And to back-up his claim that the GOP “sabotaged” the rollout of Healthcare.gov, Capehart cites these two examples from the Washington Post’s piece on Sunday hammering the administration on the Obamacare rollout. Capehart writes:
But there were two tidbits in the 2,800-word piece that were previously known but still served to enrage me, especially now that we see how well the GOP’s premeditated campaign to try to kill Healthcare.gov is working.
Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange — and Republicans would block any funding attempts. According to one former administration official, [Health and Human Services Secretary Kathleen] Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.
So, the federal exchange that Republicans said wouldn’t work ended up not working because it was starved of the money needed to help make it work.
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. Yet, according to several former officials, White House staff would not let this fact be included in the specifications. Their concern, one former official said, was that Republicans would seize on it as evidence of a feared federal takeover of the health-care system.
So, the federal exchange that Republicans said wouldn’t work ended up not working because the GOP pressured Republican governors to not form their own state exchanges. This made the federal task more complex and difficult, thus ensuring its failure.
Of course, foot dragging by a ’fraidy cat White House aided the failure. But after reading The Post story on the debacle that is the Obamacare debut, what the GOP gleefully calls a train wreck was a self-fulfilling prophesy courtesy of Republican sabotage.
But Capehart isn’t giving the whole story. Here’s the full excerpt from his first “tidbit”:
The White House was in charge, but the on-the-ground work of carrying out the law fell largely to HHS. At first, a new unit responsible for building the statute’s insurance marketplaces was created inside the office of Secretary Kathleen Sebelius.
Soon, however, it became evident that the office — with more than 200 people — would not survive on its own. It lacked tools, such as the ability to award grants and outside contracts, that were vital to its mission, said Richard Foster, Medicare’s chief actuary for nearly two decades before he retired early this year. So the office, with a slightly new name, moved in early 2011 into the Centers for Medicare and Medicaid Services (CMS), a large agency spread among locations in the District, Bethesda and Baltimore.
The move had a political rationale, as well. Tucked within a large bureaucracy, some administration officials believed, the new Center for Consumer Information and Insurance Oversight would be better insulated from the efforts of House Republicans, who were looking for ways to undermine the law. But the most basic reason was financial: Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange — and Republicans would block any funding attempts. According to one former administration official, Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.
Bureaucratic as this move may sound, it was fateful, according to current and former administration officials. It meant that the work of designing the federal health exchange — and of helping states that wanted to build their own — became fragmented. Technical staff, for instance, were separated from those assigned to write the necessary policies and regulations. The Medicaid center’s chief operating officer, a longtime career staffer named Michelle Snyder, nominally oversaw the various pieces, but, as one former administration official put it: “Implementing the exchange was one of 39 things she did. There wasn’t a person who said, ‘My job is the seamless implementation of the Affordable Care Act.’ ”
In the West Wing, the president put his trust in DeParle, who joined the White House two months after Obama took office in 2009 and had overseen the health-care legislation from its infancy. Earlier in her career, she had been a health-care administrator under President Bill Clinton and worked on the issue at the Office of Management and Budget.
Well-versed as she was, DeParle immediately recognized that she needed help, according to a former senior administration official. She tried — but failed — to lure to the White House one of the nation’s top experts, Jon Kingsdale, who had overseen the building of a similar insurance exchange in Massachusetts.
DeParle convened meetings twice a week in the Old Executive Office Building, bringing together representatives of agencies as far-flung as the Internal Revenue Service, the Centers for Disease Control and Prevention and OMB’s regulatory office — all of which had a role in putting the law into practice. They pored over spreadsheets and hashed out difficult policy questions. The work was “highly specific,” recalled Donald Berwick, who was CMS’s administrator through 2011 and now is a Democratic gubernatorial candidate in Massachusetts. “There was an implementation chart. Regulation by regulation, we would say, where is it now, who was developing it?”
A higher-level monthly meeting, intended to work through tough regulatory questions, was attended at first by Sebelius, Treasury Secretary Timothy Geithner, Chief of Staff Rahm Emanuel and Domestic Policy Council Director Melody Barnes. By late summer and early fall of 2010, the meetings petered out after some of the participants stopped attending, according to a former senior administration official.
At the White House and inside CMS, the initial focus was not on building the online marketplace but rather on rules to let young adults stay on their parents’ insurance policies and new insurance pools for Americans who were being rejected by insurance companies because they were ill.
The exchange “was in the future,” Berwick said, explaining that the Web site was, during his tenure, a matter of “conceptualization,” along with “the many other regulations we were batting out.”
With the new structure, contrary to Capehart’s claim, Sebelius had the funds she needed. But as the Post so clearly pointed out, the administration wasn’t even worrying about building the exchange yet. And if Capehart thinks the GOP has been starving HHS of funds, who is paying for the IT fixes now?
The fact is Republicans haven’t been able to stop a single cent directed at Obamacare, even after closing down the federal government.
And here’s the full excerpt for the second “tidbit”:
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. Yet, according to several former officials, White House staff would not let this fact be included in the specifications. Their concern, one former official said, was that Republicans would seize on it as evidence of a feared federal takeover of the health-care system.
So that September, when the administration issued the “scope of work” for the largest IT contract, the specifications skirted the question — saying only that “CMS will not know for certain how many states will apply” to run their own insurance exchanges.
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. “The dynamic was you’d have [CMS’s leaders] going to the White House saying, ‘We’ve got to get this process going,’ ” one former official recalled. “There would be pushback from the White House.”
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. Among the most significant were standards for insurance coverage under exchanges. The rules for these “essential health benefits” were proposed just before Thanksgiving last year and did not become final until February. Another late regulation spelled out important rules for insurance premiums.
Such delays were “a singularly bad decision,” said Foster, the former Medicare chief actuary. “It’s the president’s most significant domestic policy achievement,” he said, and the very aides who had pushed the law through Congress were risking bad implementation “for a short-term political gain.”
After the election, 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.
Capehart conveniently left out the parts in this “tidbit” that slam Team Obama for dragging its feet. More importantly, Team Obama knew the number of states in the federal exchange were increasing, but they wouldn’t tell their IT contractors the truth.
This are not the actions of a ” ‘fraidy cat White House.” They are the actions of an incompetent White House.