Sebelius: ObamaCare Rollout Tougher Than White House Expected

Health and Human Services (HHS) Secretary Kathleen Sebelius said Monday that she did not anticipate how complicated implementing the president's signature healthcare law would be.

"The politics has been relentless and that continues," Sebelius said, according to Reuters. "There was some hope that once the Supreme Court ruled in July, and then once an election occurred there would be a sense that, 'This is the law of the land, let's get on board, let's make this work.' And yet we will find ourselves having state-by-state political battles."

Speaking to students at the Harvard School of Public Health, Sebelius said implementation had been hampered both by the law's slow roll out and red-state governors and legislators who have rejected state-run insurance exchanges. 

"It is very difficult when people live in a state where there is a daily declaration, 'We will not participate in the law,' for them to figure out whether they are going to benefit," Sebelius said.

The HHS secretary said her department was "closely" monitoring state progress on the exchanges and Medicaid expansion, both set to debut at the beginning of October.

“We are doing a lot of very active one-on-one conversations with states around the country,” she said. “It’s a big lift, and I would say it’s a job that no one has ever done in this country before — not to put too fine a point on it.”

Sebelius also defended the law from criticism that health insurance premiums could rise because of the requirements under the Affordable Care Act. Last month, Sebelius became the first Obama administration official to acknowledge that insurance premiums could increase under the law. But Monday, the HHS secretary argued competition would benefit Americans as they sought a healthcare provider.

"For the first time ever in the history of the United States, they'll have to compete for service and customers, not by cherry-picking the market [and] trying to figure out who can only insure people who promise never to get sick," she said.

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Senate Democrats Air Grievances With Rollout Of Healthcare Law

Democrats who supported President Obama’s healthcare law grilled a top Health and Human Services official Thursday over what they see as holes in the implementation effort and the White House’s political bargaining.

Gary Cohen, the director of the HHS office overseeing the bulk of the healthcare law’s implementation, fielded tough questions from several Democrats.

Sen. Bill Nelson (D-Fla.) hammered HHS for inviting Congress to cut funding for a new nonprofit insurance model. Funding for healthcare co-ops was eliminated in the year-end tax deal, and Nelson said officials offered up the program as a place Congress could cut.

“Why was that negotiated away at the 11th hour?” Nelson asked.

Cohen didn’t have an answer.

Nelson noted that the co-ops funding was axed while applications for new co-ops were still in the pipeline. HHS had already approved a few new of them.

“I want somebody to be accountable for this, and if it was a mistake, for somebody to own up to it,” Nelson said.

Cohen also took hits from Sen. Maria Cantwell (D-Wash.), who criticized the administration for delaying implementation of the Basic Health Program — an option for states to provide cost-efficient health coverage outside of Medicaid and the law’s new insurance exchanges.

HHS has said it will not have the Basic Health Program ready until 2015 — a year behind schedule. State officials have balked, and Cantwell echoed their criticisms Thursday during the Senate Finance Committee hearing on the status of the implementation effort.

“We’re very concerned about the approach by the agency in trying to thwart this effort,” she said. “Are you artificially raising the cost to all taxpayers by trying to lure them onto the exchange?”

Cantwell warned that many members of the Finance Committee are familiar with state-based cost-control efforts and would not look kindly on HHS subverting them. She said the department has sidelined the Basic Health Plan in order to focus on the exchanges — which will provide subsidies from the federal government.

“What I’m very concerned about is the agency seems to think the technology of the exchange is the holy grail, and you’re trying to lure states” into the exchanges, she said.

Cohen said the Basic Health Plan has simply had to take a backseat to other priorities.

“I don’t think we’re trying to lure people into the exchange,” he said.

Finance Chairman Max Baucus (D-Mont.) was also skeptical about both the co-ops and HHS’ work on exchanges — specifically, integrating the complex and often outdated computer systems of the multiple federal agencies that will have a role in providing or assessing health coverage.

And Sen. Ron Wyden (D-Ore.) criticized the administration for not extending the law’s definition of “affordable” coverage to family plans.

The health law makes subsidies available to people who cannot buy affordable coverage from an employer, and defines an affordable plan as one that costs less than 9.5 percent of the employee’s salary. But that standard only applies to an individual policy.

So if an employee could insure herself for less than 9.5 percent of her income, but couldn’t afford to cover her whole family through her employer’s plan, she wouldn’t be eligible for subsidies and healthcare would remain unaffordable.

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