Health Exchange Rollout Glitches

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA Repeal >> Components of ACA Not Working Well >> State Health Exchanges >> Health Exchange Rollout Glitches (last updated: 11.19.15)

How Many Have Enrolled on Exchanges?

• Enroll Maven. This was a running estimate of the number of people enrolled in paid Obamacare plans calculated using enrollment statistics reported by governmental entities. It is not a measure of web hits, user registrations, applications started, applications completed or any other pre-enrollment parameter, does not include enrollments in jurisdictions which have not yet reported enrollment statistics (except confirmed registrations in states on the federal exchange) and does not count new Medicaid enrollees.  The site lists enrollment by individual state. As of 10.19.13, 18,866 were enrolled in gold, silver or bronze plans on the exchanges, representing 0.3% of the 7,066,000 administration target for 3.31.14; 9.3% of the enrollment period had elapsed at the time of this snapshot. Site has not been updated since late December.
• Laszewski, Robert. Insurance expert Robert Laszewski estimates about 20,000 signed up on the federally-run exchanges during the first 2 weeks.
• Wall Street Journal. On 10.18.13, WSJ reported enrollment figures from 10 state-run exchanges (WA, KY, MN, CT, RI, NV, MA, MD, CO, DC). These total about 72,000.

Chaos on the Exchanges

• Weaver, Christopher and Louise Radnofsky. Health Website Woes Widen as Insurers Get Wrong Data, Wall Street Journal, October 18, 2013.
• Two Weeks Later, CNN Reporter Still Can’t Sign Up For Obamacare. Real Clear Politics (video), October 14, 2013. CNN senior medical correspondent Elizabeth Cohen has been trying to set up an account on the healthcare.gov website for two weeks. “I put in my user name and password and it didn’t recognize it,” she said. “Error messages. Page not found. System down.”
• Eilperin, Juliet. Visits To Federal Health-Care Web Site Off 88%. Washington Post, October 15, 2013. The number of visitors to the federal government’s HealthCare.gov Web site dropped 88 percent between Oct. 1 and Oct. 13, according to a new analysis of America’s online use, while less than half of 1 percent of the site’s visitors successfully enrolled for health insurance the first week. The new numbers on the health-care law — released by Kantar US Insights and based on an assessment conducted by the nonpartisan research firm Millward Brown Digital — provide a partial snapshot of how the federal health-care exchange has fared since it launched at the start of the month. Of the 9.4 million unique visitors to the site during the first week, roughly a third attempted to register and 1.01 million completed registration, according to the analysis. Millward Brown Digital — which tracks the online activity of 2 million Americans, or 1 percent of all Internet users in the United States — said that roughly 36,000 Americans signed up for an insurance plan online the first week. Obama administration officials challenged the independent assessment but did not release any specific enrollment figures.
• Alex Nussbaum. U.S. Health Exchange’s Stumbles Continue for Second Week. Drew Armstrong & Shannon Pettypiece – Oct 7, 2013.  Consumers couldn’t access parts of the U.S. government’s online health-insurance exchange today, after a weekend of technical upgrades failed to eliminate delays in the system at the heart of the Affordable Care Act. The federal website, meant to serve people in 36 states, was still delivering error messages to users trying to create accounts. While most of the 14 states running their own health exchanges, including California, ran better, New York’s website had problems registering some consumers.
• Alonso-Zaldivar, Ricardo. Health care target: 500K sign-ups by end of month. The Detroit News. In September 5, 2013 memo titled Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014, DHHS officials estimated that 494,620 people would sign up for health insurance under the program by Oct. 31. And that was portrayed as a slow start. “The memo projected enrollment would reach 3.3 million nationally by Dec. 31.”

