Interesting read from Forbes
Avik Roy, Contributor-Forbes
We’ve known for at least nine months that Obamacare’s website could turn out to be a “third-world experience.” In recent weeks, we’ve learned that there hadn’t been an end-to-end test of whether Americans could enroll as late as September 26, five days before the October 1 launch. So the obvious question has been: if the administration knew the website wasn’t ready, why did they roll it out anyway? An explosive new report confirms that the decision was political. Some staffers were so desperate to persuade the President to change course that, during a September 5 demonstration of the healthcare.gov website, they “secretly rooted for it to fail so that perhaps the White House would wait to open the exchange until it was ready.”
The report comes from Amy Goldstein and Juliet Eilperin of the Washington Post. Goldstein and Eilperin interviewed “more than two dozen current and former administration officials and outsiders who worked alongside them” to get to the bottom of why the rollout of Obamacare’s insurance exchanges has been so problematic.
One of the individuals they interviewed was Harvard’s David Cutler, who served as a senior health policy advisor to the 2008 Obama Presidential campaign. On May 11, 2010, Cutler sent a searing memo to former Harvard President Larry Summers, now serving as director of Obama’s National Economic Council, relaying his concern “that the personnel and processes you have in place are not up to the task, and that health reform will be unsuccessful as a result.”
“While this memo is my own,” wrote Cutler, “the views are widely shared, including by many members of your administration (whose names I will omit but who are sufficiently nervous to urge me to write), as well as by knowledgeable outsiders such as Mark McClellan (former CMS administrator) and Henry Aaron (Brookings). Indeed, I have been at a conference on health reform the past two days, and have found not a single person who disagrees with the urgent need for action.”
“They were running the biggest start-up in the world,” Cutler told Goldstein and Eilperin. “And they didn’t have anyone who had run a start-up, or even run a business. It’s very had to think of a situation where the people best at getting legislation passed are best at implementing it. They are a different set of skills.”
In the 2010 memo, Cutler complained that the Department of Health and Human Services was “far behind the curve on the key long-term reform efforts.” Don Berwick, Obama’s choice to head the Centers for Medicare and Medicaid Services, “has never run a provider organization or insurance company, or dealt with Medicare or Medicaid reimbursement. On basic issues…Don knows relatively little.” Senior staff at CMS has “no experience running a health care organization,” Cutler said.
Cutler also criticized the person tasked with setting up the insurance exchanges, because that person was ideologically hostile to the industry. “If you cannot find a way to work with hesitant states and insurers, reform will blow up. I have seen no indication that HHS even realizes this, let alone is acting on it.”
Jeanne Lambrew, “the overall head of implementation inside HHS…is known for her knowledge of Congress, her commitment to the poor, and her mistrust of insurance companies. She is not known for operational ability, knowledge of delivery systems, or facilitating widespread change. Thus, it is not surprising that…exchange administration [is] receiving little attention. Further, the fact that Jeanne and people like her cannot get along with other people in the Administration means that…valuable problem solving time is wasted on internal fights…no one I interact with has confidence that your current personnel and configuration is up to the task.”
A running theme in the Goldstein-Eilperin piece is political paranoia, the degree to which the White House kept key details of Obamacare’s implementation secret—from its own allies—because they feared that even modest efforts at transparency would lead to criticism from Republicans. It was “a sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition.”
“According to two former officials,” they write, “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.”
“In the end…the White House quashed the diagrams,” which prevented states from learning about how the administration wanted the insurance exchanges to be designed. The administration blocked the release of key regulations until after the election, for fear of their unpopularity. “The dynamic was you’d have [CMS’s leaders] going to the White House saying, ‘We’ve got to get this process going.’ There would be pushback from the White House,” said one former official.
The White House even refused to share key information with Democratic allies in Congress. Key Congressional leaders were only notified a half-hour before the public was that President Obama was to delay the law’s employer mandate by one year. (The employer mandate requires companies with more than 50 workers to provide health coverage to each full-time employee.) In a meeting with Democrats a week before the announcement, Jeanne Lambrew “gave no hint” that a delay was imminent.
Richard Foster, the former chief actuary at CMS, described these delays as a “singularly bad decision,” one that put “short-term political gain” ahead of the successful implementation of reform.
Some staffers advocated a delay of the rollout, to no avail
A number of people buried within the administration were concerned about a botched rollout, and tried to make their concerns known. “By late 2012,” Goldstein and Eilperin write, “some staffers were aware…that the work of building the federal exchange was lagging…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 early 2012 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.”
“People were like, well…it’s a dynamic we can’t change,” a former HHS official told the reporters. “There wasn’t a way to push back or challenge it up the line. You had the policy people, largely at the White House, pushing the deadlines and tinkering with the policy, rather than the people who had to run the critical operating path design and program the system.”
On August 17, Shabnam Shahmohammad of CGI Federal—the main IT contractor for the exchange—sent an email to Tyrone Thompson of CMS, and several others, stating that they had only completed 55 percent of the tasks that they had been assigned.
On September 5—less than a month before Oct. 1 launch date—officials from the White House went over to CMS to see a “final demonstration” of the healthcare.gov website. “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 open the exchange until it was ready.”
But that demonstration—which didn’t incorporate several of the flawed back-end IT processes—seemed just fine. And so the White House stormed ahead, into the biggest blunder of Obama’s presidency.
