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White House glitches go beyond Obamacare
Edward LuceBy Edward Luce
The US president has been caught serially off guard by recent crises, from Syria to spying
Six months ago, Max Baucus, the veteran Democratic senator, said that “Obamacare” – the Affordable Care Act – was a looming “train wreck”. Senior players had privately issued the same warnings in early 2012. The White House also brushed them off. “I tried to tell people at all levels there would be huge problems and they either didn’t listen or got irritated,” says a close ally of President Barack Obama, who works with large healthcare companies. “The White House was programmed to screen out bad news.”
Whether Obamacare’s problems can quickly be resolved, or whether the law is unravelling, it is indelibly linked with Mr Obama’s name. It is his most cherished accomplishment and it will be his chief legacy. Yet it is only now, almost a month into its disastrous launch, and more than three years since it was enacted, that its implementation has been made a priority. Some visitors to the online federal health insurance exchange – the mechanism at the heart of the act – have failed to get through, in spite of repeated attempts. Others have had their personal data mixed up or switched. Hopefully for Mr Obama, and for America’s 48m uninsured, the website’s glitches can be fixed fast – November 30 is the new White House deadline. But if the “tech surge” fails to meet it – and many experts are sceptical – the whole law would be in jeopardy.
How could Mr Obama have let things get so out of hand? Republicans and Democrats alike grasp for ideological explanations. The former say that any government-run health programme is destined to fail. They overlook most of the rest of the developed world and also America’s own public systems – not to mention Nasa putting people on the moon. Liberals, on the other hand, blame Republicans for repeatedly trying to defund the ACA and for so demagogically misrepresenting it. They also stress that it is an unusually tough project because the exchanges are required to work with hundreds of private companies. Both underestimate the US government’s ability to do complex things when it wants to.
The simple explanation is that Mr Obama’s White House is dominated by a coterie of insiders who have learnt that their boss does not like to hear bad news. Nor are friendly whistleblowers made to feel welcome. Whether on Syria, spying revelations or the White House’s preferred candidate to head the Federal Reserve, the president has been caught off guard by recent crises. This is well into his fifth year in office. Even George W Bush grew in his job during his second term – to a large extent by freezing out Dick Cheney, the vice-president, as Peter Baker shows in his new book, Days of Fire. No doubt, Mr Bush had much further to grow after the monumental errors of his first term. But Mr Obama gives few signs of having found a learning curve. Although he will never again face election, the White House continues to behave as though he will. The problems with Obamacare are a feature, not a bug, of his administration.
The president’s biggest mistake was to withhold resources from the exchanges before the November 2012 election. Fearing bad publicity, the Obama campaign did not want to attract attention to the unpopular law before polling day. Given that the exchanges require seamless interface between several federal agencies at the front end and scores of private insurers at the back end, they needed all the time they could get to test the system. The White House took that away.
But the political angst did not end with last year’s re-election. As recently as August, the Obama administration made the blunder of telling the exchange’s website to show visitors the price of subsidised insurance rather than the true cost of the premiums. This was to avoid the political fallout of “rate shock” that would hit users when they saw the pre-subsidised cost of insurance. It meant the website had to verify each visitor’s identity before it could display the relevant prices. Changing such a big element of a huge system so late in the day inevitably contributed to its seizing up.
So far, only the sick and vulnerable appear to be struggling through the glacial website to buy insurance. This is the opposite of what Mr Obama needs. If the young and healthy do not sign up in large numbers, the system will suffer from adverse selection, which will unravel Obamacare’s cross-subsidy and raise costs for everyone. Young people, unlikely to be in terror of the $95 penalty they would incur for not signing up, are crucial to the project’s viability. Mr Obama has a month to win them over. In a city inured to countdowns, Washington faces two new ones – November 30 to get the exchanges working, and December 15 to finish the enrolments for next year.
It is well known that Mr Obama barely consulted Kathleen Sebelius, health secretary, during Obamacare’s stormy passage through Congress in 2009 and 2010. And it is an open secret how little they had seen each other since before this month’s crisis. Having lacked good White House access all these years – particularly when bearing bad news – Ms Sebelius is now taking the rap for the problems of the programme.
If Jeff Zients, who was last week made head of the White House tech surge, can help fix things then Ms Sebelius might keep her job. Either way, it is troubling how often the president’s appointees end up taking the blame for problems they have tried to flag. It is a sign of a dysfunctional White House. Mr Obama will never again face election. But his legacy will forever be linked to the fate of his signature reform