Criticism from ACA Supporters

• Johnson, Andrew. Wasserman Schultz: Exchanges Needed “Better Design,” Better Rollout. National Review Online, October 15, 2012. Add Debbie Wasserman Schultz to the list of important Dems disappointed by Obamacare’s online exchanges. The Democratic National Committee chairman admitted the website’s shortcomings should have been addressed before launch, in an interview with HuffPost Live on Tuesday. “I don’t think we should be making excuses,” Wasserman Schultz said of the website’s issues. “There should have been a better rollout and a better design.”
• Halper, Daniel. Former Press Secty Gibbs: Roll Out “Embarrassing,” Says People Should Be Fired. Weekly Standard, October 14, 2013. “Let’s just say this is excruciatingly embarrassing for the White House and for the Department of Health and Human Services,” said Gibbs. “This was bungled badly. This was not a server problem, like, right, just too many people came to the website. This is a website architecture problem .”I think it is, again, excruciatingly embarrassing. It’s not fatal, because there are still many weeks and days to go before the enrollment period closes at the end of March .”But, boy, if they don’t get these glitches figured out fast, people aren’t going to come back for visits 15 through 18. And I will say this. I hope they are working day and night to get this done. And when they get it fixed, I hope they fire some people that were in charge of making sure this thing was supposed to work. We knew there were going to be some glitches. But these were glitches that go, quite frankly, way beyond the pale of what should be expected.”

• Liberal Blogger Ezra Klein: Obamacare Rollout Has So Far ‘Been a Big Failure.’ Washington Free Beacon, October 14, 2013. Liberal MSNBC contributor Ezra Klein continued his criticism of the Obamacare website Monday on Morning Joe, saying it was a “big failure” so far on the part of the Obama administration. “The way this IT is going out is a disaster,” he said. “They have done a terrible job on this website. We’re a couple weeks in now. People can’t sign up. People have tried 20, 30, 40 times. It’s one thing for that to be true in the first three or four days, it’s another for it to be true two or three weeks in.” “One of the Obama administration’s jobs, separate from all of the political stuff we talk about here, is to simply run things like this well, to run their signature legislative initiative well, to do government in a way that makes people confident and able to use it,” he said. “On that so far, this has been a big failure.”

Uncertainty Over Timeframe of Problem Resolution

• Kaiser Health News. Tech Experts Say Total Overhaul Of Healthcare.Gov May Be Needed. October 18, 2013. Because the exchange relies on 10-year-old technology, it’s conceivable that only a total overhaul will fix its problems.
• Levin, Yuval. Assessing the Exchanges. NRO, October 17, 2013. No one wants to say how long it might take, and no one would share with me what estimates they might be getting from their contractors (whom they no longer trust anyway), but there has so far been relatively little progress and it seems like everyone involved is preparing for a process that will take months, not weeks. An extension of the enrollment period for coverage, now set to end on March 31, seems to be almost taken for granted.
• WH Press Secty Jay Carney Won’t Say When Obamacare Will Be Fully Functional. Washington Free Beacon, October 15, 2013. White House Press Secretary Jay Carney dodged when asked Tuesday about when the Obamacare website would be fully functional, which entities were working on it and what it cost the federal government, referring the questioner to Health and Human Services: “And there are a lot of people hard at work on this, but for details of the work being done and the process in place, I’d refer you to HHS.”

• Suderman, Peter. Administration Blows Its Credibility With Disastrous Obamacare Rollout. Reason, October 17, 2013. The Obama administration doesn’t want to talk about Obamacare. At a press briefing on Tuesday, White House Press Secretary Jay Carney dodged questions about the ongoing failure of the law’s federally-run health insurance portal, Healthcare.gov, which after two weeks is still practically impenetrable to all but the most dedicated users. Carney refused to say when the exchange might be working, and directed reporters’ questions to the agencies in charge of the project. “Those are all questions for HHS and CMS,” he said, referring to the Department of Health and Human Services and the Center for Medicare and Medicaid Services. But the head of HHS isn’t saying much. Following a disastrous interview with Jon Stewart on The Daily Show last week, HHS Secretary Kathleen Sebelius has avoided most media inquiries. The head of CMS, Marylyn Tavenner, is staying mum too. She refused to answer questions New York Times reporters posed about the performance of the exchanges.

• Mangan, Dan. Aetna CEO: ‘So Much Wrong’ With Obamacare, Says Could Take 3 Years to Work. CNBC, October 14, 2013. Aetna’s CEO gave a harshly critical review Monday of the federal government’s Obamacare marketplace, saying, “There’s so much wrong, you just don’t know what’s broken until you get a lot more of it fixed.” “It’s all been on the fly,” Bertolini said of the construction of the marketplace and the integration of insurers such as Aetna, whose plans are being offered to up 40 million customers.”I think the bigger issue is, will enough people sign up to make it work?” said Bertolini. “I think the attention span of the younger generation in using technology is that if it doesn’t work the first time, it’s going to be pretty hard to get them back the second time,” he said. “If the program blows up because people don’t sign up, then the program’s not going to move ahead … all that well.” Asked if he would have delayed the launch of the exchange given its earlier problems, Bertolini said, “I would have, if I’d been in their seat.” But, he added, “the politics got in the way of a good business decision.” He said it could take three years or so before the marketplace’s problems are fully sorted out.

