres­i­dent has sketched out such a vision. How­ever, I do not believe the rel­e­vant mem­bers of the Admin­is­tra­tion under­stand the President’s vision or have the capa­bil­ity to carry it out.

Another piece worth a read: “What’s Really Obstruct­ing Oba­macare? GOP Resisters,” by Michael Tomasky of Newsweek/Daily Beast. Tomasky writes that while media reports have focused on the prob­lems of Healthcare.gov, not enough atten­tion has been paid to the efforts by Repub­li­cans to obstruct the law. He wrote:

All across the coun­try, Repub­li­can gov­er­nors and insur­ance com­mis­sion­ers have actively and directly blocked efforts to make the law work. In August, the Obama admin­is­tra­tion announced that it had awarded con­tracts to 105 “nav­i­ga­tors” to help guide peo­ple through their new predica­ments and options. There were local health-care providers, com­mu­nity groups, Planned Par­ent­hood out­posts, and even busi­ness groups. Again– peo­ple and groups given the job, under an exist­ing fed­eral law, to help peo­ple under­stand that law.

What has hap­pened, pre­dictably, is that in at least 17 states where Repub­li­cans are in charge, a vari­ety of road­blocks has been thrown in front of these folks. In Indi­ana, they were required to pay fees of $175. In Florida, which under Gov­er­nor Rick Scott (who knows a thing or two about how to game the health-care sys­tem, you may recall) has been prob­a­bly the most aggres­sive state of all here, the health depart­ment ruled that local public-health offices can’t have nav­i­ga­tors on their premises (inter­est­ing, because local pub­lic health offices tend to be where unin­sured peo­ple hang out). In West Vir­ginia, Utah, Penn­syl­va­nia, and other states, grantees have said no thanks and returned the dough after statewide GOP elected offi­cials started get­ting in their faces and ask­ing lots of ques­tions about how they oper­ate and what they planned to do. Ten­nessee issued “emer­gency rules” requir­ing their employ­ees to be fin­ger­printed and undergo back­ground checks.

Amer­ica, 2013: No back­ground checks to buy assault weapons. But you damn well bet­ter not try to enroll some­one in health care.

I sus­pect in the weeks ahead, we will see more report­ing on both story lines: how the admin­is­tra­tion mis­man­aged the roll­out of the law and how Repub­li­cans have tried to ensure its fail­ure. But let’s not lose sight of con­sumers, whose lives will be directly affected by the act and what’s hap­pen­ing now.

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