Clipboard: Without an outside ACA czar, an avalanche of troubles

Health and Human Services Secretary Kathleen Sebelius is surrounded by photographers on Capitol Hill in Washington, Wednesday, Oct. 30, 2013, prior to testifying before the House Energy and Commerce Committee hearing on the difficulties plaguing the implementation of the Affordable Care Act. Sebelius, President Barack Obama's top health official faced tough questioning by a congressional committee Wednesday that will demand she explain how the administration stumbled so badly in its crippled online launch of the president's health care overhaul. (AP Photo/ Evan Vucci)
Health and Human Services Secretary Kathleen Sebelius is surrounded by photographers on Capitol Hill in Washington, Wednesday, Oct. 30, 2013, prior to testifying before the House Energy and Commerce Committee hearing on the difficulties plaguing the implementation of the Affordable Care Act. Sebelius, President Barack Obama's top health official faced tough questioning by a congressional committee Wednesday that will demand she explain how the administration stumbled so badly in its crippled online launch of the president's health care overhaul. (AP Photo/ Evan Vucci)
AP

Sunday’s Washington Post story about the breakdown in the White House’s management of the Affordable Care Act is a must-read.

Reporters Amy Goldstein and Juliet Eilperin outline how the decision to ignore advice to hire an outside health care czar to manage implementation of the program led to an avalanche of challenges that led to the failed launch of the HealthCare.gov last month.

David Cutler, a Harvard economist and former advisor to the Obama campaign, sent a memo to top administration officials in 2010 saying that early implementation efforts hadn’t gone far enough, and he worried that those leading the effort from within the administration did not “understand the President’s vision or have the capability to carry it out.”

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“They were running the biggest start-up in the world, and they didn’t have anyone who had run a start-up, or even run a business,” Cutler told the Post.

The story explains how the Obama administration leaders’ political sensitivities and reluctance to give the Republicans any fodder caused them to pullback, slow, or shield from the public view certain implementation steps or challenges with the health care rollout.

In one case, the administration delayed the deadline by which states had to decide whether they would create their own insurance marketplaces, hoping that more would opt in after the 2012 election and narrow the scope of the federal exchange. Cutler renewed his warnings then, to no avail, he told the Post.

The story unravels a little like a historical thriller that you know ends in disaster:

A month [before the website launched], on Sept. 5, White House officials visited CMS for a final demonstration of HealthCare.gov. Some staff members worried that it would fail right in front of the president’s aides. A few secretly rooted for it to fail so that perhaps the White House would wait to open the exchange until it was ready.

Yet on that day, using a simplified demonstration application, the Web site appeared to work just fine.