• Mangan, Dan. How Long To Fix Obamacare Tech Problems? Possibly A Long Time. CNBC, October 10, 2013. Some insurance experts warn that the federal Obamacare marketplace has a month or so to heal itself or risk harming enrollment. Others say it could be months, if not much longer, before the website is free of tech problems. “I think it could easily take up to two years before all these things are working working smoothly,” said Lisa Carroll, president of the Mosaic Insurance Exchange and the Small Businesses Service Bureau in Massachusetts. “This is just an ecommerce project of epic proportion,” said Carroll. Carroll said the complicated task of getting all facets of the federal health insurance market to interact with each other correctly is made more complicated by rule changes and clarifications that have to be accounted for by software. Sumit Nijhawan, CEO of insurance data integrity provider Infogix, said, “My crystal ball tells me it’s going to take anywhere from six to nine months” to resolve those problems. Nijhawan said the problems could get a bit worse before they get better when exchanges start dealing with a large influx of people enrolling before the Dec. 15 deadline for the start of coverage on Jan. 1.

• Klein, Philip. Behind The Curtain, More Waving Red Flags For Obamacare. Washington Examiner, October 17, 2013. Administration officials have emphasized that Americans have until the end of next March to purchase health plans through the exchanges. But insurers are focused on a much earlier date: Jan. 1. That’s when the insurance plans will start to become active. The nightmare scenario for insurers would be if, at the beginning of the new year, they are bombarded by complaints from consumers who, based on information displayed on the federal website, were expecting a certain set of benefits that don’t correspond to the plans to which they signed up. This doesn’t even get to the broader health policy issue. The success of Obamacare hinges on the exchanges being able to enroll enough young and healthy individuals to offset the cost of covering older and sicker patients, particularly those with pre-existing conditions. Right now, there isn’t enough data available to say whether insurers are achieving the right mix of enrollees. In the past, administration officials have said that roughly 40 percent of expected 7 million enrollees need to be from the young and healthy demographic. But they have been mum about how many people have successfully enrolled through the federal website so far, saying that they won’t be able to make that information available until the middle of November. But if the technological issues don’t get cleared up in the next month (looking less likely) or if new problems arise once applicants get further along in the process (more likely), Obamacare could turn out to be a bigger disaster than even its most ardent critics predicted.

