By James Bach
Gary Cohen, Deputy Administrator and Director, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid
Services, is not a computer guy. He’s a lawyer. He knows the insurance industry. And yet he was put in charge of a very large and important project: Healthcare.gov.
Here’s what BusinessWeek said about him on August 22nd:
“Gary Cohen seems awfully calm for a man whose job is to make sure Obamacare doesn’t flop. As head of CCIIO (awkward pronunciation: Suh-SIE-O), he oversees the complex, politically fraught system of state health insurance exchanges that will begin signing up uninsured Americans starting on Oct. 1. It hasn’t exactly been a smooth rollout. Many Americans still have no idea the exchanges exist, and the administration has struggled to explain who’s eligible for coverage under the Affordable Care Act and how they enroll. Cohen is convinced the confusion will clear up once things are up and running. “We’re going to get to the point where the discussions we’re having today will fade into the background,” he says.
He should have known that the system wasn’t going to work, at that point. But he’s not a technology guy, so perhaps he thought some big-brained hacker from the movies was going to pull it together at the last minute?
Here’s what he was asked and what he answered at a House Committee on Oversight hearing on May 21st:
Ms. DUCKWORTH. …Could you speak a little bit on the Administration’s readiness toreach out to this huge number of people so that they can enroll intime? Basically, you say that you are going to be ready to go onOctober 1st, and you need to be. If not, what do you need in orderto get ready and have a successful rollout of these provisions?
Mr. COHEN. So we have a plan in place that basically is timedso that people are getting the information close to the time inwhich there is something that they can do with it. So right now weare in what we call the education phase, which began in Januaryand proceeds through June, where we are just putting out information.We are in the process of re-purposing the HealthCare.gov siteto be really a consumer information site. Our call center will begoing live in June, where people will be able to call and get informationthat way. And then starting in the summer we will beginwhat we call the anticipation, or get ready phase. And I am not anexpert in these things, but what I understand is that if you starttoo early and then people say, well, what do I do, and then thereis nothing that they can do because it is too soon, then you mayend up having people who get a little bit kind of frustrated or disappointed.So we really are gearing towards making sure the people get theinformation they need in time for October, when they actually cantake action and begin to get enrollment coverage.
Hmm. He was asked directly if he needed anything to make sure he was ready to go on October 1st. His answer was basically: no thank you.
Did he really think everything was on track? Why didn’t his people prepare him to set expectations better?
Mr. GOSAR. Mr. Cohen, how closely is HHS working with IRS on Obamacareimplementation?Mr. COHEN. We are working closely with IRS on those aspects ofimplementation where we have to work together, so, for example,as you know, in determining whether a person is eligible for Medicaidor CHIP on the one hand, or tax credits in the marketplaceson the other, income is a test, and we are working with IRS onverifying people’s income when they apply.Mr. GOSAR. So the IRS is going to be gathering and sending thisenormous amount of taxpayer information to all the 50 exchanges.All 50 exchanges are to be ready by October 1st, right?Mr. COHEN. Yes.Mr. GOSAR. So will there be any problems with this massiveamount of data sharing?Mr. COHEN. No. And data sharing may not be exactly the rightway to look at it. Basically what will happen is people will put informationabout their income in an application; that informationwill be verified by data that comes from the IRS, but there is noexchange of information from the IRS to the exchange; the informationgoes out, it is verified, and it comes back.Mr. GOSAR. But it is still from the exchange going to the IRS,and that is where I am going.Mr. COHEN. It is going to the data hub. Information is comingfrom the IRS to the data hub and from the exchange to the datahub, and there is a comparison and then there is an answer back.But the tax information isn’t actually going to the exchange.
What a refreshingly blunt answer to the question of whether there will be any trouble with data exchange: No. Unfortunately, we now know there are massive problems with that. Why didn’t he give a more nuanced answer? Why didn’t he hedge? This is why I think he’s an innocent– a child put in charge of the chocolate factory. He didn’t need to be, but that’s how he played it. I guess he was distracted by other duties and trusted the technologists? Or maybe he dismissed the concerns of the technologists as mere excuses? I wonder.