Four Questions for Sebelius About HealthCare.gov

WASHINGTON, DC - FEBRUARY 04: U.S. Secretary of Health and Human Services Kathleen Sebelius speaks during the opening plenary of the National Health Policy Conference organized by The AcademyHealth February 4, 2013 in Washington, DC. Sebelius spoke on the Obama Administration's health policy priorities.  
National Journal
Sam Baker
Oct. 29, 2013, 4 p.m.

House Re­pub­lic­ans will set their sights Wed­nes­day on Health and Hu­man Ser­vices Sec­ret­ary Kath­leen Se­beli­us, who is sched­uled to testi­fy for the first time since the messy launch of Health­Care.gov.

The site’s well-doc­u­mented tech­nic­al prob­lems have caused fresh polit­ic­al head­aches for the White House and Demo­crat­ic in­cum­bents fa­cing tough races next year. The flaws are also hav­ing a sub­stant­ive ef­fect — keep­ing people from sign­ing up for health care plans that the White House has been pro­mot­ing for years.

Se­beli­us’s pre­pared testi­mony ac­know­ledges that the site’s rol­lout has been “frus­trat­ing” for con­sumers, but doesn’t con­cede any mis­takes by HHS. It puts the blame on the con­tract­ors who built the site — not on HHS or the Cen­ters for Medi­care and Medi­caid Ser­vices, the HHS agency that dir­ectly over­sees Obama­care im­ple­ment­a­tion.

That likely won’t sit well with Re­pub­lic­ans on the En­ergy and Com­merce Com­mit­tee, who are hop­ing to use the tech­nic­al prob­lems as part of a broad­er case against the fed­er­al gov­ern­ment — not against gov­ern­ment con­tract­ors.

Here are four ques­tions for Se­beli­us — ques­tions she’s either likely to face, or that would help shed light on what really went wrong with Health­Care.gov:

If HHS didn’t make mis­takes, are you fix­ing prob­lems that don’t ex­ist?

Health­Care.gov’s con­tract­ors faul­ted CMS last week for put­ting it­self in charge of in­teg­rat­ing the sys­tems built by vari­ous private com­pan­ies, rather than put­ting one of them in charge of pulling everything to­geth­er. They said the in­di­vidu­al pieces worked fine; the sys­tem broke down once CMS in­teg­rated it all and tested it from front to back.

Se­beli­us’s pre­pared testi­mony dir­ectly chal­lenges that charge, put­ting the blame back on the con­tract­ors.

“CMS has a track re­cord of suc­cess­fully over­see­ing the many con­tract­ors our pro­grams de­pend on to func­tion. Un­for­tu­nately, a sub­set of those con­tracts for Health­Care.gov have not met ex­pect­a­tions,” Se­beli­us’s testi­mony says.

But here’s the thing: The way the White House has re­spon­ded to the site’s ini­tial fail­ure seems to sug­gest that over­sight was in­deed lack­ing. The ad­min­is­tra­tion brought in former White House budget dir­ect­or Jef­frey Zi­ents, who has a back­ground in man­age­ment con­sult­ing, to quar­ter­back the re­pair ef­fort. And Zi­ents des­ig­nated one con­tract­or to take the lead in co­ordin­at­ing every­one’s fixes.

So if, as Se­beli­us says, the prob­lem wasn’t with CMS’s man­age­ment of the site, why have the most vis­ible changes so far dealt with man­age­ment and over­sight?

When did you find out the site failed cer­tain tests, and what did you do about it?

Se­beli­us’s deputy, CMS Ad­min­is­trat­or Mar­ilyn Taven­ner, said Tues­day that she wasn’t pre­pared for the mag­nitude of prob­lems the site ex­per­i­enced once it launched — even though the con­tract­ors said they no­ti­fied their con­tacts at CMS that late-stage test­ing wasn’t look­ing good.

So did seni­or HHS of­fi­cials not know that the site was per­form­ing poorly in tests right be­fore its launch? If not, why not? Isn’t that ex­actly the kind of thing Se­beli­us should have been on top of?

Or did they know big prob­lems were com­ing and simply sug­ar­coated their ex­pect­a­tions for law­makers and the press? If that’s the case, why did HHS keep telling Con­gress and the pub­lic it would be ready on time? Was there any dis­cus­sion of a delay? Any be­hind-the-scenes con­sequences for the fail­ure to launch?

Neither scen­ario looks great for the ad­min­is­tra­tion, but it’s a key ques­tion in tra­cing ac­count­ab­il­ity for the web­site’s fail­ures.

Re­port­ers have been shut down without so much as an evas­ive non­answer when they’ve asked when Se­beli­us knew about the site’s prob­lems. Maybe En­ergy and Com­merce will have bet­ter luck.

Why are in­sur­ance com­pan­ies get­ting in­ac­cur­ate data?

CMS said Tues­day that it has made strong pro­gress on the most glar­ing prob­lem with Health­Care.gov — the pro­cess for cre­at­ing an ac­count. Also on the top of Zi­ents’s “punch list” for re­pairs, though, are ser­i­ous prob­lems with the data the site is feed­ing to in­sur­ance com­pan­ies. In­surers are get­ting du­plic­ate re­cords, in­ac­cur­ate re­cords, and en­roll­ments fol­lowed by can­cel­la­tions.

Se­beli­us’s testi­mony re­it­er­ates the ad­min­is­tra­tion’s ex­plan­a­tion that heavy traffic con­trib­uted to Health­Care.gov’s prob­lems. But traffic al­most surely didn’t cause the back-end prob­lems with in­surers, and fix­ing those is­sues is crit­ic­al to suc­cess­ful en­roll­ment.

Are you sure you know the ex­tent of the prob­lems?

Zi­ents and CMS haven’t re­leased their full “punch list,” but they’ve said they’re con­fid­ent the site will be ready by the end of Novem­ber. Es­pe­cially giv­en the prob­lems on the back end, can HHS say for sure that its dia­gnos­is has been com­plete, and that oth­er prob­lems won’t emerge and side­line the pro­cess be­fore it’s fin­ished?

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