Monday, November 4, 2013

Finding a cure for what is ailing and the Affordable Care Act

Kathleen Sebelius testifing before the House Energy and Commerce Committee

Last week, both Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS) and Marilyn Tavenner, Administrator of the Center for Medicare and Medicaid Services (CMS), testified before Congressional Committees as representatives of the Obama Administration giving their side of the story regarding the failed Open Enrollment launch of the Affordability Care Act (ACA). Just when we were hoping that was on the mend because of the announcement that Optum/QSSI was taking the role of system integrator and additional help was coming from Silicon Valley and Jeffrey Zients, Director of the National Economic Council and founder/former CEO of Portfolio Logic, suffered another setback. This time Verizon was reported to be responsible for a system outage that occurred the weekend before Secretary Sebelius and Administrator Tavenner testified before Congress.

On Wednesday, October 31, Secretary Sebelius faced a tough crowd of Republicans with a series of questions about not only the website’s maladies, but also privacy and security issues/breaches and health insurance cancellation notices received by two millions[i] Americans from insurers who blamed the cancellation on ACA’s requirements.  They also peppered her with questions about whether the President intentionally deceived or misled the American public when he repeatedly said that people could keep their existing insurance plans if they liked it, and the 50% or higher rate increases for new plans insurer are offering those whose plans have been cancelled. Insurers are justifying the rate increases by saying the ACA law is forcing the change. Although Democrats were generally supportive, they too wanted substantive answers on why the website continues to be plagued by problems.

Ms. Sebelius apologized 
in her opening statement for the inexcusable: a failed launch of She committed to fixing the website, and earning back the confidence of the American public.  But even as she tried to move the conversation away from the website by talking about the goals and other successes of the ACA, such as:

     * The promise of significantly lower premiums via the
Marketplace (both federal and state health     
     *  Some insurance companies finalizing rates for the
         marketplace that are even lower than they initially
         proposed which will result in significant cost savings to
     *  Discounts via tax credits and subsidies that could
         amount to 35% off of the undiscounted marketplace

         rates for those who qualify; [ii]

it was reported that was down and it remained down for duration of the Hearing making it difficult to change the subject. 

And when the Republicans did change the subject, they went to another hotspot for the Obama Administration:  millions of Americans receiving health insurance cancellation notices and President Obama’s words that “if you like your health care plan, you can keep your health care plan”.  In two days of testimony by both Secretary Sebelius and Administrator Tavenner, there was no easy and simple response to the challenge that the President was not truthful about the effects of the ACA law on the insurance market place and its current customers. Talk of grandfathered clauses and the hope that individuals who recently received cancellation notices will shop for new plans via the federal and state health exchanges did not fully address the anxiety some Americans are feeling about having what’s familiar to them taken away when they were told otherwise.  A concise and succinct message that explains what has happened and what affected consumers should do next is needed. Not just anecdotes about the experiences of a few people who have been able to overcome all of the challenges of the website and enroll in a plan.

Marilyn Tavenner, CMS Adminstrator
The premise of creating competition by aggregating noninsured young and old, sick and healthy Americans into large groups similar to the groups that large employers benefit from is admirable.  Administrator Tavenner testified on Tuesday, October 29th, before the House of Representatives’ Ways and Means Committee  that 80% of those who apply for coverage through the “Marketplace” will qualify for some type of assistance[iii].  That’s great news for those who will eventually get the expected tax credit and subsidies. 

The problem is the website’s issues have been going on for over a month now, and instead of “our patient” being downgraded to stable condition, news reports of more outages and system problems have kept it in intensive care.  Also, news of cancellation notices consumers are receiving from well-known insurers like Kaiser Permanente of California, Blue Cross Blue Shield of Florida, Highmark Health Services of Pennsylvania and Carefirst Blue Cross Blue Shield of Maryland continue to undermined the recovery process.  The millions of people who are visiting looking for a solution to their health insurance needs want to know that the ACA law is going to deliver the help it promised.  Although the ACA law is not just the website, right now the other good benefits of the law have taken a back seat because of a lack of information that would normally be accessible through the website.  This has caused people to fear that they will be left in a lurch paying higher prices for health insurance, left without coverage and/or penalized because they do not have coverage by the deadline.  Saying that the cancellations are happening because those policies are “substandard” is not enough.

The bottom line is until is fixed so that consumers have a shopping experience that is acceptable, all the Obama Administration’s messaging about the benefits of the ACA law sound like a broken record.  People want to know, ‘what have you done for me lately’?  The fact that the Marketplace rates are finalized and stable for 2014 is newsworthy but this message is being eclipsed by the other stories about the website’s ills and cancelled health plans, etc.  November 30 is the deadline to find a cure or people are going to really start wondering if this program can be cured.

[i] Obamacare: More than 2 million people getting booted from existing health insurance plans, October 29, 2013,
{ii] Prepared testimony on the Affordable Care Act Implementation by Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services, before the U. S. House Committee On Energy and Commerce Committee, October 30, 2013,
[iii] Prepared testimony on the Affordable Care Act Implementation by Marilyn Tavenner, Administrator, Center for Medicare and Medicaid Services, U.S. Department of Health and Human Services, before the U. S. House on Ways and Means, October 29, 2013,