The only upside for the Obama administration in the troubled launch of the health insurance marketplace is that it is still early days for the program.
On Oct. 1, the government rolled out its vehicle for providing health insurance to persons currently without coverage. The rollout featured the launch of HealthCare.gov — a website where consumers can purchase a policy online through a health insurance exchange in their state. The exchanges are basically formed by a roster of government-approved, competing healthcare insurance vendors.
Creation of the exchanges is a key element of the Patient Protection and Affordable Care Act signed into law by President Obama in March 2010.
To say the rollout did not go well would be an understatement. The huge number of visitors to the websites created Internet traffic jams resulting in delays measured not in hours but in days, according to administration officials. Reports of glitches hit such a volume that President Obama himself felt compelled to address the situation in a live White House Rose Garden address on Monday.
Obama emphatically touted the benefits of the health insurance program while conceding that the implementation was worse than disappointing.
“The problem has been that the website that’s supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody, and there’s no sugarcoating it,” Obama said. “The website has been too slow, [and] people have been getting stuck during the application process.”
The widespread reports of problems were quickly followed by a sort of running postmortem on why things went wrong.
Private sector IT and insurance representatives warned the Obama administration that the Internet portal wasn’t ready for the proposed Oct. 1 launch, according to several press reports citing anonymous sources.
Both a June 2013 report from the General Accountability Office and testimony presented at a House Energy and Commerce Committee hearing in September cited potential problems and expressed concern about fixing them in time for the Oct. 1 rollout.
At issue is whether the Department of Health and Human Services and its Center for Medicare and Medicaid Services, as well as private sector contractors to HHS, failed in meeting the IT requirements for the health exchange program.
Conversely, it’s questionable whether the design of the insurance program itself, as well as regulatory provisions of the Affordable Care Act, were so complex — and finalized so late in the game — that the IT component suffered as a result.
The answer appears to be that both factors contributed to the rollout problems.
Complex IT Mission
“The establishment of health insurance exchanges is one of the most complex IT projects ever initiated by the federal government. Coupling the complexity of the project with a tight implementation timeline and informational delays has clearly strained state capacities to complete their exchanges on time and as originally scoped,” Brett Graham, partner and managing director at Leavitt Partners said at the House hearing in September.
Challenges included the complexity of an exchange’s architecture; data verification and integration with the federal data services hub, and privacy and security requirements, he observed.
“The amount of work, tight timeframes and limited resources would have made this website launch a challenge for any company or government entity,” Jennifer Covich Bordenick, CEO of the eHealth Initiative, told the E-Commerce Times.
At the moment, there seems to be a question as to whether the problems are just growing pains or whether they’re inherent in the concept of the exchanges themselves.
“Based on comments from the administration over the weekend and early this week, it appears there are some issues with the website beyond the early glitches. What may end up distinguishing a glitch from a larger problem may be the time it takes to resolve the issue — and we don’t know the answer to that yet,” Elizabeth Carpenter, senior manager at Avalere Health, told the E-Commerce Times.
The Obama administration has been under fire from opponents of the ACA who object to Obamacare either on grounds of political philosophy or that its scope is too broad to be workable as a government project. The problem-plagued rollout has only intensified that criticism.
“This is not about the ACA — it is really about the website,” said Bordenick. “ACA provides significant benefits and access to millions of people who didn’t have it before. The website has dozens of glitches which will be addressed — but the site has absolutely nothing to do with the benefits offered by the ACA.”
One operational problem that seemed to baffle many IT and marketing experts was the decision by CMS to require visitors to register on the website before being allowed to examine or shop for options related to insurance plans and prices. The mere requirement could be a put-off in any Internet marketing vehicle, and more so because the HealthCare.gov registration process has proven to be both invasive as to privacy and tedious to complete.
“Most e-commerce websites allow you to browse or shop first, then set up your account at check out. Healthcare.gov takes the opposite approach, and in hindsight, I think that was a mistake,” Bordenick said.
“On the other hand, many people just want to know how much it will cost — and a calculator can help with that. The fact they are now directing people to the Kaiser Family Foundation calculator for a rough estimate is a smart idea,” she noted.
One administration representative indirectly conceded the error.
“The initial wave of interest stressed the account service, resulting in many consumers experiencing trouble signing up, while those that were able to sign up sometimes had problems logging in,” said Lindsay Holst, director of online content for the Office of Digital Strategy at the White House.
“In response, we have made a number of improvements. Initially, we implemented a virtual waiting room, but many found this experience to be confusing. We continued to add more capacity in order to meet demand and execute software fixes to address the sign up and log in issues, stabilizing those parts of the service and allowing us to remove the virtual waiting room,” she said.
Government Has Time to Recover
Despite the rash of negative publicity, there is no need to push the panic button, Bordenick contended.
“There is plenty of time. The March 31 deadline for consumers to sign up is months away. People who sign up right now won’t even start receiving benefits until 2014. Changing deadlines is not required at this time, and not necessary,” she said.
“However, it may be necessary to encourage people to revisit the website once the technical problems are resolved,” added Bordenick.
“We will have plenty of opportunities to review exactly what went wrong with HealthCare.gov’s rollout, but in the short term it’s critical that we focus on fixing those problems so folks can get access to the healthcare that they clearly want and need,” Sen. Tom Carper, D-Del., told the E-Commerce Times.
“That’s why, broadly speaking, it’s important that we learn the right lessons from this experience,” he said, “so that we can continue to improve the way the federal government handles its massive information technology portfolio in all areas moving forward.”