Dark days ahead for ObamaCare

 

The Obama administration is facing a slew of healthcare challenges as the winter holidays approach. 

While this fall has been a far cry from last year, when HealthCare.gov was melting down, 2014 has brought wholly unexpected problems to the fore for federal health officials and the White House. 

Take the conflict surrounding Jonathan Gruber, the ObamaCare consultant whose suggestion that a "lack of transparency" and voters' "stupidity" helped the law pass, went viral.

Though Democrats have sought to distance themselves from Gruber, his remarks have become a new flashpoint in debate over healthcare reform, invigorating GOP critics as the party prepares to take control of the Senate.

Gruber has agreed to testify before the House Oversight Committee on Dec. 9, in a final hearing for outgoing chairman and relentless administration antagonist Rep. Darrell Issa (R-Calif.).

The gathering, also set to include Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner, is sure to prove a distraction for the White House as officials try once again to keep a lid on opposition to the law.

Here are four additional challenges that the administration faces on healthcare this winter.

Open enrollment

ObamaCare's health insurance exchanges have opened for enrollment with few stumbles this year, in a victory for Health and Human Services Secretary Sylvia BurwellSylvia Mathews BurwellHHS launches contest to make bills simpler Obama administration takes step to reform Medicare payments Rubio breaks with GOP, backs Obama Zika request MORE.

But that doesn't mean the open enrollment period doesn't come with other difficulties. The administration has just until Feb. 15 to bring millions of new customers into the system and encourage existing enrollees to come back and shop again.

The three-month window — about half as long as last year — is proceeding while the back-end of HealthCare.gov remains partly unfinished. Health insurers have been exasperated by the delays, as health officials verify some account and application details by hand.

The goal for 2015 is to ramp up enrollment in a way that continues to bring down the uninsured rate and deepen roots for the exchanges.

Yet in a sign of lowered expectations, the administration is projecting just 9 to 9.9 million will sign up this year, short of the 13 million predicted by the Congressional Budget Office.

Flawed enrollment figure fallout

A Republican investigation revealed Nov. 20 that ObamaCare enrollment figures at HHS were inflated by roughly 400,000 people after the department miscounted dental plans as medical coverage.

The finding was a public relations setback for Burwell and the Obama administration, bringing back partisan strife over enrollment figures that had quieted since the spring.

Seeking to contain the fallout, Burwell asked managers at HHS to report suggestions for strengthening the department's "culture of increased transparency, ownership and accountability."

Still, Tavenner is expected to receive tough questions about the mistakes when she testifies before House Oversight on Dec. 9. The blunders are also likely to cloud any future enrollment figures the administration seeks to tout for 2015.

Tavenner appeared to blame the miscounting on HealthCare.gov in a recent letter to House Republicans.

“Once the automated system for effectuated enrollment is functional, the Centers for Medicare & Medicaid Services will be able to more easily report the number who has paid their premiums,” Tavenner wrote.

Non-profit birth control cases

The Obama administration was not pleased with the Supreme Court this month when it decided to hear King v. Burwell, a case that challenges the validity of subsidies distributed through ObamaCare's federally run exchanges.

Coverage of that case distracted from the fact, however, that the administration faces mounting challenges to the law's birth control mandate from non-profit groups.

Religious plaintiffs in more than 50 cases argue that participating in any process that leads to birth control coverage for their employees violates their faith, even if they do not pay for or distribute the benefits.

The administration says that it has made several accommodations that adequately address these concerns.

There are several hearings taking place over the next month, including in the 7th, 8th, 10th Circuits, advocates said, possibly signaling a string of decisions in the new year.

While circuits have not split on the question yet, experts believe the Supreme Court is likely to agree to hear the case next term.

 

Ebola

While the issue has receded dramatically from U.S. headlines, the Obama administration is still heavily involved in beating back the Ebola virus in West Africa.

U.S. Brigadier General Frank Tate announced good news on that front in recent days, reporting a "dramatic improvement" in the outbreak in Liberia, where U.S. efforts are focused.

Two of the planned 17 Ebola treatment units will not be constructed as a result of a decrease in new daily cases, and the Liberian government has set a national target of no new cases by Dec. 25.

Still, with a total death toll of 5,420, Ebola remains especially dangerous to Sierra Leone and its capital city, Freetown.

The World Health Organization has reported that only 13 percent of Ebola patients in the country are isolated, portending much wider spread of the virus.

"We are nowhere near out of the woods yet in West Africa," President Obama said this month.

"Although we should feel optimistic about our capacity to solve the Ebola crisis, we cannot be complacent simply because the news attention on it has waned," he said.