Health and Human Services Secretary Kathleen Sebelius will testify before the House Committee on Energy and Commerce on Wednesday as the administration continues to defend its rocky rollout of HealthCare.gov. Below are five key questions Sebelius must answer about why President Obama’s top domestic policy accomplishment went so wrong:
1. How could this happen?
In her prepared opening remarks, Sebelius will admit that “The initial consumer experience of HealthCare.gov has not lived up to the expectations of the American people and is not acceptable.” She’ll attribute the early website failures to “a subset” of contractors and “the initial wave of interest.” Indeed, the reason behind the failure appears to be multifaceted: a complicated federal procurement process prevented HHS from hiring the very best technology companies, poor oversight and coordination of all 55 contractors working on the website, missed or delayed deadlines, bureaucratic disarray, last minute policy decisions, and not enough time for testing the entire website “end-to-end.”
2. Did the president violate his promise? If you like the coverage you have, can you keep it?
Sebelius will stress that 85 percent of Americans “already have health coverage through an employer-based plan, or health benefit, such as Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP),” suggesting that those individuals will be able to keep their coverage. However, some subset of the 14 million Americans who buy their insurance on the individual health care market are receiving cancellation notices from their insurers, informing them that their policies don’t meet the new minimum benefit standards established by the law. While about half will qualify for tax credits and purchase more comprehensive coverage at lower cost, many will have to pay higher premiums for a better product. President Obama did not mention these changes when he was lobbying Congress to enact reform.
3. Did the administration know that the site wouldn’t be ready for an Oct. 1 launch date?
Previous testimony has revealed that at least one of the primary contractors responsible for HealthCare.gov informed the administration two weeks before Oct. 1 that the website had crashed in testing of small traffic numbers. Three weeks prior to launch, a report from contractor CGI informed officials that “there is not enough time built in to allow for adequate performance testing.” On Tuesday, Center for Medicare & Medicaid Services head Marilyn Tavenner said that the administration did not anticipate widespread problems and only expected “the customary glitches that you see, but no, not this.” She told a House Committee that given the short turnaround time, officials did decide to delay some aspects of the rollout, including the Spanish-language website and the online SHOP exchanges for small businesses.
4. Did you delay key decisions and regulations until after the 2012 elections and did that contribute to the problems?
The Wall Street Journal has reported that the administration stalled “key regulations” for months “while the Supreme Court weighed the constitutionality of the law and the president campaigned for re-election in the 2012 contest.” “In one case, a rule governing the design of plans to be sold on the exchange was completed and signed by Ms. Tavenner, the CMS administrator, on May 15, 2012, approved by Ms. Sebelius that Aug. 6 but not released publicly until Nov. 26, three weeks after the election, regulatory records show.”
5. What if the website problems aren’t fixed by the end of November?
Since the rocky launch of the website, the administration has brought in “the best and brightest” technicians from inside and outside of government to diagnose and fix the problems. That “tech surge” determined that the website is indeed fixable and will be up and running by the end of November. Given that timeline, uninsured Americans will have just weeks to enroll in coverage by Dec. 15 for insurance that begins on Jan. 1. While the administration has already fixed a small glitch in the enrollment period — ensuring that Americans who sign up for insurance during the last day of open enrollment (March 31) aren’t subject to the individual mandate penalty — lawmakers on both sides of the aisle are advocating for the extension of enrollment or delay of the individual mandate. The Congressional Budget Office has estimated that postponing the requirement would cause less people to purchase insurance and increase premiums. The change would boost the number of uninsured by 11 million people in 2014 and attract sicker beneficiaries into the law’s exchanges.
While the administration predicts that 7 million uninsured Americans will sign up for coverage in the exchanges by the end of the year, on Tuesday Tavenner told a House committee that the administration expects low enrollment numbers when it releases initial figures next month.