Emails obtained by the Washington Examiner through a Freedom of Information Act request raise new questions about how much the White House knew about Health and Human Services Secretary Kathleen Sebelius' fundraising for Obamacare and whether she solicited donations from entities she regulates.
White House officials have said they did not sign off on calls made by Sebelius to solicit donations from private entities for Enroll America, an outside nonprofit with close White House ties that promotes enrollment in the health law's insurance exchanges. Officials say they were only generally aware Sebelius would be seeking support from outside groups.
In late January, HHS's Freedom of Information Act office released 257 pages of emails in response to a June request from the Washington Examiner.
The documents are heavily redacted with 12 pages withheld in their entirety and another 179 pages of “responsive records” still “under review for consultation” before a decision is made on their release.
The emails show that White House Office of Public Engagement staffers participated in weekly conference calls with HHS and Enroll America. The emails also show that the agenda of these phone meetings included Sebelius' calls to outside entities, high-level operational planning and more focused outreach with private partners through senior White House aides.
In one email, dated May 6, 2013, Anton Gunn, then director of external affairs for HHS, said he believed two separate conference calls should be merged — one that involved Enroll America and HHS and another that included the White House. The email was sent to Anne Filipic, the president of Enroll America and former OPE deputy director, and other HHS and Enroll America staff.
“I believe the content of these calls has overlapped on more than one occasion, but I want to make sure HHS and Enroll America are clear that we agree that these calls should be permanently merged in to [sic] ONE call with White House staff and that call should happen Weekly? Or is it every other week?” Gunn asked.
Filipic responded that a weekly call “makes sense” and believed it should combine “WH/HHS/EA.”
Earlier in the email, Gunn said the calls between Enroll America and HHS were “high level” and “focused on operational issues like “data/Legal Issues, KGS calls, Branding, etc.,” while the calls that included Enroll America, HHS and OPE seemed to be “detailed planning calls and more focused on Outreach/Engagement/Partnerships using the WH and WH Principals.”
In other emails provided to the Examiner, “KGS calls” refers to phone calls Sebelius made to private companies and nonprofits discussing Enroll America.
A later email shows that a scheduled separate White House conference call, coordinated by then-deputy director of public engagement Stephanie Valencia, had been canceled so that only one joint phone meeting between HHS, Enroll America and the White House would occur each week.
Two White House staffers from the OPE — Valencia and Ari Matusiak, the White House director of private sector engagement — were included in one series of heavily redacted emails with the subject line “Johnson & Johnson CEO – Meeting Request” — dated April 1, 2013.
An email was sent from Filipic to Anton Gunn, who was then head of HHS' external affairs, and Mandy Cohen, a senior adviser to the Centers for Medicare and Medicaid Services administrator, as well as Valencia and Matusiak.
Neither the White House nor HHS responded to questions about why White House staffers were included on those emails or whether Sebelius asked for financial help during the meeting with Johnson & Johnson.
In later emails, with redacted sections, Filipic writes Gunn saying she is eager to hear how the “call” with Johnson & Johnson went.
The company confirmed the meeting to the Washington Examiner and said no donation had been made. But a Johnson & Johnson spokesman did not respond to questions about whether Sebelius asked for money.
In another set of emails, Sebelius received talking points from Enroll America that were also used by Nancy-Ann DeParle, a former head of the White House Office of Health Reform during the Congressional fight to pass Obamacare, who went on to become the president's deputy chief of staff for policy.
DeParle left after Obama's re-election, and served as a guest scholar last year at Brookings and serves on various health care company boards. She spent the last year asking insurers to donate to Enroll America, according to a report from Politico.
DeParle was regularly asking insurance companies to cut checks to promote Obamacare, but it is unclear whether the talking points she shared with Sebelius included a direct request for financial donations, contrary to Sebelius’ claim that she did not specifically request money from entities HHS regulates.
Emails show Sebelius used the talking points for phone calls with Kaiser Permanente's then-President George Halvorson, as well as with Ascension Health's then-President Tony Tersigni.
Kaiser Permanente, the largest managed care organization in the country, and Ascension Health, a large Catholic nonprofit that operates a network of health facilities, are both regulated by HHS.
In one email Filipic sent to senior HHS and CMS aides, she provides a “call sheet” ahead of Sebelius’ phone call to Halvorson.
“It is worth reiterating that Nancy-Ann is scheduled to speak to George tomorrow morning,” she writes in an email dated March 21, 2013. “As you can imagine, her call sheet looks very similar!”
