Eighteen of the 32 top management jobs in the federal agency that is "ground zero" for running Obamacare are either vacant or filled on an acting basis.
The agency is the Center for Consumer Information and Insurance Oversight. Its problems start at the top.
Gary Cohen's last day as CCIIO's deputy administrator after less than two years on the job will be March 31, the latest departure from the agency.
Including Cohen's position, more than half of the most important jobs in CCIIO are either vacant or held by caretaking “acting directors.”
Cohen is the third director in the agency’s short four-year history. His last day coincides with the official deadline for Obamacare signups, though the White House extended the signup deadline on Tuesday.
The agency has overseen implementation of the most vital parts of Obamacare, including insurance regulation and pricing, operation of state health insurance exchanges, consumer support and the establishment of start-up health care cooperatives to compete with private insurers.
The vacancies and caretaker statuses within CCIIO can be seen in six of its eight operational groups.
In the consumer services area, acting directors run all five of CCIIO’s consumer support groups.
Three of the four CCIIO officials running the Insurance Programs Group are acting directors.
Acting directors occupy three of the four posts at CCIIO’s State Exchange Group, which regulates the state-based health exchanges.
The position of director of exchanges implementation and policy coordination at CCIIO is vacant. Also vacant is the top post running the agency's Office of Special Initiatives and Pricing.
At CCIIO’s Exchange Policy and Operations Group, an acting director runs the group’s plan management policy and operations office.
The lone exception is the Payment Policy and Financial Management Group. All five of its directors are permanent officials. The unit's internal Business Operations Staff also has a full-time director.
Originally known as the Office of Consumer Information and Insurance Oversight within the Department of Health and Human Services, Obama administration officials feared congressional Republicans would defund the operation.
After the move, Jay Angoff, the office's first director and a former plaintiff's attorney, was named a special adviser to Sebelius. He remained at HHS.
Cohen initially joined as the director of CCIIO's Oversight Group, but left for California Health Benefit Exchange, where he served as general counsel.
Then came director No. 2, Steve Larsen, who led the “new” CCIIO at CMS. After serving only a year, Larsen bolted from the agency to become a top executive at Optum, which is owned by UnitedHealth Group.
Both Larsen and Cohen exemplify the revolving door between government and private interests. Cohen once served as vice president and chief counsel for Fireman's Fund Insurance Co.
Larsen's Optum also owns QSSI, the current technology integrator for the deeply troubled healthcare.gov website.
QSSI acquired its latest website role after healthcare.gov's launch in October. The change was made while Larsen was executive vice president for government solutions at Optum.
John Palguta, vice president of the nonpartisan Partnership for Public Service, told the Washington Examiner that CCIIO’s multiple vacancies and acting directors are “red flags."
"It’s unusual to see quite this many vacancies and acting directors,” he said.
Palguta was in the federal civil service in human relations for 37 years, working at the Merit Systems Protection Board and at the Office of Personnel Management.
“My expectation is this is not the most desirable state for the organization,” he said.
Sally Pipes, president and CEO of the conservative-leaning Pacific Research Institute and a critic of the Obamacare law, attributed at least some of the high turnover rate within CCIIO to worries that the program isn't a good place for people with promising careers.
“I think a lot of people don’t want to tie their cart to a horse that they think is going to be a failure because it’s going to have a negative impact on their career path,” Pipes said.
“Good people don’t want to join something they think is not going to be a success,” she said. As a result, “they can’t attract and they can’t retain."
Mandy Cohen will be interim CCIIO administrator during the search for a permanent replacement for Gary Cohen. The two are not related.
She is also acting director of CCIIO's Consumer Support Group.
A CMS spokesman declined to comment on Cohen's departure or the high number of vacancies and acting officials.