Fire Sebelius Now!

While thoughtful Republicans spent the last two weeks wondering how they could rescue their party from the wingnuts who hijacked it, thoughtful Democrats spent the last two weeks nursing a different worry: The rollout of the Affordable Care Act’s exchanges was such a disaster, the ACA was in danger of turning into the trainwreck the wingnuts predicted. In the end, the sanity caucus within the GOP prevailed. It is less clear if the sanity caucus within the Democrats will but there is a sure fire test of the proposition. Health and Human Services Secretary Kathleen Sebelius should be fired for rank incompetence.

At the Atlantic, Garance Franke-Ruta details the number of people who have signed up at the state-run exchanges. HHS has not released numbers for how many have signed up through the federal exchange. Franke-Ruta concludes with a hopeful, yet truly damning, admission:

Meanwhile, in the small alternate universe of states where enrollment has not been thwarted by technical issues at the state or federal level, the data suggests what must be a welcome proof of concept for the exchanges. The demand is there and people are completing applications through the marketplaces at a solid clip where it's possible for them to do so.

“Thwarted.” “Where it’s possible for them to do so.” The incompetence of HHS in setting up the exchanges is “thwarting” the implementation of the President’s signature policy. Obama likes to say that good policy is good politics, but good policy requires implementation, not just legislation.

An even more damning critique came from Robert Laszewski of Health Policy & Strategy Associates in an interview with Ezra Klein at the Washington Post’s wonderful “wonkblog.” Laszewski laments:

I think they trusted their subcontractors. There’s an astronaut joke that an astronaut is a guy sitting on top of a rocket assembled by the lowest bidders. Obamacare is a bit like the astronaut on top of the rocket. As I understand it, some of these were no-bid contracts, like CGI.

So I think some of the problem is the Obama administration never brought in heavyweight IT people to oversee this. Are there no Democrats in Silicon Valley? Kathleen Sebelius was the governor of Kansas. Mary Tavenner is a nurse and health policy person. Their senior people had no information technology background. And they’re listening to the consultants! There’s an old joke in the insurance industry that you don’t get very far if you bet your career on promises the IT department is making. And these people didn’t just bet their career on it. They bet Obama’s signature project on it!

Laszewski also identifies the core psychological problem that has afflicted HHS’s rollout of the exchanges:

They were paranoid because Obamacare was under siege. I understand that. If they were open with their partners there would’ve been criticism, but it would’ve been constructive criticism. None of us had any idea that the government Web site would require security sign-ins before browsing. Why did that have to be a secret? No one will read a newspaper article about that. If it had been transparent I think most of this would’ve been caught upfront. That really hurt them.

I would submit that the continuing GOP opposition to the ACA was entirely predictable and if the team at HHS felt “paranoid” they needed to get some help with that, not allow that paranoia to cripple their effort to fix the problems with the website in advance of its rollout.

These criticisms are not the words of Sen. Ted Cruz. Garance Franke-Ruta is no Tea Partyer. Lord knows that Team Obama certainly figured out how to make IT work for them at campaign time. But, for the rollout of their signature policy achievement, something we are repeatedly told will help millions of fellow citizens, HHS went with a firm that had no track record of achieving anything like the kind of technical expertise this project would demand.

The IT debacle comes on top of the failure of Sebelius to mount an effective political defense of the ACA, as mentioned in this blog previously. Remember Zoe Lihn? Of course you don’t. She was the little girl with a pre-existing condition who was featured on the first night of the Democratic National Convention. Her mother explained that they had not been able to get health insurance for Zoe until the ACA was enacted. “Like so many moms with sick children, “Zoe’s mom Stacey told the convention, “I shed tears and I could breathe easier knowing that we have that net below us to catch us if we fall, or if, God forbid, Zoe needs a heart transplant – Obamacare provides my family security and relief.” There were few dry eyes in the hall. But, that was the last we saw of little Zoe. If the entire country could remember her name and her story, do you really think the GOP’s efforts to overturn the law would still be getting a hearing? 

Any optimism about Sebelius’ political skills should have been answered fully, and negatively, by her painful interview with Jon Stewart which you can watch by clicking here.

Sebelius is also largely to blame for the fraught relations between the administration and the Catholic Church. First, she listened uncritically to the recommendation of the Institute for Medicine and threw Sr. Carol Keehan under the bus, adopting an exemption to the contraception mandate that was so narrow, the President himself felt called upon to invite Cardinal Timothy Dolan into the Oval Office and promise he would fix it. Then, the President’s political advisors discerned an opening – the war on women – and Sebelius, who is a Catholic, did not have the foresight to suggest that lying to the Cardinal-Archbishop of New York is never a good idea and, more importantly, the Catholic Church would be needed to implement the ACA. The largest provider of social services to the very people the ACA aimed to help, the poor and the working poor, HHS needs the Church’s many agencies to help people navigate the new law and sign up for coverage. But, HHS’s various attempts at accommodation have been so grudging, the relationship remains poisoned.

To be clear, I do not let the USCCB off the hook. Had they stuck to the principal and principled concern for the integrity of our Catholic institutions, they might have carried the day. But, once we started arguing that the conscience rights of Taco Bell were at issue, and that the conscience rights of employers trumped the conscience rights of workers, the administration had reason to think that nothing they could do would make a difference. How different the entire thing would have been if President Obama had kept his promise to Cardinal Dolan? How different the whole rollout would be if Sebelius had urged the President to do so? How different these first weeks of implementation would be if every Catholic parish and school and charity were helping people to sign up for coverage?

Sebelius has so misjudged and mishandled everything about the ACA, we can pronounce against her the fateful verdict: You have been weighed in the scales and found wanting. It is time for her to go.