Well-versed as she was, DeParle immediately recognized that she needed help, according to a former senior administration official. She tried — but failed — to lure to the White House one of the nation’s top experts, Jon Kingsdale, who had overseen the building of a similar insurance exchange in Massachusetts.
DeParle convened meetings twice a week in the Old Executive Office Building, bringing together representatives of agencies as far-flung as the Internal Revenue Service, the Centers for Disease Control and Prevention and OMB’s regulatory office — all of which had a role in putting the law into practice. They pored over spreadsheets and hashed out difficult policy questions. The work was "highly specific," recalled Donald Berwick, who was CMS’s administrator through 2011 and now is a Democratic gubernatorial candidate in Massachusetts. "There was an implementation chart. Regulation by regulation, we would say, where is it now, who was developing it?"
A higher-level monthly meeting, intended to work through tough regulatory questions, was attended at first by Sebelius, Treasury Secretary Timothy Geithner, Chief of Staff Rahm Emanuel and Domestic Policy Council Director Melody Barnes. By late summer and early fall of 2010, the meetings petered out after some of participants stopped attending, according to a former senior administration official.
At the White House and inside CMS, the initial focus was not on building the online marketplace but rather on rules to let young adults stay on their parents’ insurance policies and new insurance pools for Americans who were being rejected by insurance companies because they were ill.
The exchange "was in the future," Berwick said, explaining that the website was, during his tenure, a matter of "conceptualization," along with "the many other regulations we were batting out."
From the beginning, the administration worked in a venomous political climate. "You’re basically trying to build a complicated building in a war zone, because the Republicans are lobbing bombs at us," the White House official said.
White House officials contend that the political sensitivities did not influence the substance or pace of the work. But others who were involved say otherwise.
According to two former officials, CMS staff members struggled at "multiple meetings" during the spring of 2011 to persuade White House officials for permission to publish diagrams known as "concepts of operation," which they believed were necessary to show states what a federal exchange would look like. The two officials said the White House was reluctant because the diagrams were complex, and they feared that the Republicans might reprise a tactic from the 1990s of then-Sen. Bob Dole, R-Kan., who mockingly brandished intricate charts created by a task force led by first lady Hillary Clinton.
In the end, one of the former officials said, the White House quashed the diagrams, telling CMS, instead, to praise early work on those state exchanges that matched the hidden federal thinking.
By then, DeParle was no longer directly in charge, since she had been promoted in February 2011 to be the president’s deputy chief of staff for policy. Her successor, Jeanne Lambrew , worked on the law’s passage in Sebelius’ office and, years earlier, had worked on health reform under the Clinton White House.