Avik Roy, Contributor-Forbes
We’ve known for at least nine months that Obamacare’s website could turn out to be a “third-world experience.” In recent weeks, we’ve learned that there hadn’t been an end-to-end test of whether Americans could enroll as late as September 26, five days before the October 1 launch. So the obvious question has been: if the administration knew the website wasn’t ready, why did they roll it out anyway? An explosive new report confirms that the decision was political. Some staffers were so desperate to persuade the President to change course that, during a September 5 demonstration of the healthcare.gov website, they “secretly rooted for it to fail so that perhaps the White House would wait to open the exchange until it was ready.”
The report comes from Amy Goldstein and Juliet Eilperin of the Washington Post. Goldstein and Eilperin interviewed “more than two dozen current and former administration officials and outsiders who worked alongside them” to get to the bottom of why the rollout of Obamacare’s insurance exchanges has been so problematic.
One of the individuals they interviewed was Harvard’s David Cutler, who served as a senior health policy advisor to the 2008 Obama Presidential campaign. On May 11, 2010, Cutler sent a searing memo to former Harvard President Larry Summers, now serving as director of Obama’s National Economic Council, relaying his concern “that the personnel and processes you have in place are not up to the task, and that health reform will be unsuccessful as a result.”
“While this memo is my own,” wrote Cutler, “the views are widely shared, including by many members of your administration (whose names I will omit but who are sufficiently nervous to urge me to write), as well as by knowledgeable outsiders such as Mark McClellan (former CMS administrator) and Henry Aaron (Brookings). Indeed, I have been at a conference on health reform the past two days, and have found not a single person who disagrees with the urgent need for action.”
“They were running the biggest start-up in the world,” Cutler told Goldstein and Eilperin. “And they didn’t have anyone who had run a start-up, or even run a business. It’s very had to think of a situation where the people best at getting legislation passed are best at implementing it. They are a different set of skills.”
In the 2010 memo, Cutler complained that the Department of Health and Human Services was “far behind the curve on the key long-term reform efforts.” Don Berwick, Obama’s choice to head the Centers for Medicare and Medicaid Services, “has never run a provider organization or insurance company, or dealt with Medicare or Medicaid reimbursement. On basic issues…Don knows relatively little.” Senior staff at CMS has “no experience running a health care organization,” Cutler said.
Cutler also criticized the person tasked with setting up the insurance exchanges, because that person was ideologically hostile to the industry. “If you cannot find a way to work with hesitant states and insurers, reform will blow up. I have seen no indication that HHS even realizes this, let alone is acting on it.”
Jeanne Lambrew, “the overall head of implementation inside HHS…is known for her knowledge of Congress, her commitment to the poor, and her mistrust of insurance companies. She is not known for operational ability, knowledge of delivery systems, or facilitating widespread change. Thus, it is not surprising that…exchange administration [is] receiving little attention. Further, the fact that Jeanne and people like her cannot get along with other people in the Administration means that…valuable problem solving time is wasted on internal fights…no one I interact with has confidence that your current personnel and configuration is up to the task.”
A running theme in the Goldstein-Eilperin piece is political paranoia, the degree to which the White House kept key details of Obamacare’s implementation secret—from its own allies—because they feared that even modest efforts at transparency would lead to criticism from Republicans. It was “a sensitivity so intense that the president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition.”
“According to two former officials,” they write, “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.”
“In the end…the White House quashed the diagrams,” which prevented states from learning about how the administration wanted the insurance exchanges to be designed. The administration blocked the release of key regulations until after the election, for fear of their unpopularity. “The dynamic was you’d have [CMS’s leaders] going to the White House saying, ‘We’ve got to get this process going.’ There would be pushback from the White House,” said one former official.
The White House even refused to share key information with Democratic allies in Congress. Key Congressional leaders were only notified a half-hour before the public was that President Obama was to delay the law’s employer mandate by one year. (The employer mandate requires companies with more than 50 workers to provide health coverage to each full-time employee.) In a meeting with Democrats a week before the announcement, Jeanne Lambrew “gave no hint” that a delay was imminent.
Richard Foster, the former chief actuary at CMS, described these delays as a “singularly bad decision,” one that put “short-term political gain” ahead of the successful implementation of reform.
Some staffers advocated a delay of the rollout, to no avail
A number of people buried within the administration were concerned about a botched rollout, and tried to make their concerns known. “By late 2012,” Goldstein and Eilperin write, “some staffers were aware…that the work of building the federal exchange was lagging…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 early 2012 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.”
“People were like, well…it’s a dynamic we can’t change,” a former HHS official told the reporters. “There wasn’t a way to push back or challenge it up the line. You had the policy people, largely at the White House, pushing the deadlines and tinkering with the policy, rather than the people who had to run the critical operating path design and program the system.”
On August 17, Shabnam Shahmohammad of CGI Federal—the main IT contractor for the exchange—sent an email to Tyrone Thompson of CMS, and several others, stating that they had only completed 55 percent of the tasks that they had been assigned.
On September 5—less than a month before Oct. 1 launch date—officials from the White House went over to CMS to see a “final demonstration” of the healthcare.gov website. “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 open the exchange until it was ready.”
But that demonstration—which didn’t incorporate several of the flawed back-end IT processes—seemed just fine. And so the White House stormed ahead, into the biggest blunder of Obama’s presidency.
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