Top five O-Care controversies

The Obama administration faced an extraordinarily tough year when it came to Affordable Care Act’s rollout and the surrounding debate. Between missed deadlines, botched projects and massive PR stumbles, the White House spent months trying to recover momentum for its signature domestic achievement.

Below are the healthcare law’s top controversies in 2013:

1) Canceled health plans

One of President Obama’s key promises — that under ObamaCare, you could keep your health plan if you like it — was turned on its head this fall when millions of people received cancellation notices from their insurance companies. The wave created a political firestorm for the White House as Republicans hammered Obama on his promise, which had also been echoed by many Democrats on Capitol Hill. The assurance was eventually labeled “Lie of the Year” by Politifact, a fact-checking organization with ties to the Tampa Bay Times.

The controversy took an unexpected turn in mid-November when former President Bill Clinton urged Obama to “honor the commitment,” even if it meant a policy fix that would alter the Affordable Care Act’s rollout. Days later, Obama announced that insurance companies could continue offering plans that would have been canceled under ObamaCare to their existing holders for an additional year.

The cancellation “fix” has had mixed results. Obama’s announcement prompted an immediate backlash from health insurers loathe to accept blame for canceled plans. Several states have said they will not accept late renewals, arguing that plans that do not comply with ObamaCare are substandard. And the House passed legislation for a broader “fix” that received support from 39 Democrats.

While the criticism has quieted, plan cancellations are expected to be a major theme in next year’s midterm elections. Republicans are eager to blame vulnerable Democrats for vowing that consumers could keep their coverage and frame the issue as part of a wider narrative of dysfunction surrounding ObamaCare’s rollout. Democrats will try to argue that the law extends help to many people whose plans have been canceled, and that any GOP healthcare plan would also disrupt individuals’ coverage, but it remains to be seen how much these arguments will help.

2) HealthCare.gov

ObamaCare’s federal enrollment website was supposed to be the easy part of the law’s rollout. During its construction, the system was repeatedly compared to sites like Travelocity and Match.com, where millions of users can simultaneously navigate a complex, individualized shopping experience. But trouble was apparent on the morning of the launch, as users faced delays and glitchy code. The vast and persistent problems with HealthCare.gov created months of negative news for the White House and thwarted millions of users hoping to purchase health insurance.

The site has improved after hundreds of fixes to revamp the user experience and increase capacity. Criticism has quieted, and the administration has sought to relieve deadline pressure on consumers who faced technical problems with the system. Yet some issues are still lingering, including back-end glitches that have generated flawed transmissions from HealthCare.gov to insurance companies. The administration also flubbed other online enrollment systems, launching the Spanish-language site months late and delaying web-based sign-ups for small businesses by one year.

3) Employer mandate delay

The Obama administration took everyone by surprise in July by announcing that larger employers would not be required to offer health insurance to their workers until 2015. The decision came in reaction to pressure from the business community, which had sought more time to build the technical systems required to comply with the “employer mandate.” Republicans immediately pounced on the move as a double-standard, since consumers will still be required to comply with the individual mandate to carry health insurance starting in 2014.

4) Government shutdown fight

The federal government shut down on Oct. 1 over a fiscal stalemate that was defined by Republicans’ opposition to ObamaCare. The House GOP made three government-funding offers as the shutdown loomed in late September, each attacking the healthcare law in a different way. (One would have defunded the law, one would have delayed it for one year, and one would have delayed the individual mandate for one year.) Senate Democrats and the White House firmly rejected each bill, and vulnerable Dems in the upper chamber failed to rally around the GOP position as some conservatives had hoped. The shutdown saw Republicans’ poll numbers drop, even as ObamaCare’s new insurance exchanges began facing massive technical problems on Oct. 1. The final deal to reopen the government did virtually nothing to alter the healthcare law.

5) Congressional subsidies

The month of January will see lawmakers and most staffers enter ObamaCare’s new insurance exchanges, but this shift did not come without controversy. The first firestorm came in the summer when the administration ruled that members and aides can continue receiving a generous employer healthcare subsidy despite moving out of the Federal Employee Health Benefits Plan. Many people had expressed concerns that Capitol Hill workers would depart to the private sector if made to pay the entire cost of their healthcare coverage like those in the individual market. President Obama reportedly told lawmakers he was personally involved in preventing this outcome.

The decision to extend subsidies to members and staff was widely criticized on the right, and it prompted Sen. David Vitter (R-La.) to propose legislation that would stop the contributions from going forward. Vitter’s bills became part of several distinct conflicts throughout the fall, including debate over raising the debt ceiling in October.

Conflict reared its head again when news broke that lawmakers could keep their aides off of the exchanges by deeming them “official staff” instead of “official office.” Some pro-ObamaCare offices later regretted choices to shift workers on the exchanges, citing higher costs for older staffers. Aides also encountered problems enrolling in the District of Columbia’s new marketplace, and received notices to confirm their sign-ups in person rather than online.