Sebelius Faults Texas Leaders Over Efforts Targeting Obamacare

While visiting Austin to highlight health insurance enrollment efforts under the federal Affordable Care Act, U.S. Health and Human Services Secretary Kathleen Sebelius acknowledged Friday that the online marketplace still isn’t working smoothly and criticized some Texas leaders for continuing to mount a political campaign against the law.

“It’s unfortunate that it is still being conducted as a political campaign and not as the law,” she said in an interview with the Tribune. “This is no longer a political debate; it’s the law of the land.”

Sebelius acknowledged that the success of the law hinges on enrollment efforts in Texas, which has the highest rate of uninsured residents in the nation — a quarter of the state's population, roughly 6 million people, are uninsured. Health care advocates and local elected officials across the state are working to educate Texans about their health care options in the federal marketplace, Sebelius said. But the political backlash promulgated by state leaders, including Gov. Rick Perry and U.S. Sen. Ted Cruz, “has come with a lot of fear and misinformation, and that is a difficult atmosphere for people to understand a new program."

Critics of the law have said that insurance premiums would ultimately climb and that businesses would cut back on employee hours or reduce existing health benefits. Even proponents of the law, such as state Sen. Wendy Davis, D-Fort Worth, have said technical problems need to be resolved because they are discouraging Texans from enrolling.

“With Secretary Sebelius in Texas today, she should keep in mind three things: Texans believe our federal government should be accountable, transparent and limited," U.S. Sen. John Cornyn, R-Texas, said in a statement. “If she’s still confused about who exactly she works for and if she hasn’t come ready to answer questions about why hundreds of millions of taxpayer dollars have been wasted on a botched product, she might as well not visit.”

The Affordable Care Act, also known as Obamacare, requires most Texans to carry health insurance beginning in 2014. The online health insurance marketplace that the federal government launched on Oct. 1 offers dozens of health plans and sliding-scale tax credits to help poor individuals and families purchase coverage, but it has been plagued with problems tied to the initiative's website.

“It’s far from being optimum, and we won’t stop until it is,” Sebelius told reporters at the CommUnityCare health center in Austin. Sebelius and Austin Mayor Lee Leffingwell toured the East Austin facility and met with certified application counselors who were helping Texans enroll using the website.

After the tour, she told reporters that six months of additional testing would have been ideal.

“We did not have the luxury of that. We had an administration that said it’s go time on Oct. 1,” she said, adding that House Republicans' efforts to stop implementation of the law, even at the cost of shutting down the government, did not contribute to an ideal atmosphere for the program’s launch.

For consumers, the website has been slow and full of glitches that have prevented them from signing up and shopping for health plans. There has also been a delay in the launch of a Spanish-language version of the website, and even larger problems remain on the back end of the website that consumers have not noticed. The site still isn’t able to transfer Medicaid-eligible applicants’ information to the state agency that oversees the program, the Texas Health and Human Services Commission. Furthermore, insurance companies have reported that the website is sending them wrong information about consumers who have purchased their health plans. In some cases, consumers may believe they’ve signed up for insurance and discover later that they are not covered because the insurance company did not receive correct information.

“Healthcare.gov, the website, is far from perfect,” Sebelius said. “It is getting better every day, but we have every intent to not stop until it is smoothly operating for the large volume of people who really want to use the website.”

Thousands of Texans who purchase their own insurance could experience a lapse in coverage if the problems with the federal website persist, because many insurance companies are canceling existing policies and pushing their customers to purchase new health plans on the marketplace. Texas’ high-risk insurance pool, which offers coverage to people denied by insurance companies for pre-existing conditions, is also shutting down at the end of the year. Individuals who want to replace lost coverage with a health plan in the marketplace must purchase a plan on or before Dec. 15 for the coverage to be effective on Jan. 1.

Sebelius emphasized that there are 26 weeks remaining for Texans to purchase a plan on the exchange and that they are working quickly to fix the technical problems. She said the Spanish version of the website will be running within the next two weeks.

Perry and the Texas Legislature chose not to set up a state-run marketplace or to expand Medicaid to cover impoverished adults. Perry has said he doesn't want to expand a "broken system."

“There will be millions of people still left uninsured on the side of the road if Medicaid expansion does not happen here in Texas,” Sebelius said, adding that she hopes talks about funding the program continue in the U.S. House and Senate.  

On a previous trip to Texas, Sebelius said she’s open to a “uniquely Texan” approach to expanding Medicaid coverage to impoverished adults. She elaborated on Friday that it’s up to the Texas Legislature to determine what that approach would be.

“It isn’t up to me to say what a Texas plan may look like,” she said, explaining states like Pennsylvania and Arkansas have created unique Medicaid expansion plans. There “isn’t one cookie-cutter approach.”

Many Texans, including Perry and GOP gubernatorial candidate Greg Abbott, have also raised concerns about the security of private information the website requires people to provide.

Sebelius said the security level of the website exceeds the privacy thresholds of others. “That information isn’t stored anywhere,” she said, explaining that the information is sent to the IRS and then Homeland Security for verification, without being stored by the federal government. “They are just verifying data and moving on.”

After her visit to Austin, Sebelius took part in a panel discussion in San Antonio. She further addressed the issues with the marketplace website, saying efforts to improve the site have included appointing Jeff Zients, the former Office of Management and Budget acting director, as her management lieutenant. The role of a general contractor currently being used to work on the site has also been expanded.

Sebelius said Zients would oversee efforts to fix issues with healthcare.gov.

She said that at times, only three out of 10 people can get through the entire insurance obtainment process on the website because of functionality issues, including connections on the website not working well.

Sebelius said Centers for Medicare and Medicaid Services employees have worked on the website’s technical issues but that the general contractor working on the website will now take on that role as well to make sure there is a day-to-day effort to correct functionality issues.

The panel included San Antonio Mayor Julián Castro, who spoke about city efforts to make insurance more accessible through the marketplace site.

Castro said San Antonio 311 employees and others who work closely with the public have been trained on the basics of how to obtain coverage. He said that coverage information has been placed in all city libraries and that San Antonio agencies, including hospitals and community outreach organizations, are working to inform the public about the marketplace.

“We know that folks access information in so many different ways, and I’m pleased that here in San Antonio, in Bexar County, that we have a full-court press,” Castro said.