Exchange experts say the Healthcare.gov website issues probably cannot and will not be solved overnight, despite President Barack Obama’s statement Monday that “these problems are getting fixed.”
Don Garlitz is executive director of exchange services for Chicago-based bswift, an administrative technology service provider that is directly responsible for state exchange systems in Utah. While doesn’t have all the information to comment on specific shortfalls of the federal system, which developed serious issues from its launch three weeks ago, he says:
“On the whole, I think it’s a shame that they tried to come out of the gate with a technology solution that was not fully figured, thinking they could pull the trigger on day one and it would all work. But as we’re not personally involved in eligibility computations, I don’t think that we even know what’s going to happen at the state level.”
Garlitz says the state systems do, by comparison, seem to be enjoying some smoother sailing, though major backlogs and service interruptions have been reported on exchanges from coast to coast.
And while the president has vowed that technical experts will immediately help address the current access and processing bottleneck, Garlitz notes that other issues may haunt the federal exchange portal for months, if not years, to come.
“My biggest concern is the long-term strategic challenge that comes from the fact that the feds are not keeping any records of who’s applying for what, which is perhaps intentional. We’ve heard that folks have, by accident, been enrolled with the wrong carrier, or the wrong effective date — and once that information was transferred to a carrier, the government site drops the data. What happens when a consumer thought they should enroll, and they didn’t? Who has those records?”
Failed testing
Meanwhile, in the weeks before the start of the Affordable Care Act, officials failed to complete exhaustive testing of the program’s website in a push to begin signups by Oct. 1, according to people involved in the rollout.
The federal Healthcare.gov site went live without attempts to replicate a customer’s complete experience, said a person familiar with the project who asked not to be identified to discuss what happened.
The introduction was so rushed that, as recently as last week, the exchange’s computer code contained placeholder language that programmers typically use in preliminary drafts, says Clay Johnson, a former White House presidential innovation fellow during 2012-2013.
“It was a perfect storm for an IT meltdown,” says John Gorman, a former assistant to the director of the Health Care Financing Administration’s Office of Managed Care, the predecessor to the agency responsible, now known as the Centers for Medicare and Medicaid Services, or CMS.
The website flaws have made it harder for people to enroll, marring its debut and giving critics ammunition to undercut the law by detractors and supporters alike. The failures may discourage the young, healthy, Web-savvy consumers whose participation is critical to offset the risk of insuring older, sicker people and to keep the program sustainable.
“If they can’t get it fixed for most people by mid-November, they start raising questions about who’s going to enroll and concerns about adverse enrollment,” says Gail Wilensky, a former administrator of HCFA and now a senior fellow at Project Hope at Center for Health Affairs.
Software bugs
The system’s start was hobbled by software errors and overwhelmed by higher-than-anticipated consumer demand. About 8.6 million people visited the federal online health exchange in the first week, running long waits that kept many from registering to check out insurance options. At one point, the site posted error messages in at least 24 states.
Patti Unruh, a spokeswoman for the Centers for Medicare and Medicaid Services, didn’t answer e-mailed questions about website testing or communication with contractors.
While the ACA survived Supreme Court review last year, Republicans in Congress have sought to delay the law or strip funding for its implementation. Their objections triggered a fiscal standoff that culminated in the 16-day partial U.S. government shutdown that ended last week.
Adjusting deadlines
White House Press Secretary Jay Carney yesterday opened the door to adjusting deadlines for those who can’t get coverage because of signup delays.
“The system was tested,” he said. “And based on the expectations we had, you know, we were confident that it was going to work more effectively than it’s been working.”
Open enrollment is scheduled to close March 31 and the deadline to sign up in time to avoid a fine for not having insurance is Feb. 15.
The Government Accountability Office, Congress’s investigative arm, warned in June of shortcomings in testing, and the prime contractor’s record in Canada offered another red flag.
Ontario in 2012 abandoned a project managed by CGI Group Inc. to establish a diabetes registry about three and a half years after it was supposed to be completed, according to a provincial auditor general’s report.