Reasons for Poor Performance

• Ornstein, Charles. Here’s Why Healthcare.gov Broke Down. ProPublica, October 16, 2013. Federal officials have pointed to overwhelming demand to explain the site’s problems. But web developers, other experts and journalists have uncovered more fundamental issues with the design and functioning of the site. Here are excerpts from five of the better stories explaining what happened….
• Pollock, Richard. Troubled Obamacare website wasn’t tested until a week before launch. Washington Examiner, October 17, 2013.  Federal officials did not permit testing of the Obamacare healthcare.gov website or issue final system requirements until four to six days before its Oct. 1 launch, according to an individual with direct knowledge of the project. The individual, who spoke on condition of anonymity, described the troubled Obamacare website project as suffering from top-level management disarray, changing systems requirements and recurring delays. The root cause of the problems was a pivotal decision by Centers for Medicare and Medicaid Services officials to act as systems integrator, the central coordinator for the entire program. Usually this role is reserved for the prime information technology contractor. As a result, full testing of the site was delayed until four to six days before the fateful Oct. 1 launch of the health care exchanges, the individual said. “Normally a system this size would need 4-6 months of testing and performance tuning, not 4-6 days,” the individual said.
• Levin, Yuval. Assessing the Exchanges. NRO, October 17, 2013. They believed (as I did too, I admit) that whatever technical problems the exchange sites encountered at first could be cleared up quickly and simply once things got going—that the contractors developing the websites could just respond to problems on the fly, as they became apparent. It is now increasingly obvious to them that this is simply not how things work, that building a website like this is a matter of exceedingly complex programming and not “design,” and that the problems that plague the federal exchanges (and some state exchanges) are much more severe and fundamental than anything they imagined possible. That doesn’t mean they can’t be fixed, of course, and perhaps even fixed relatively quickly, but it means that at the very least the opening weeks (and quite possibly months) of the Obamacare exchanges will be very different from what either the administration or its critics expected.
• Pollock, Richard. Feds Reviewed Only One Bid For Obamacare Website Design. Washington Examiner, October 14, 2013. Federal officials considered only one firm to design the Obamacare health insurance exchange website that has performed abysmally since its Oct. 1 debut. Rather than open the contracting process to a competitive public solicitation with multiple bidders, officials at CMS accepted a sole bidder, CGI Federal, the U.S. subsidiary of a Canadian company with an uneven record of IT pricing and contract performance. CMS officials are tight-lipped about why CGI was chosen or how it happened. They also refuse to say if other firms competed with CGI, or if there was ever a public solicitation for building Healthcare.gov, the backbone of Obamacare’s problem-plagued web portal. In awarding the Healthcare.gov contract, CMS relied on a little-known federal contracting system called ID/IQ, which is government jargon for “Indefinite Delivery and Indefinite Quantity.” The multiple awards were in the form of “task orders” for projects of widely varying size. Over the life of the CGI contract — which expires in 2017 — the IT firm can receive awards worth anywhere from the “$1,000 to $4 billion,” according to a contracting document provided by CGI to the Washington Examiner.
• Viebeck, Elise. Analysis Highlights Flaws With Obamacare Sites’ Design. The Hill, October 17, 2013. Many state ObamaCare enrollment portals did not take steps to ensure smooth user navigation, just one in a rash of problems with the sites, a new analysis argued. An expert with Huge, the digital agency, found that ObamaCare’s state-run exchanges showcase a variety of design decisions that may be more and less successful at wooing patients online.
• Kennedy, Kelly. Health Care Exchange Problems Due to “Core Fundamental Design Flaw.” USA Today, October 16, 2013. Two weeks into the launch of the federal health insurance exchange, the website is still plagued with problems, leading critics to wonder if the problem is worse than it appears. There are two key issues at the core of the problem, said Dan Schuyler, a director at Leavitt Partners, a health care group by former Health and Human Services secretary Mike Leavitt. One is the volume, which HHS estimates at 14.6 million unique visitors, and the second is the platform’s design. The main problem, Schuyler said, could be “core fundamental design flow,” but it’s impossible to know because HHS is saying so little. “Only the contractors and HHS know that,” he said. They need to figure out the problem soon, Schuyler said, if the government is to meet its goal of 7 million new health customers signing up on the exchanges by March 31. “That’s 39,000 enrolled a day, and we’re not seeing anywhere near that volume,” Schuyler said. “If they don’t get it fixed within two or three weeks, we’re going to have a backlog of consumers who won’t be able to enroll.”
• Manjoo, Farhad. Why Government Tech Is So Poor. Wall Street Journal, October 16, 2013. When you examine the follies at the heart of Healthcare.gov, two important factors stand out, experts say. The first is personnel—like many government IT projects, this was implemented by people who don’t understand IT. “There’s a lack of technology leadership at the agency level, leading to an inability to execute,” said Vivek Kundra, who was appointed the nation’s first chief information officer by President Barack Obama in 2009 and who is now an executive at the cloud-services company Salesforce.com Inc. Mr. Kundra said that when he was the nation’s CIO, the White House pushed a “cloud-first policy” that encouraged government agencies to avoid creating new server farms every time they had to build new websites, which is how the rest of the world works with tech. “It seems like with Healthcare.gov, a set of decisions were made at the agency level that aren’t in line with how modern technology is deployed,” Mr. Kundra said.
• Pear, Robert, Sharon LaFraniere, Ian Austen. From the Start, Signs of Trouble at Health Portal. New York Times, October 12, 2013. One highly unusual decision, reached early in the project, proved critical: the Medicare and Medicaid agency assumed the role of project quarterback, responsible for making sure each separately designed database and piece of software worked with the others, instead of assigning that task to a lead contractor. Some people intimately involved in the project seriously doubted that the agency had the in-house capability to handle such a mammoth technical task of software engineering while simultaneously supervising 55 contractors. An internal government progress report in September 2011 identified a lack of employees “to manage the multiple activities and contractors happening concurrently” as a “major risk” to the whole project.