In an attempt to prove that early enrollment numbers are not necessarily an indication of overall success, President Barack Obama speaks in Boston today, focusing on parallels between the Affordable Care Act and the Massachusetts health reform effort that began in 2006. A template of sorts for the ACA, the Massachusetts Health Connector enrolled only 0.3% of premium-paying adults in its first month, Obama will point out.

In a pre-speech White House briefing Tuesday, administration representatives said Obama will discuss the low number of enrollees — the exact number which is yet to be released by the Department of Health and Human Services.

In Massachusetts, 123 consumers signed up with a paid premium during the Health Connector’s launch month, rising to 36,000 by the end of year. It took a long time for sign-ups to come in, and as the deadlines approached there was a large increase in the number of healthy people signing up, said Jonathan Gruber, a professor of economics at the Massachusetts Institute of Technology and the creator of health reform in the state, on the White House-organized call.

It is not at all interesting or important how many people sign up before the ACA’s March deadline, Gruber stated: “What matters is it will ramp up. … Success needs to be measured in months and years, not days and weeks.

“We didn’t freak out [in Massachusetts] about daily and weekly movement,” he adds. “We need to be patient.”

Jon Kingsdale, founding executive director of the Massachusetts Health Connector and managing director of Wakely Consulting Group, also said during the call that he expects a lot of browsing in the marketplaces. In his state, a study found that for every 100 hits there was one purchase. “It’s a bit of a daunting effort,” he says. “It’s a marathon and not a sprint.”

Further, he explains, insurance is a “tough” sale. “… There will be a lot of browsing.”

'Hold me accountable'

A day after her deputy apologized for the failures with the Affordable Care Act insurance exchange, U.S. Health Secretary Kathleen Sebelius followed suit and told Congress that she shoulders the blame for the botched rollout.

“Hold me accountable for the debacle,” Sebelius said in response to accusations at a congressional hearing today that her deputies failed to do their jobs. “I’m responsible.”

In a contentious exchange, lawmakers quizzed Sebelius on the malfunctioning website set up as part of the ACA. They also raised privacy concerns, asked about broken promises that people would be able to keep existing medical plans and questioned whether there was a way to penalize the contractors that built the site.

“I am as frustrated and angry as anyone with the flawed launch of Healthcare.gov,” Sebelius told the House Energy and Commerce Committee. “Let me say directly to these Americans:  You deserve better. I apologize.”

Marilyn Tavenner, the administrator for the Centers for Medicare and Medicaid Services, appeared before the House Ways and Means Committee yesterday and blamed outside contractors for the website woes, though she apologized to Americans for the exchange’s flaws. Tavenner’s agency is part of the Department of Health and Human Services, run by Sebelius.

Sebelius told the Energy and Commerce Committee that she is working to correct the technology issues that have made it hard for people to enroll. Her agency though may not be able to penalize the contractors that helped design healthcare.gov, which included CGI Group Inc. and UnitedHealth Group Inc.

Deeper issues

“There isn’t a built-in penalty but I can tell you that paying for work that isn’t complete is not something that we will do,” Sebelius said.

Committee Chairman Fred Upton, a Michigan Republican, said “Americans are scared and frustrated.” He cited constituents’ concern that their existing health policies would be canceled, their premiums would rise or they would face tax penalties.

More than 30 House Republicans and at least three U.S. senators are asking for Sebelius to step down. They include Senators Pat Roberts of Kansas and John Barrasso of Wyoming, as well as Representative Paul Ryan, the Republican vice presidential candidate in 2012 whose losing campaign promised to repeal the Affordable Care Act if elected.

“The bottom line is the problems with ‘Obamacare’ run deeper than just the website,” House Majority Leader Eric Cantor, a Virginia Republican, said yesterday at a news conference.

Political opposition

Joanne Peters, a spokeswoman for the Health and Human Services Department, said many of those calling for Sebelius to quit have long opposed the ACA.

“There has been a longstanding political opposition to the law by some, despite the benefits it is delivering to millions of Americans,” Peters said in an e-mail. Sebelius “is committed to getting this right and ensuring that healthcare.gov is working smoothly.”

No Democrat has publicly questioned Sebelius’s leadership despite the exchange being plagued by delays and error messages that have prevented some people from completing applications. A few days ago, the data hub that routes tax information to sites run by the federal government and 14 states lost connectivity after workers tried to replace a broken networking component.

In the lead-up to this month’s rollout, Sebelius gave few hints of anything wrong, telling a House committee in June that the online marketplace would be ready. Sebelius today said her agency is working to correct the flaws.

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