Officially, [Kathleen] Sebelius made the decision to resign and was not forced out. And while that may be narrowly true, she was clearly out of favor in the administration. With Sebelius leaving, the White House can try for a reset on healthcare, just as benefits are beginning and the law seems to be back on track. And her departure might offer the Democrats some political distance from Obamacare's turbulent launch ahead of the midterm elections.All true, all fair. But there's also 7.5M signups, and that'll be what folks remember 30 years from now. In the meantime, Sebelius will be remembered for the bad along with the good.
Even though enrollment spiked just before the March 31 deadline and reached the 7 million goal the White House had originally set, Healthcare.gov was a tremendous embarrassment for the Obama Administration. Though the president had suggested buying insurance through the exchange would be like shopping on Amazon, the site wasn't nearly ready when it went live: The exchange melted down with even moderately high numbers of users, data weren't transmitted correctly, and major parts of the site's infrastructure still aren't built.
On Thursday morning, Kathleen Sebelius testified before Congress and announced that Obamacare signups had reached 7.5 million people.More politics and policy below the fold.
On Thursday evening, news broke that Sebelius was stepping down as Secretary of Health and Human Services.
Maybe Sebelius and her supporters hoped that the morning news would put a more positive spin on the evening’s. If so, they were very, very wrong. The first sentence of the New York Times article on her resignation described a “stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act.” Expect more of the same in the coming hours and days.
Sebelius deserves at least some of that treatment. The technological failures of healthcare.gov during October and November—and the failure to anticipate a wave of private plan cancellations—represented low points for the cause of health care reform, the Obama presidency, and liberalism more generally. HHS was in charge of Obamacare implementation and Sebelius was in charge of HHS. In one of her many grueling sessions of congressional testimony, Sebelius said that critics should hold her accountable for those failures. They are now doing that—actually, they've been doing that for some time. That opening Times paragraph is what accountability sounds like.
Kathleen Sebelius is resigning because Obamacare has wonBrian Beutler:
The Affordable Care Act's enrollment comeback has confounded conservatives in many ways. The realization that there happens to be popular demand for something as self-evidently grotesque as Obamacare has given rise to a palpable cognitive dissonance on the right. A growing recognition among Republicans that they can't bank on organizing the midterm campaign around relentless Obamacare opposition has party elders looking at contingency plans (even if they haven't exactly gone back to the drawing board).Michael Hiltzik:
But most importantly, it has thrown the conservative health policy community for a loop, and completely wrong-footed Republicans in Congress who were hoping -- against considerable odds and a well-worn historical pattern -- to craft an Obamacare alternative that both passes the laugh test and doesn't create a significantly lower level of welfare. If enrollment had sputtered, that task would have been considerably easier. The fact it surged in March, and continues to grow today, measurably limits their options. And to that end, Talking Points Memo wins our quote of the week award for scoring this anonymous reckoning from a GOP congressional aide.If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that's absolutely true. As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. ... To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.
Sebelius is faulted, for the most part deservedly, for presiding over the initial failure of the website. The exact nature of her dereliction is murky, however; so many of its moving parts broke down it's still hard to say what could have been avoided and how. Jonathan Cohn argues in the New Republic that although Sebelius had experience as a regulator in Kansas and as a political leader with a record of bipartisan collaboration, "what Obamacare needed more was a deft, aggressive manager." He asserts that "Sebelius did not grasp the severity of tech problems at healthcare.gov until the day it went live and crashed."The new normal, from the Tennessean:
Actually, we may have to wait for Sebelius' memoirs, if she writes them, to know when she recognized the severity of the problems. But it's probably more fair to say that what Sebelius needed was a "deft, aggressive manager" of the technological rollout.
A technology wonk might have had the website working better, but would have been utterly unable to navigate the ideological shoals through which Obamacare has had to sail. There probably aren't too many political figures who could have dealt with the relentless assault on the ACA with as much equanimity as Sebelius mustered. The record of the last six months suggests that even a flawless launch of HealthCare.gov would not have stemmed the attacks on the law. After all, it's operating fine now; have you heard a single Republican acknowledge that?
Later, TriStar filed a claim with BlueCross BlueShield of Tennessee for more than $44,000 for Klar's care. Under his Network S plan with BlueCross, Klar has a deductible and coinsurance of roughly $1,500 each. Beyond that, he pays 20 percent of the overall bill. BlueCross pays the rest.Greg Sargent:
Representatives from TriStar say that Klar's high out-of-network care bill is due to a policy change that BlueCross implemented last year to shift more of the cost of care onto members.
But the insurance company is saying that $44,000 is too high for anybody to pay for out-of-network emergency care. BlueCross suggests in the lawsuit that a reasonable amount to charge is around $9,500, which is about 200 percent of what Southern Hills would receive for treating a Medicare beneficiary for the same condition.
Klar's case highlights a new shift in the nation's health care system. As customers increasingly switch to plans that require members to shoulder more of the cost of health care, people are beginning to see behind the curtain of the hospital billing process.
In this case, BlueCross is stepping in. The idea of an insurance company taking legal action against a provider on behalf of a member is a novel one. "I got out of law school 42 years ago this May, and I've not seen it before," said Klar's lawyer, Gary Blackburn. "I think it's unusual."
The Republican position — that the law can’t work by definition – is essentially an admission that Republicans simply don’t support doing what Obamacare sets out to do: Expand coverage to the number of people the law hopes to cover, through a combination of increased government oversight over the health system and — yep — spending money. The GOP focus on only those being negatively impacted by the law, and the aggressive hyping of cancellations into “millions” of full blown “horror stories” – combined with the steadfast refusal to acknowledge the very existence of the law’s beneficiaries — is, at bottom, just another way to fudge the actual GOP position: Flat out opposition to doing what it takes to expand health care to lots and lots of people.
Sometimes Republicans are candid about this position, such as when Paul Ryan forthrightly admitted that once Obamacare is repealed, its popular provisions should not be restored because it would be too expensive. Others, however, recognize the political problem here, and continue to say they support Obamacare’s general goals while declining to detail how a replacement would accomplish them. The problem for Republicans is that they want to persuade folks that they, too, support these general goals — hence the perpetual promise of vague alternatives — but this posture is fundamentally incompatible with the idea that Obamacare cannot work by definition, because there’s no alternative way to accomplish those goals at the law’s scale.