Medicare Chief Marilyn Tavenner will be questioned Tuesday by the House Ways and Means Committee not only on what went wrong with HealthCare.gov, but also whether lawmakers can trust Obama administration promises to have things running efficiently by the end of November.
At stake is what the Republicans' partial government shutdown could not achieve: a delay of President Barack Obama's law expanding coverage for millions of uninsured Americans. As a result of widespread sign-up problems, even some Democrats have joined Republicans in calling for a one-year postponement of the law's tax penalties for people who fail to obtain health insurance. The insurance industry warns that would saddle the new system with too many high-cost patients.
Less well known than Health and Human Services Secretary Kathleen Sebelius, Tavenner was closer to the day-to-day work of setting up the enrolmentwebsite, which was handled by experts within her agency, the Centers for Medicare and Medicaid Services, along with outside contractors. Like other administration officials, she previously had assured Congress that everything was on track for a reasonably smooth launch in all 50 states. Medicare and Medicaid are the government programs that provide health care coverage for the elderly and poors.
"If people can't navigate such a dysfunctional and overly complex system, is it fair for the IRS to impose tax penalties?" said Ways and Means Chairman Dave Camp. In a concession, the White House has said it will waive Internal Revenue Service-imposed penalties for anyone who signs up by March 31, in effect granting a limited grace period.
Tavenner began her career as a nurse and built a successful record as a hospital executive before entering public service. Seen as a businesslike manager, she has enjoyed support from lawmakers across the political spectrum. Indeed, Republicans are calling for Sebelius to resign, not Tavenner. But the Medicare chief's professional reputation is also at stake.
On Monday, a spokeswoman acknowledged Tavenner's central role. The Medicare agency "has said we are responsible for the issues the website is currently facing," communications director Julie Bataille said. As administrator, Tavenner "has been in charge of the overall ... implementation effort."
What Tavenner knew about the potential for problems and who she told will be key questions from lawmakers. Additionally, some are concerned about the security of the HealthCare.gov site. Others worry about unintended consequences from the feverish, hasty work to repair the site.
Sebelius is likely to face some of the same questions Wednesday when she appears before another powerful House panel, the Energy and Commerce Committee.
With congressional elections coming next year, Republicans are using the troubled launch of the government website to regain support after their effort to defund the health care law led to a 16-day partial government shutdown.
Momentum to fix the problems has grown since Obama personally acknowledged the problems last week. He sent in management consultant Jeff Zients to assess the situation. By the end of the week, Zients reported that he had two big lists with dozens of needed fixes, and said he was optimistic they could be completed by Nov. 30.
HHS also announced that an outside company would assume the role of general contractor shepherding the fixes, in effect taking over the co-ordination job that Tavenner's agency had been doing.
Although the administration has released a blizzard of statistics on the numbers of people visiting the website, opening accounts and having their income verified by the Internal Revenue Service, it has yet to say how many have successfully enrolled for health insurance.
The website was supposed to be the online portal to coverage for people who don't have a health insurance plan through their employer. Its target audience is not only uninsured Americans but those who already purchase coverage individually. A companion site for small businesses has also run into problems.
Under the law, middle-class people can qualify for tax credits to make private health insurance more affordable, while low-income people will be steered to Medicaid in states agreeing to expand that safety net program.
The U.S. has been the only major developed country without a national health care system, and the overhaul was supposed to change that. The system is not the centralized, government-run setup seen in places like Britain and instead uses various ways to require or encourage Americans to get private or, for the poor or elderly, government-provided insurance.
What's become known as "Obamacare" is the closest the U.S. has ever come to universal health care after a century of efforts, and it has been under heavy attack by opposition Republicans from the start.