Four questions facing Sebelius

Health and Human Services Secretary Kathleen Sebelius is expected to be grilled Wednesday when she becomes the highest-ranking official to testify about the problems plaguing the HealthCare.gov website as well as questions surrounding the implementation of the Affordable Care Act. Here are four of the questions she is likely to have to answer.

1. When did she find out about the problems with the website?

Last Friday in Austin, Texas, Sebelius was asked at what point did she realize the system wasn’t going to operate the way it was envisioned.

“Well actually I didn’t realize it wouldn’t be operating optimally before the launch. I think we knew that if we had had another six months we would probably test further, but I don’t think that anyone fully realized that both volume caused problems, but volume also exposed some problems.”

Andrew Slavitt from the contractor QSSI testified last week before a congressional committee the company noted software problems before the launch. Cheryl Campbell, an executive of a different contractor CGI, told the same hearing top officials at the Centers for Medicare and Medicaid Services (CMS), the part of the Department of Health and Human Services responsible for setting up the site and implementing the law, were continually briefed. CMS Administrator Marilyn Tavenner told the House Ways and Means Committee Tuesday “We had tested the website, and we were comfortable with its performance.” So what did HHS officials know about any problems and were White House officials notified of any problems?

In an interview with CNN’s Chief Medical Correspondent Dr. Sanjay Gupta last week, Sebelius was asked when President Obama first knew of the problems. “I think it became clear fairly early on, the first couple of days...” Gupta then asked: not before that? She answered “no sir.”

2. Why wasn’t more testing done?

Contractors working on the website say they warned CMS officials about some of the problems they were seeing and that only two weeks was allotted for full testing before the Oct. 1 launch. QSSI's Slavitt said during his testimony last week the company had informed CMS more testing was necessary and added "months would have been nice." However, none of these red flags were raised by contractors or the government in a congressional hearing in September.
Some of the most comprehensive system testing came just weeks before the Oct. 1 launch, and the Washington Post has reported at that time problems were detected.

Officials from several contractors said it was CMS’ decision to go ahead and go live with the site.
Sebelius and other administration officials have blamed the initial volume as a major reason for the inability of people to set up accounts and use the site, although other problems have been reported as ongoing, such as bad enrollment information being sent to insurance companies.

“We tested to a level that was five times the level that Medicare.gov, a well-known operating website, had ever had. We thought if you increase that volume five times that’s probably the maximum hit you would get at one time particularly with a brand new site,” Sebelius said last week. “We were just wildly incorrect. Numbers so far exceeded that now there are very specific diagnostics in place.”

She told CNN’s Gupta that if “we had an ideal situation and could have built the product in, you know, a five-year period of time, we probably would have taken five years. But we didn't have five years. And certainly Americans who rely on health coverage didn't have five years for us to wait. We wanted to make sure we made good on this final implementation of the law.”
Rep. Fred Upton, R-Michigan, chairman of the House Energy and Commerce Committee, which is holding Wednesday's hearing, said "The testing was so poor ... in essence, it's like contractors building a house, but the guy building the first level, the first story didn't know that the basement is on the next lot. I mean, there was just no connectivity. We heard those complaints from a number of different private sides. But at the end of the day, this was not ready. It's been a disaster in the making," he told CNN's Wolf Blitzer on the Situation Room.

3. How much will the fixes cost?

HHS officials have not said how much the fixes to HealthCare.gov may cost. When CMS announced on Friday QSSI was being brought on as the general contractor overseeing the changes, officials said the company's original contract was being expanded but would not say how much more it may be paid. Also CMS officials have repeatedly refused to divulge information about who is doing the "tech surge" which is bolstering the existing staff working on the site to improve the technical capabilities and operations.

"We are bringing in people from both inside and outside the government to scrub in with the team and help improve HealthCare.gov," Sebelius says in her prepared testimony.

Upton said she will also be pressed on how much this will cost. "We know it's in the hundreds of millions of dollars what they've spent so far. We don't know if there are penalties that are going to be imposed because they didn't get this thing done right. We have no clue what the additional cost will be to try and get it right as the secretary said by the end of next month. We'll try to get an answer to that," he told CNN.

4. What will she say to those whose policies are being cancelled?

Upton claims millions of people are receiving notices their current insurance policies are being cancelled because they don't comply with minimum standards set by the Affordable Care Act. These are people who have individual policies - not ones under their employer which is the vast majority of Americans or have Medicaid or Medicare. The Obama Administration estimates about 5% of the nation have individual policies which often have less generous coverage, such as not including hospital or mental coverage, as well as higher deductibles making them much cheaper.

The White House was criticized Tuesday by Republicans because President Obama had often said that people who like their insurance policies and want to keep them will be able to. White House Press Secretary Jay Carney fought back against that criticism saying if people had their plans before the Affordable Care Act was passed they are "grandfathered in" - meaning by law they can keep them. For others who have obtained this insurance after Obamacare became law, those are the plans that are subject to possible cancellation.

Sebelius is likely to get a question similar to one posed by Upton on CNN on Tuesday saying those facing cancellation should be given more time to enroll in an alternative plan. "Why not allow them to have that choice for the next year knowing that this roll out has been so poorly designed?"

Her response could mirror what Carney said on Tuesday: these people deserve better coverage as soon as possible. "Those are the Americans who have been most subject to the wild vagaries of the system as it existed before the Affordable Care Act, who at the drop of a hat could have lost coverage or been told that their premiums were doubling, or that they would have no longer been able to get coverage for a specific condition because it was preexisting. All that changes come January 1st. "

CNN's Adam Aigner-Treworgy contributed to this story