Who Holds the Most Influence Over the Fate of Obamacare? These 7 People

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Obamacare clearly has bigger problems than the GOP.

Sure, the Republican Party has been relentless in its efforts to defeat the president's healthcare reform law - from voting for its repeal 41 times in the House to forcing a 16-day government shutdown in an attempt to prevent its funding or delay its implementation.

With the problem-plagued rollout of the law's critical online marketplace, critics have launched some vicious attacks …and not just from the Right. Former Obama Press Secretary Robert Gibbs called the website troubles "excruciatingly embarrassing." The Washington Post 's liberal blogger Ezra Klein, one of the law's biggest advocates in the media, termed the launch a "disaster" and a "failure." The avalanche of criticism, including from such figures who have defended the Obama administration and the Affordable Care Act, magnifies the threat to the program from the troubled website.

As the administration scrambles to put together a "tech surge," an as-yet untold number of programmers will be tasked with fixing the site's flaws. But whether or not their efforts succeed, the fate of Obamacare may well be determined by a key group of other players.

Here are seven people who wield enough clout to decide the fate of the president's signature health care law as well as its website:

President Obama

While attempting to sell his own signature health care law, President Obama has at times been his own worst enemy. His Monday press conference prompted comparisons to a used car dealer or an infomercial pitchman. Obama didn't specify exactly what went wrong or who was to blame for the problems. Instead, he continued to sell his law, bragging that it was a "good product" and offering a phone number for the call assistance centers. "I want to repeat that: 1-800-318-2596. Wait times have averaged less than one minute so far on the call centers," Obama said.
Others may be handling the dirty work of fixing the marketplace's technology, but the president must still steer through a public relations crisis and convince Americans to enroll in his exchanges.


Kathleen Sebelius

However deeply the Secretary of Health and Human Services was or wasn't involved in the technical development of the HealthCare.gov site, she has been the second most visible figure (behind the president) in the launch. Unfortunately for the Obama administration, she has stumbled at times in that role. In an interview with Jon Stewart two weeks ago, Sebelius was unable to explain why the website had so many problems.

In an interview with CNN on Tuesday, she said that despite growing concerns over the technology, the president didn't hear about the problems with the exchanges until after they went live on Oct. 1. Those appearances failed to answer key questions and may have only served to raise more public relations issues for the White House. Sebelius is expected to testify before Congress next week. But if her performance is anything like her recent interviews, the fire surrounding Sebelius may only get hotter.

Jeffrey Zients

The former acting director of the Office of Management and Budget is slated to become the director of the National Economic Council in January. Before he gets there, though, he's been given another title: Mr. Fix-It. The White House tapped Zients, a 46-year-old described as "an expert in the field of effective management" and known for cutting through red tape , to troubleshoot the HealthCare.gov site. Zients had served as the country's first "Chief Performance Officer" and had helped fix problems with the 2009 Cash for Clunkers program. Now, as the first person publicly named to be part of the "tech surge" strategy for the site, he'll have to help make sure the government doesn't have another clunker on its hands.


Jon Stewart

Fast-talking, liberal comedian Jon Stewart delivered another scathing takedown of the HealthCare.gov site on his show Monday night, but his ridicule is no laughing matter for the administration. Stewart's "The Daily Show" audience is dominated by the same young people the president needs to persuade to enroll in the exchanges in order for his law to succeed. In fact, earlier this year, the Obama administration estimated that it would need some 2.7 million "young invincibles" ages 18-34 to sign up through the insurance exchanges to offset costs in other areas. If Stewart's repeated and ruthless criticism of the website deters these healthy young Americans from signing up if or when they are able to, Obamacare could enter a death spiral as insurance prices climb higher and higher.


Chris Chocola and Jim DeMint

Club for Growth President Chris Chocola and Heritage Foundation President Jim DeMint are the key players fueling the "defund Obamacare" movement. Both have urged GOP lawmakers to do everything they can to thwart the president's health care law. Their two groups wield enormous power over the Republican Party, exerting their influence by ranking lawmakers on their conservative voting records and using - or threatening to use - substantial campaign donations for or against candidates.
In the most recent example of their undisputed influence, both groups advocated against passing a "clean" bill to fund the government because it failed to strip out funding for Obamacare. Heritage Action, the lobbying and advocacy arm of the Heritage Foundation also sealed the fate of Speaker John Boehner's last-ditch attempt to push a House GOP plan ahead of the debt-ceiling deadline last week when it announced it opposed the proposal.

Even as many Republicans acknowledge that they lost the shutdown fight, the influence of these conservatives has been instrumental in marshaling continued opposition to Obamacare, potentially undermining its odds of attracting consumers.

In fact, even after it was clear that the GOP had lost the government shutdown battle to defund Obamacare, Heritage Action CEO Michael Needham signaled that the group was still determined to go after the law, and will use the next election cycle as a jumping off point to attempt to repeal it in 2017. "Well, everybody knows that we're not going to be able to repeal this law until 2017, and that we have to win the Senate and win the White House," Needham said on Fox News.

John Koskinen

Even if everything under the law actually goes according to plan, the Internal Revenue Service could still screw things up. That's because starting in 2015, the IRS will be playing a key role in implementing the law by collecting penalties from Americans who violate the individual mandate by choosing not to have health insurance. However, IRS watchdogs worry that the giant agency won't be prepared to enforce the 47 new taxes and regulations introduced by Obamacare. While testifying before Congress earlier this year, Treasury Inspector General Russell George said the increased amount of responsibility the IRS has under Obamacare will "lead to problems."

In August, President Obama nominated Koskinen to run the tax agency. "John is an expert at turning around institutions in need of reform," Obama said at the time. "I am confident that John will do whatever it takes to restore the public's trust in the agency." Koskinen, the 74-year-old former chairman of Freddie Mac still needs to be confirmed by the Senate, but he'll have a long to-do list once he takes over the embattled IRS. Making sure it can handle the Obamacare changes will have to be high on that list.

Editor's Note: This article by Brianna Ehley originally appeared on The Fiscal Times.

For more from The Fiscal Times:

Obamacare Tech Companies Are Failing Upward


Hillary Clinton Thrives, for Now, in Political Catbird Seat

Obama to Chide Republicans on Spending Cuts at School Event


Follow The Fiscal Times on Twitter @TheFiscalTimes.



The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of The NASDAQ OMX Group, Inc.



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