The blame game over HealthCare.gov is just getting started.
The site's botched launch has caused a political headache for the White House, and persistent problems could seriously undermine the law's chances for success.
Republicans smell blood, and some Democrats – including former White House Press Secretary Robert Gibbs – also want someone to be held accountable.
We don't know yet exactly what happened, who was responsible, or how senior officials handled the situation. There's still a lot to learn before assigning blame. But in health care and political circles, people are already speculating about where the buck will stop.
Here's a look at some of names that have been mentioned so far, and the arguments for and against each of them taking the fall.
Kathleen Sebelius: Secretary of Health and Human Services
Pro: She's far and away the most visible official with a day-to-day hand in implementing the Affordable Care Act. Sebelius has been there through the entire process, from getting the law passed to the disastrous launch of HealthCare.gov. The idea of firing someone over the rocky rollout is partly about the political symbolism of accountability, and nothing would send a louder message than asking Sebelius to step down.
Con: Sebelius has been a loyal soldier in the Obamacare wars for six years. A former governor and insurance commissioner, she has helped negotiate waivers and exceptions that brought red-state governors into the law's Medicaid expansion. Also, she can't be replaced. Literally. It's hard to imagine Senate Republicans allowing a new HHS secretary to make it through the confirmation process, and having only an acting secretary would be a major hindrance to the ongoing implementation effort.
Marilyn Tavenner: Administrator, Centers for Medicare and Medicaid Services
Pro: If Sebelius is too big of a concession from the White House, it makes sense to start looking down the chain of command. And that brings you to Tavenner. She leads CMS, which houses the office that implemented the law and inked the contracts to build HealthCare.gov. CMS' decision to integrate contractors' products itself, rather than turning to one of the contractors, is emerging as one of the key factors in the website's troubles.
Con: People like Tavenner. Insurers like her, colleagues like her – even Republicans like her. Her nomination won bipartisan support after House Majority Leader Eric Cantor (R-Va.) testified on her behalf. She's well-regarded throughout the health care industry and has a reputation as an attentive, engaged leader. Privately, the early word on her response to the HealthCare.gov debacle is also positive. Tavenner is set to testify on the Hill next week, but barring any big revelations, she is seen as unlikely to lose her job.
Gary Cohen: Director, Center for Consumer Information and Insurance Oversight
Pro: Cohen's office, CCIIO, is the one directly in charge of Affordable Care Act implementation. Sebelius and Tavenner have other responsibilities, but Cohen is all Obamacare all the time. And it was Cohen who testified before Congress that the website and federally run insurance exchanges would be ready on Oct. 1.
Con: It's not clear where in the process bad decisions were made. Did Cohen's office decide to put CMS in charge of integrating insurers' various systems, or did it simply execute a decision from higher up? Cohen testifies regularly before Congress and seems to have at least a respectful relationship with Republicans, but he's hardly a household name.
Henry Chao: Chief Information Officer, CMS
Pro: Chao emerged as a possible target during last week's hearing with HealthCare.gov contractors. The contractors testified that Chao decided to remove a feature allowing people to shop for insurance without creating an account. That decision contributed to the site's overload and has been criticized as a design flaw in the federal exchanges.
Con: Although the contractors said last week that Chao made the call to ax the shopping feature, Rep. Darrell Issa (R-Calif.) has intimated that the decision actually came from the White House. Chao is also a career civil servant at CMS, and political appointees are more likely to take the fall when the president needs to fire somebody.
Jeanne Lambrew, Deputy Assistant to the President for Health Policy
Pro: Lambrew is a senior health care adviser inside the White House. If the search for a scapegoat turns to the West Wing, rather than HHS, it could turn to Lambrew. Relatively new advisers brought in recently to help with the launch probably weren't involved in actually building the exchange, and other, longer-serving officials have left. Lambrew is still there, and still involved in the details of Obamacare implementation.
Con: This option just doesn't get much traction in the health care world. Lambrew's name comes up as an option if Obama decides he needs to fire someone in the White House – almost by a process of elimination rather than a proactive suggestion. We'll see what congressional Republicans uncover about the decision-making process, but for now, the attention and speculation is focused mainly on HHS.
Pro: Will firing someone really change the politics of Obamacare? If HealthCare.gov is indeed fixed by mid-November, as CMS says it will be, its problems will likely be well into the public's rearview mirror by the 2014 midterms, and certainly by 2016. Firing someone won't improve the politics of Obamacare, and it won't improve relationships with Republicans. If ending a short-term political headache comes at the cost of leadership or expertise the administration truly needs, is it worth it?
Con: Even some Democrats say someone's head needs to roll over the botched rollout. It undermined Obama's signature domestic achievement and reignited a campaign issue they wanted to avoid. This was an embarrassing screw-up that made it harder to access a benefit Obama has spent years promising. The public – not to mention the insurance companies fearful about the bottom line – will want to see someone held responsible.