Let’s start with the newsiest based on giant news that broke just hours before the press conference and move on from there.
1. Hey, from where do you derive the legal authority to change large parts of this law passed by Congress? And, if you believe you have the legal justification for it, what’s to stop a future president from simply deciding he won’t enforce large parts of it?
2. How exactly does the hardship exemption work? Do you have a ballpark number for how many Americans might be eligible? Is there an enforcement mechanism? For instance, will the IRS or someone demand to see a cancellation letter and proof a family couldn’t afford a new plan? If they don’t have the proper evidence would they later face any consequences?
3. Does the administration have the authority to exempt people from certain taxes on an ad hoc basis? From where does it derive this power? Are there other taxes from which people could be exempted by the president’s decree?
4. The demographic make-up of the group enrolled in the exchanges is extremely important to making the law work and avoiding a death spiral, or adverse selection. HHS has been extremely stingy with numbers and specifics about those demographics. Do you have them? Are you getting reports or any sense of what the pool looks like? Colorado, for instance, is enrolling large numbers of 45+ citizens. Does that suggest to you that the health of the pools is in danger? And, could we get some assurances from you that the administration will be transparent about these numbers as we move forward?
5. A report today reveals that Teresa Fryer, chief information security officer for the Centers for Medicare and Medicaid Services (CMS), thought HealthCare.gov was so full of security holes it should be denied its “Authority to Operate” certification but was overridden. Your HHS Secretary Kathleen Sebelius has said she had no knowledge of security concerns yet Fryer has reportedly told Congress members she briefed Sebelius and others. Were you aware of any security concerns before the launch? Are you at all confident Americans who are submitting sensitive information to the site are safe? Will the federal government be transparent about breaches when and if they happen?
Follow up: There have already been two “high-risk” security findings found as the site has been operating over the past months, along with several medium and low-risk findings. Are you kept abreast of these findings? How did the site launch with these security issues unresolved? Should it have been delayed until they were fixed?
6. Today, just hours before we came to this press conference, the HealthCare.gov website was down. It had a note on it referring to the crash as “scheduled maintenance.” Was it scheduled maintenance today or just another crash? And, if it was scheduled maintenance, why was maintenance scheduled just days before the extended deadline for enrollment?
7. Given the high number of cancellation notices that have gone out—estimates are rough, but some think it may be in the millions if you add up data available to us state by state—combined with the persistent problems with the website, isn’t it possible that the net number of insured will actually go up in the new year? As the formerly insured add to the uninsured pool because they cannot afford a new plan, or they can’t get through the process on HealthCare.gov, or take this latest exemption as a reason to put off purchasing altogether, wouldn’t that destroy this law’s raison d’etre? What does it mean if ACA, which was meant to get the uninsured insured, is a net negative in terms of insured Americans in 2014?
8. CMS/HHS officials have testified that the portion of HealthCare.gov that would actually pay insurance companies has not yet been built. HHS has said it will use a “workaround” that involves having insurance companies estimate what they are owed in subsidies and later resolving differences. How is it possible a payment mechanism for subsidies was not built into the original site, as launched. When will it be built? Do you feel confident the federal government can transfer subsidies via this workaround? Given the complexity of the subsidy formula, are you confident insurance companies even know where to begin in calculating what they’re owed? How will we know tax money is not lost on overestimations?
9. Many insurance companies have reported getting bad data and duplicative data from HealthCare.gov about enrollees. They also fear they are missing some data entirely. Is there a possibility that some of the Americans who were able to get through HealthCare.gov’s enrollment process might think they’re enrolled but they’re not? How can those people protect themselves from this possibility?
10. Your announcement about the hardship exemption to ACA’s rules allows those who feel they cannot afford a new exchange-eligible plan with all the Essential Health Benefits to avoid penalty for not being insured or to buy a catastrophic plan that was supposed to be for young people. Is the acknowledgement of this “hardship” an acknowledgment that the ACA has more problems than a broken website and bad publicity? That it has substantive problems too, such as unaffordability?
In doing this, your administration has deemed the ACA itself “an unexpected natural or human-caused event.” In other words, it is a hardship, is it not?
11. Ezra Klein of the Washington Post, longtime supporter and reporter on the Affordable Care Act, wrote today that your hardship exemption is the “first crack in the individual mandate.” He also warned that it might make it harder for you and Democrats in Congress to resist calls to extend the exemption to others. How do you justify exempting those who were formerly insured but now cannot afford a plan but not those who never were insured because they couldn’t afford plans? Why not do what some have suggested and delay the individual mandate for everyone?
And, finally, since the press loves so much to talk about the politics and feelings of things instead of the actual news causing millions to lose their insurance, I offer this one.
12. You are about to embark on a two-week Hawaiian vacation. While no one begrudges the president Christmas with his family, are you aware that two state-level Obamacare exchange directors have resigned over taking ill-timed tropical vacations within the last two weeks? Are you sending the wrong message by leaving for so long while your legacy law is in pretty great peril, while Americans are still reeling from cancellations and the prospect of being uninsured? What will you be doing from Hawaii to ensure HealthCare.gov’s problems are resolved? Should we anticipate any other law changes while you’re gone?
And, while we’re on the subject of resignations and such, let’s make this a baker’s dozen:
13. Thus far, not one person has been fired for the roll-out of ACA you yourself have called “screwed up.” Why not? Has anyone been disciplined? If not, why not? Will anyone lose their job over this now three-month-long calamity?
It is rare that the White House press corps asks exactly what I want it to ask, but today’s display, with a few notable exceptions, was truly irresponsible. Not only would critics of Obamacare like to know how Obama proposes to fix it, but I’m sure the law’s liberal champions would appreciate some more information and assurances as well. Real people are losing their real coverage in real life, and the press corps is wasting the bulk of its questions on this pitifully rare opportunity on how the president feels about this rolling calamity. Well, if the president’s mind-numbing self-reflection can cure your kids when they get sick, you’re in luck, America. Otherwise, you’ll have to wait for the next meeting of the White House Encounter Group for a shot at more answers from the man in charge.