Obamacare and the Sebelius legacy

It's doubtful that anyone ever expected the resignation of Kathleen Sebelius as secretary of Health and Human Services--whether it came last fall during the website disaster or on Thursday, when it actually was announced--to bring clarity to the national debate over the Affordable Care Act.

And it hasn't. Most of the reporting of her announcement has highlighted the rocky launch of the government's enrollment portal, HealthCare.gov. The law's surprising success in overcoming its stumble at the starting gate, as represented by this week's announcement that 7.5 million Americans have signed up for insurance for 2014 via the state and federal exchanges, gets second billing at best. That's life in politics--Sebelius's obituary will probably read the same way, no matter what Obamacare's record shows when that day comes. 

Still, it's proper now to put the ups and downs of the ACA's launch under Sebelius' leadership in context. The rollout was not going to be easy under even perfect conditions. It was complicated vastly by the decision by 34 states to rely on the federal website to handle their enrollments, and by 34 to let the feds create their exchanges either wholly or in partnership. (States are not necessarily in both groups.) The refusal by 25 states to expand Medicaid also cut into the ranks of Americans helped by the law.

Sebelius is faulted, for the most part deservedly, for presiding over the initial failure of the website. The exact nature of her dereliction is murky, however; so many of its moving parts broke down it's still hard to say what could have been avoided and how. Jonathan Cohn argues in the New Republic that although Sebelius had experience as a regulator in Kansas and as a political leader with a record of bipartisan collaboration, "what Obamacare needed more was a deft, aggressive manager." He asserts that "Sebelius did not grasp the severity of tech problems at healthcare.gov until the day it went live and crashed."

Actually, we may have to wait for Sebelius' memoirs, if she writes them, to know when she recognized the severity of the problems. But it's probably more fair to say that what Sebelius needed was a "deft, aggressive manager" of the technological rollout.

A technology wonk might have had the website working better, but would have been utterly unable to navigate the ideological shoals through which Obamacare has had to sail. There probably aren't too many political figures who could have dealt with the relentless assault on the ACA with as much equanimity as Sebelius mustered. The record of the last six months suggests that even a flawless launch of HealthCare.gov would not have stemmed the attacks on the law. After all, it's operating fine now; have you heard a single Republican acknowledge that?

The appointment of White House budget chief Sylvia Mathews Burwell as Sebelius' successor offers a chance to provide clarity on the Affordable Care Act. Her confirmation hearings will provoke a Republican swarm. It will be up to Burwell to voice the full-throated defense of a law that has been lacking on the Democratic side, despite its having brought health insurance to 9.5 million or more Americans.

Republicans will unleash every threadbare and fabricated attack on the law in their arsenal. These have all been heard and punctured before, but if Burwell handles her task adeptly, she can put an end to much of the sophistry. The law is working; it has brought insurance to millions of Americans who didn't have it before; it has begun to reduce the rate of healthcare cost increases. Burwell can and should issue a challenge to the anti-Obamacare holdouts: There are parts of the law that need improvement, as is true of any law; if Republicans really care about bringing affordable healthcare to their constituents, they should roll up their sleeves and help her do so. 

Reach me at @hiltzikm on Twitter, Facebook, Google+ or by email. MORE FROM MICHAEL HILTZIK

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