It’s not exactly a secret that the first month of the Affordable Care Act’s open-enrollment period has been marred by dramatic difficulties. And whether one loves or hates “Obamacare,” the administration deserves much of the criticism it’s received – the last several weeks have been a poorly managed mess.
But when it comes to assigning blame and responsibility, President Obama and his team aren’t the only ones on the hot seat.
Late last week, Todd Purdum had a surprisingly hard-hitting piece in Politico, making the case that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Purdum added, “That may sound like a left-wing conspiracy theory … but there is a strong factual basis for such a charge.”
As a long-time proponent of the argument, I was glad to see the thesis in print. I was also glad to see this well-reported Washington Post piece from Amy Goldstein and Juliet Eilperin yesterday on what went wrong with the system rollout. It’s the most detailed report I’ve seen anywhere on this, and it noted a detail that’s been largely overlooked: control over the online marketplaces had to be moved under the Centers for Medicare and Medicaid Services.
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.
A White House official added, “You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us.”
I can appreciate why this seems self-serving from the perspective of the administration – they’re trying to put out fires, so of course they’d like the GOP to share in the blame – but the arguments have the benefit of being accurate. The need for a federal health exchange became overwhelming in large part because so many Republican governors and state legislatures hoped to sabotage “Obamacare” on their end. When it became clear the administration would have to scramble to accommodate the unexpected work, HHS officials got stuck because they didn’t have the resources – because congressional Republicans were sabotaging “Obamacare” on their end.
Kevin Drum added, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
Quite right. I’d just add that the scope of the GOP’s sabotage campaign is hard to overstate. It includes everything from lawmakers ignoring constituent questions to public misinformation campaigns, discouraging public-private partnerships to denying implementation funds, blocking Medicaid expansion to blocking CMS nominees in the Senate, refusing to create marketplaces to prohibiting “Navigators” from doing their jobs.
Does a dysfunctional website matter? Of course it does, but so does this.