U.S. Department of Health and Human Services/AP
In this Oct. 28, 2013, screenshot, the US Department of Health and Human Services' main landing web page for HealthCare.gov.

Obamacare: Warning about shaky rollout came as early as 2010, report says

Two months after Obamacare was enacted, a memo from an outside consultant questioned whether the appropriate personnel were launching the program.

In a May 2010 memo, a health-care adviser to President Obama bluntly told the White House economic director that the team responsible for enacting Obamacare lacked the necessary expertise.

"I do not believe the relevant members of the administration understand the president's vision or have the capability to carry it out," outside consultant David Cutler, a Harvard economics professor, wrote in the memo, which CBS News said it obtained. The recipient of the memo was Larry Summers, head of the National Economic Council.

It is not clear how far Mr. Cutler's memo traveled through the administration or whether it influenced the course of the Obamacare rollout, whose website malfunctions have embarrassed the administration and frustrated health-insurance shoppers since the Oct. 1 launch.  

The partisan battles surrounding Obamacare led the administration to keep its cards close to the vest, CBS suggests.

The White House "relied on appointed bureaucrats and senior White House health care advisers," according to an article on the CBS News website. "Fearful of constant attacks from congressional Republicans, the White House became secretive about the law's complexity and regulatory reach."

The Affordable Care Act was signed into law in March 2010, and the memo cited by CBS was sent two months later.

According to United Press International, more specific problems were brushed aside as late as September of this year. "Two private contractors testified before a House panel [the week of Oct. 28] they told administration officials the site had troubles two weeks before it opened to the public but the officials swept aside their advice to meet the Oct. 1 deadline," the news agency reports.

Just days before passage of the Affordable Care Act, Cutler publicly expressed optimistic support for the legislation, although he didn't comment on implementation. In response to concerns that Obamacare would fail to lower health-care costs, he evaluated in an opinion piece for The Wall Street Journal whether the plan incorporated 10 cost-lowering ideas. Cutler found that Obamacare incorporated six ideas fully and three partially. Only the public insurance option, which had faced opposition from the GOP and others, was not part of the plan.

"What is on the table is the most significant action on medical spending ever proposed in the United States," he concluded. "Should we really walk away from that?"

But in an interview around the same time as the memo to Mr. Summers, Cutler questioned whether the responsibility for implementing the reforms should lie with the Centers for Medicare & Medicaid Services (CMS). Overseeing insurance exchanges is “a completely different activity from running a Medicare program, so I wouldn’t necessarily give CMS running insurance exchanges,” he told the "Health Affairs" blog.

In the memo to Summers, he wrote, "It is frustrating any time you really want to see something succeed because you believe it's good for people, and it doesn't get off on the right foot."

"You need to have people who have understanding of the political process, people who understand how to work within an administration and people who understand how to start and build a business," he also wrote. "[U]nfortunately, they just didn't get all of those people together."

Mitt Romney, who enacted similar health-care reforms for Massachusetts when he was governor, told NBC's "Meet the Press" Sunday that Mr. Obama's mishandling of the national plan was "rotting" the foundation of his presidency. Current Massachusetts Gov. Deval Patrick (D) has argued, according to CBS, that the website problems are a blessing in disguise: In resolving them, the president will have another opportunity to sell the country on the plan, he said.

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