In 2010, President Obama was facing a dilemma on the newly passed Affordable Care Act.
Many aides—including director of the White House’s National Economic Council Larry Summers and Peter Orszag, head of the Office of Management and Budget — were warned that there wasn’t anyone in the administration “up to the task” of implementing the complex, 2,000-page legislation, writes Amy Goldstein and Juliet Eilperin of the Washington Post.
Instead of appointing a “czar” to oversee health care reform, someone experienced in business, insurance and technology, Obama insisted that his health care policy team, headed by White House Office of Health Reform Nancy-Ann DeParle, be in charge of making the ACA a reality.
The administration’s inflexible approach has now become the central issue in the disastrous debut of the federal health care marketplace. The glitch-plagued rollout has observers questioning if the administration was ever capable of undertaking such a vast, multifaceted project.
Republican hatred of the law also made matters worse; there were occasions where everything slowed down or was performed in secret, in fear of giving ammunition to the opposition. The GOP controlled House would also limit funding consistently for the healthcare.gov website.
All of the various factors came to a head on the October 1 start date, even though Obama gave notice to his staff back in March 2010 to get started on carrying out the ACA law the “next day.”
The lack of the ability to provide outside contracts and grants was another significant roadblock, as well as adding the Center for Consumer Information and Insurance Oversight to the massive Centers for Medicare and Medicaid Services (CMS) agency. By incorporating it into the CMS, the group tasked with implementing the law was shielded from Republican legislators looking to cut off funding.
The plan was as political as it was financial, according to The Post.
There were enough funds for the states to expand Medicaid and create health care exchanges, but not enough for a federal insurance marketplace — exactly what was needed when states like Florida refused to accept funds to make their own state-run marketplace. That refusal put the onus on the administration to create a website, something underfunded by the Republicans from day one. It quickly became a fragmented, disjointed process.
“You’re basically trying to build a complicated building in a war zone because the Republicans are lobbing bombs at us,” a White House official told The Post.
Demonstrating progress in the elaborate website design through updated reports to Congress was nixed by the administration. The White House was afraid it would lead to a GOP backlash, the same strategy used by former Sen. Bob Dole to undermine Hillary Clinton’s health care reform task force in the 1990s. They opted to praise the state exchanges while masking their thoughts on the federal program.
Although there were warnings of “not having the right people for the job” throughout 2012, Obama insisted that they “have to do it right,” saying it was the most critical issue in his presidency.
In a final run-through of the Healthcare.gov website September 5, The Post article reports, many staffers wished it would fail so it they would wait for the rollout until the exchanges were completed. Unfortunately, using a simplified application that day, the site worked properly.