The troubles hampering the Affordable Care Act may linger before they subside.
On Wednesday, it was hard to miss the hazard signs.
More than a dozen Senate Democrats vented frustrations about the administration’s website and communications bungles during a two-hour meeting with President Obama at the White House. The bull session lasted so long, the president was late for a flight to Dallas.
Once on the ground in Texas, the president’s script called for him to castigate Republican Gov. Rick Perry for declining to expand Medicaid to 1 million eligible uninsured Texans. But instead of lingering over the image of Perry as the Grinch, the president was forced to race through his remarks in 13 minutes, including a rapid-fire rebuttal to criticisms that the health law forced millions of Americans to lose the insurance coverage they liked.
Then he headlined two fundraisers in Dallas for Senate Democrats.
The administration’s implementation troubles dominated a Senate hearing Wednesday at which Health and Human Services Secretary Kathleen Sebelius was again in the docks over the flawed HealthCare.gov website. Instead of celebrating the law’s expanded benefits, Obama has been tasked to explain to millions of Americans why they can’t keep their coverage when he once assured them they could.
“More people are losing their insurance than are signing up on the website, and they are being directed to a website that doesn't even work,” Sen. Pat Roberts, R-Kan., told Sebelius before he asked her to resign her Cabinet post.
The secretary did not respond, but spokesmen for her department later confirmed to reporters that at least one manager involved in the HealthCare.gov project would leave the government next week. Tony Trenkle, the chief information officer in charge a billion-dollar information technology budget at HHS, will head to the private sector after Nov. 15 and be replaced by a colleague serving in an acting capacity, according to an email distributed at HHS and confirmed by officials. A spokeswoman declined to say if Trenkle was fired or had resigned.
At the White House, the president and his top aides tried to calm Democratic senators facing re-election next year who are feeling pummeled by the GOP and concerned that the president’s team appears slow to steady all that they’re tasked to manage. They “admitted they have a messaging problem, but not yet a way to fix it,” an aide to one of the 15 senators told RCP after the meeting.
This week, Democratic Sens. Mark Begich of Alaska and Barbara Mikulski of Maryland both used the term “crisis of confidence” to describe the public’s reaction to the administration’s disastrous rollout of the health law since October.
In Texas, the president raced through his criticism that Perry blocked working poor people from tapping health benefits under Medicaid and paced in front of supporters who crowded behind barriers at the Temple Emanu-El, telling them, “We are going to get this done.”
The president added, “One of the things that sometimes gets me a little frustrated, although I understand it because I’m in politics, is folks who are complaining about how the website is not working, and [who say] 'Why isn’t Obama fixing this?’ and ‘All these people are uninsured,’ and yet they're leaving a million people right now without health insurance that they could immediately fix. There’s not a lot of logic to that.”
Though he was aiming his ire at Republicans, an hour earlier Obama had heard similar complaints from members of his own party. Many Democratic lawmakers have heard howls from constituents who purchased private insurance on their own, and recently were notified by insurers that they must select new policies or shop on the new insurance exchanges because the Affordable Care Act judged their plans to be inadequate.
At every turn, Obama and Sebelius insist necessary website repairs can be completed by the end of November to let consumers buy insurance in time to comply with the law. But lawmakers from both parties say they remain uneasy, and have drafted legislative proposals to address public complaints. Some of their ideas: let Americans keep their existing or recently canceled insurance after Jan. 1; extend the enrollment period beyond March 31; drop the federal requirement that all Americans have basic health insurance; and jettison federal penalties.
Next week, the administration said it will unveil its count of people who enrolled in new private insurance plans offered since Oct. 1, which will be the first measure of public demand and the first official look at whether the government is realistic to expect 7 million new insured people by the end of 2014.
The insurers participating in the exchanges fret that new customers will prove expensive if they skew older and sicker, rather than young and healthy. The companies have problems with the federal website, as well, which hinders accurate issuances of new policies. The government does not rule out that some insurers in some exchanges could back away from commitments over time.
“Our agreement with issuers states that if an issuer ceases to provide coverage under any Qualified Health Plans (QHPs) or Stand-Alone Dental Plans (SADPs) in the states it offered them, then our agreement with that issuer will automatically terminate,” an HHS official explained to RCP in an email, asking not to be named.
“We do not expect this to be a common occurrence, and it is important to note that termination of the agreement does not relieve an issuer of any obligations it may have under applicable state law to offer coverage for a full plan year,” he said.
Obama next week will acknowledge high Medicaid enrollments in states that agreed to expand benefits in exchange for federal cost-sharing. Sebelius said 30 governors from both parties fit that general description (although some state legislatures do not back their governors on this matter).
The statistics expected to be released next week will also describe the population added to the Children’s Health Insurance Program, which covers nearly 8 million children. At the same time, the number of cancellations of existing private coverage since Oct. 1 may vastly exceed the number of consumers who successfully maneuvered through HealthCare.gov to enroll by next week.
Some GOP critics of the health law are preparing to assail the state-by-state expansions of Medicaid -- made voluntary rather than mandatory when the Supreme Court upheld the Affordable Care Act -- as a question of budget liabilities, rather than a benefit for improved health.
“Are we going to be able to afford this increase in Medicaid?” Wyoming Sen. Mike Enzi asked Sebelius on Wednesday.
The administration is drastically lowering expectations for the total number of completed enrollments for private coverage during the initial months. The website is such a mess, an accurate tally by next week is proving to be a challenge, officials said.
“I think there was a [HHS] memo internally that called for about a million people to be enrolled through December, but … we're updating those targets,” Sebelius said. “I can tell you our early enrollment numbers are going to be very low.”
She also noted that early applications launched on the wobbly site got stuck, were incomplete or in error, and the government is trying to sort out what to do with thousands of such attempts. That problem is unlikely to be resolved by next week.
“We have a very specific plan to go back and re-invite people back to the site who started at one point along the way and may have been [so] frustrated that they gave up,” the secretary explained.
“We don't want to do that until we're sure that their experience will be significantly better than it was the first time. We know that a lot of young folks have little patience with any technology that doesn't work instantaneously. So that audience is particularly important to get a very highly functional site up and running.”
Some “navigators” working as guides to help people enroll have told consumers to dive back into HealthCare.gov at the end of November and before Dec. 15. Coverage under the law can begin on Jan. 1.
Evidence suggests weeks may not be enough to cure all of the complex problems in the system. On Wednesday, the website was “performing slowly” with persistent error messages, according to a spokeswoman for the Centers for Medicare and Medicaid Services. Overnight, tech teams again completed “dozens” of software fixes. For example, experts labored through the night so consumers could see an accurate notification message when an application for insurance is being processed successfully.
“I do feel that there is no excuse for what has been a miserable five weeks,” Sebelius told the Senate Finance Committee. “I am committed to the fix of the website.”
RCP congressional reporter Caitlin Huey-Burns contributed to this report.
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