A meeting with Kathleen Sebelius about Obamacare

Recently, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights.

First and foremost, addressing the issue of the website, to us in the room and later to the crowd, the secretary said, “It’s like the first quarter” of a football game, and we should not “declare it game over.” As a life long football fan, I agree that we must not rush to judgment. In fact, I would expand the analogy further. The rollout is the kickoff in the first quarter of the first game of the first season. Many more seasons or enrollment periods will come for the ACA. And yes, the administration fumbled the ball on the kickoff with its website.

I had watched Secretary Sebelius being grilled in Washington by the Republican legislators. Many said that the website exemplifies the failure of Obamacare as a whole.

What is so ironic is that the very congressmen and women who were berating Sebelius due to ACA’s website failure have been trying to repeal, replace and de-fund the ACA. At times I wonder, in their heart of hearts did the congressmen and women really want the website to work perfectly?

“It’s politics,” a colleague at the meeting tells me.

So if we look at the ACA beyond the politics, we, as Americans, realize there are many compelling challenges we face.

First, as people begin signing up, albeit in trickling numbers, we are recognizing that many lack health care literacy, especially as it relates to health insurance. People may understand terms like deductible, premium and co-pay. But few know the bronze, silver and platinum options or terms such as co-insurance. Even I had to refer to the glossary on the healthcare.gov website to learn that “Coinsurance is similar to copayment, except it’s a percentage of costs you pay (instead of a fixed amount).

Another challenge has been to better understand why some privately insured individuals are having their coverage dropped, despite the President pledging “if you like your health insurance, you can keep it.” A New Yorker magazine article looked at the “winners, losers and the unaffected” among the population as a whole with respect to insurance status due to ACA. The writer estimates that 80 percent of people will be unaffected, and 3 percent will have no real consequences but will have to buy new but similar plans. However 3 percent will be losers, in that they will have to buy a higher-quality plan (which provides the mandated 10 essential health benefits with no annual cap and may cost more), and 14 percent will be clear winners who will gain access to affordable health insurance.

A third challenge for the ACA has been how divisive it is to the American people. Despite the frustrations with the enrollment on the website, the public has been evenly divided between those who approve or disapprove of the program. However, if we look at those statistics closely, more than 10 percent of those who disapprove of the health law do so because they wanted a more liberal plan, such as a single payer or a public option.

In our meeting with the secretary, we brought up our greatest concern and challenge that the law poses for Tennesseans: the lack of Medicaid expansion and how the secretary could work with Governor Haslam. By one estimate, the Tennessee legislature and governor are leaving $300 million on the table every quarter that they decline to accept Medicaid expansion, such as the plan adopted by Arkansas. Each quarter, millions of Tennessean’s tax dollars are siphoned to other states to pay for their Medicaid expansion, and hospitals like the Regional Medical Center and others are feeling the strain. The next step is for the governor to submit a plan to the secretary on how Tennessee may consider expanding Medicaid, and receive the additional Medicaid funding.

During our half-hour discussion, I closely watched the secretary to see if she seemed bitter, blaming or defensive. Instead, I found her to be genuinely regretful that the website has caused frustration to so many Americans. I think she was blind-sided by the complexity of the intersection of computers and health care. I can empathize with her; recently, I too was blind-sided and failed miserably — and that was simply trying to implement an electronic medical system in my own office.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and The Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain. This article originally appeared in The Huffington Post.

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  • PoliticallyIncorrectMD

    So based on the last paragraph the excuse for this complete failure is being “blindsided”. Great! Still want the government involved in directing healthcare, anybody ?

    • James_04

      I’m really keen for these people to take over and “fundamentally transform” one-sixth of the American economy. I mean, based on their display of shining competence so far, what could go wrong??

    • Mengles

      “I think she was blind-sided by the complexity of the intersection of computers and health care.”

      The IT part of healthcare is the LEAST of Obamacare’s problems.

      • May Wright

        The gruffest, most curmudgeonly conservative I know is hoping that the website gets fixed as soon as possible, because he feels much as you do, that the IT part is the least of the ACA’s problems. He wants it working so that people can get in and start becoming cognizant of the more grave issues.

        • ninguem

          Indeed. Get it to collapse faster that way.

  • doc99

    The idea that cancellations affect only 3 – 5% is a myth.
    http://Www.forbes..com/sites/the apothecary/2013/11/fact-checking-the-presidents-kind-Of-sort-of-apology-for-Obamacare-driven-insurance-cancellations/

  • Ron Smith

    I’m sorry, Manoj, but to be frank you talk like a Democratic shill. You’re not trying to explain anything. You’re trying to convince us that somehow Obombacare is going to come back and everything is OK.

    I’ve already enumerated why I think that won’t happen. Blackberry is a prime example. Once they were on top. Despite however great the second round product was, the lack of foresight and innovation in their first one proved that they weren’t worth a second look.

    Obombacare won’t be worth a second look either, because the first impression will never be forgotten. I predict right now that Obombacare is done. The American people know now exactly why government should never, ever be in control of health care. Too many problems with their implementation and rollout of the web site really have left the most important risk exposed.

    That risk is security and fraud. You may as well post your social security number and every credit card number, pin, expiration date, security code, and password on Facebook, because that’s exactly what you’ll be doing if you do any business with the government.

    Time to rake the scraps of this mess off into the trash can and move on, because its done. Good riddance!


    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • May Wright

      The narrowed provider network and the high out of pocket limits which are going to shock those who aren’t used to paying for their own routine healthcare needs are the two biggest health-related issues I see with the ACA, but the data security issue is one that I see as becoming a bigger and bigger problem the more people start signing up. Maybe each healthcare.gov account should come with a free subscription to LifeLock.

  • May Wright

    “Dressed in a light green blazer…”

    Why no fashion commentary on any of the men present? If you had been meeting with Health and Human Services Secretary Ken Sebelius, would it have been important to make a point of what he was wearing?

    Sorry, this is just a pet peeve of mine.

  • NewMexicoRam

    What if they get the website up and running well (even taking care of the security risks)?
    Will more people sign up? Let’s just say they do.
    There still will be millions who are being forced to pay more for things they don’t want in their insurance.
    And going further, what about when the employer mandates and fines take effect in 2015?
    I predict this current mess will look like a small blemish compared to the multi-millions who will lose employer based plans.

  • NewMexicoRam

    They had to pass the bill to find out what was in it because they knew people wouldn’t like what was in it.
    Why people keep voting Democrat can only be answered by understanding the Democrats keep the money flowing to way too many people.

  • buzzkillerjsmith

    Dr. J. failed at his EHR. What is this column, some kind of a sophisticated joke that we’re all missing? Or is Dr. J really that incompetent at connecting the dots in this world?

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