“I do think it's worthwhile for George to hear from a number of folks, but want to be clear about the multiple calls, so that we do not cross wires,” she continues.
Filipic then mentions that she will provide a call sheet for Sebelius' call to Tersigni the next day and says “Nancy-Ann is NOT currently schedule [sic] to call Tony.”
HHS did not respond to requests for a copy of the call sheet and the FOIA response did not include attachments to any of the emails provided.
Kaiser Permanente donated an unspecified amount to Enroll America. Halvorson also joined its board of directors, along with executives from Blue Shield of California and Teva Pharmaceuticals USA, the largest manufacturer of generic drugs in the world. It is not known whether Ascension Health, a member of the group's Advisory Council, cut a check to Enroll America.
The White House did not respond to questions about what its aides knew about the fundraising or whether any White House staffers were directly involved in soliciting for Enroll America.
HHS has repeatedly declined to answer the Examiner's questions about the emails and has said all of its fundraising activity on behalf of Enroll America is legal and proper.
HHS spokeswoman Erin Shields acknowledged in a statement that officials "worked collaboratively across the administration to get the word out about enrollment through education and outreach efforts."
Shields defended the fundraising, pointing to a provision in the Public Health Service Act, which she said allows HHS to work with public and private partners “to advance public health.”
"The Secretary is authorized to support (and encourage others to support) programs and private non-profit entities working in programs related to health information and health promotion, preventive health services, and education in the appropriate use of health care,” she continued.
Shields also cited the George W. Bush administration's "use of public-private partnerships to launch the Medicare prescription drug program and enroll children in the Children's Health Insurance Program.”
The disclosure that Sebelius sought private donations to help launch Obamacare has outraged Republicans. They charge that she is trying to circumvent Congress after lawmakers denied additional funding to promote the Affordable Care Act.
Two House committees launched investigations and Republicans asked the Government Accountability Office, the investigative arm of Congress, and the HHS inspector general to probe the extent to which Sebelius and her staff are coordinating with Enroll America and other organizations.
Sebelius has defended her actions as legal and proper and said officials made similar efforts under President George W. Bush to roll out Medicare Part D’s prescription drug program.
Sebelius said she only directly solicited two groups, both of which are not regulated by HHS: the Robert Wood Johnson Foundation and H&R Block. Sebelius said she called three groups HHS regulates — Kaiser Permanente, Johnson & Johnson and Ascension Health — but asked them only for general support and didn't specifically request money.
The Robert Wood Johnson Foundation, a nonprofit focused on public health, last year said it had contributed $14 million to Enroll America. While Johnson & Johnson has not donated, the foundation owns more than $1 billion worth of company stock. The Food and Drug Administration, an HHS agency, also regulates Johnson & Johnson's drugs and medical devices.
H&R Block is the largest tax preparation company in the country, and stands to reap a windfall in new business under Obamacare as consumers seek tax subsidies under the law. Last year, the New York Times reported that H&R Block pledged $500,000 to Enroll America, but a company spokesman says the firm ultimately decided against donating.
Republicans contend that Sebelius' fundraising is different than what occurred under Bush because Congress specifically defunded additional money from being spent to promote Obamacare enrollment. They point to the Anti-Deficiency Act, which prohibits government agencies from accepting voluntary services or donations.
Watchdogs and ethics attorneys disagree over whether Sebelius' fundraising violated federal laws, but all say asking private companies to financially support Obamacare's rollout raises serious ethical questions. They also say the Public Health Service Act does not allow the White House or CMS to engage in such solicitation.
Craig Holman, an ethics expert at Public Citizen, a government watchdog organization, said he believes Sebelius' fundraising is legal, but full of “ethical landmines.”
“It has the appearance of the administration putting pressure on business that they want something from business — could be support for a change in the Obamacare law or another type of quid pro quo,” he said. “It is certainly worthy of investigating.”
Meredith McGehee, policy director for the Campaign Legal Center, said any investigation should focus on whether there was intimidation on behalf of HHS.
She said the Obama administration, ahead of the fundraising drive, should have set clear conflict-of-interest rules as they did when doling out $700 billion in taxpayer dollars from the Troubled Asset Relief Program.
“I'm really puzzled why the White House hasn't set out clear rules,” she said.
“The way they've handled this – maybe because of the bad rollout – seems so ham-handed,” she continued. But she added that it is not too late for the White House to say “we’re going to set some rules.”