President Barack Obama Monday for the first time said he was upset with the online exchange’s performance so far.
“There’s no sugarcoating it: the website has been too slow,” Obama said in the White House Rose Garden. “Nobody’s madder than me about the fact that the website isn’t working as well as it should, which means it’s going to get fixed.”
Obama stood in the same spot on Oct. 1 for the opening of the federal online exchange, boasting of a shopping experience comparable to electronic-commerce sites run by Kayak Software Corp. and Amazon.com Inc. Pop singer Lady Gaga promoted the website with a Twitter message to 40 million followers.
The U.S. government, which plans to spend $82 billion on information technology in fiscal 2014, has a history of mismanaging projects. Recent failures include the Homeland Security Department January 2011 cancellation of a $1 billion network of sensors and cameras to monitor the U.S. border with Mexico, according to a GAO report issued in July.
IT failures
Breakdowns haven’t been confined to the public sector. United Continental Holdings Inc. delayed thousands of passengers and hundreds of flights in a series of software breakdowns in 2012 after the merged United and Continental stitched together computer systems.
The London Olympics’ website last year was riddled by technical issues that hampered ticket sales.
The GAO cited issues with the health exchange’s website in June. While CMS completed many tasks needed to open the federal exchanges on time, “many remain to be completed and some were behind schedule,” the watchdog said.
“Several critical tasks, such as final testing with federal and state partners, remain to be completed,” the report said. Investigators found “many activities yet to be performed” that “suggest a potential for challenges.”
In the Ontario project, CGI underestimated how long the work would take and failed to effectively manage completion of project components, according to the auditors’ report.
CGI’s project plan “appeared to contain many errors and omissions, which led to rejections and reworking of the design,” the auditors’ report said. Three years after the project was supposed to be done, “there were still hundreds of defects remaining,” it said.
‘Remain confident’
Linda Odorisio, vice president of U.S. communications for CGI, said in a statement that company employees, “along with CMS and its other contractors, are working around the clock toward the improvement of healthcare.gov, a system that is complex, ambitious and unprecedented. We remain confident in our ability to deliver continuous improvement in system performance and a more positive user experience.”
The Centers for Medicare and Medicaid Services didn’t give CGI final technical requirements for healthcare.gov until May, according to one person familiar with the project. About a third of the work the contractor had previously performed had to be thrown out and started over as a result, the person said.
HHS was making changes to the exchanges hours before they were scheduled to go live, Sanjay Singh, chief executive officer at software contractor hCentive Inc., said in a Sept. 30 phone interview.
Hurry up
Singh, whose company did exchange work for an insurer working with the federal site, said at the time that his employees were rushing to accommodate “a late-night patch” that the department had just added.
“There was not enough time to do end-to-end testing,” he said. “The system keeps changing, so how do you run the tests?”
Singh nonetheless said on Sept. 30 that he thought the exchanges were ready to open, with basic functions available. Insurers and government were counting on low volume initially to give them more time to complete development, he said.
Carney, Obama’s spokesman, on Monday said there was enough testing to give administration officials confidence the websites would work better than they have.
More than one-third of funding for ACA contracts with the top 10 exchange vendors was committed in the six months before the exchanges opened, according to a preliminary analysis by Peter Gosselin, a senior health analyst with Bloomberg Government in Washington.
‘Really rushing’
“On a consistent basis, it shows they were really rushing, and we see the results,” Gosselin says.
Secretary of Health and Human Services Kathleen Sebelius agreed Monday to testify before the House Energy and Commerce Committee on Oct. 30. Representatives of contractors have been summoned to appear before the committee on Oct. 24.
“We are now entering week four of the botched health care rollout, and with hundreds of millions of taxpayer dollars spent for a system that still does not work, Congress and the American people deserve answers,” the committee’s chairman, Republican Representative Fred Upton of Michigan, said in a statement.
