Five People Obama Could Fire Over Obamacare

Here are the officials who might become casualties of the HealthCare.gov debacle.

HHS Secretary Sebelius
National Journal
Sam Baker
Oct. 26, 2013, 6:11 a.m.

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.

No one

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.

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