And it isn’t likely to get better anytime soon …
by Peter Suderman
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.
That’s hardly a shock. What could either of them say? The federal exchange system simply does not work. And the administration has run out of excuses. Even President Obama—who initially excused the exchange problems as being typical of a large technology rollout—has begun to talk more frankly about the system’s flaws. “The website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable,” he said on Tuesday.
It is clear now that, despite occasional suggestions of light at the end of the tunnel, the administration does not know how long the exchange problems will take to fix. At this point, then, it is necessary to at least consider the possibility that the federal exchanges, and perhaps a few of the state-run counterparts as well, are simply not going to work, at least not in the relatively short time the administration has to get the system on track.
Given how little information is available to outsiders, it’s hard to judge with great certainty. It is of course possible that the problems could be resolved in a few days or a few weeks. But the administration’s obfuscations, as well the repeated assurances both before and after the opening of the exchanges that they had everything under control, don’t inspire confidence that meaningful fixes are on the way. Already there are signals that the exchange problems could be deep and long-lasting.
Initially, the administration pinned problems with an unexpected amount of traffic. “These bugs were functions of volume,” White House technology adviser Todd Park told USA Today. “Take away the volume and it works.”
That excuse no longer holds up. The volume’s gone, and the website still doesn’t work. Web traffic to HealthCare.gov dropped 88 percent from October 1, the day the exchanges opened, to October 13, according to data released this week by Kantar US Insights. Yet despite plummeting traffic, many users remained unable to even create the accounts necessary to begin the application process.
The insurance industry is sounding the alarm too. Cigna has told brokers in the four federal exchange states it’s selling policies not to even attempt to sell subsidized insurance before next month. There are multiple reports of serious problems with the industry end of the exchange tech, with the system relaying multiple enrollment and unenrollment notices for the same individual—and without the timestamps that might help insurers understand which action was the user’s final one.
Insurance consultant Robert Laszewski, who has been working with health plans selling insurance on the exchanges, told The Washington Post this week that he wouldn’t even bother using the federal exchange system himself, and would advise others to avoid it. “People are just wasting their time,” he said, adding that fixes haven’t been forthcoming. “There’s no evidence of any improvement so far.”
The CEO of Aetna, meanwhile, told CNBC that testing of the system has been done on the fly, and that health insurers—who are connected directly to the exchange systems—didn’t get the code to connect their systems until a month before the exchanges opened. He predicted that it could be three years until all the problems are solved.
Three years! The administration already had three years to build the system. They failed—in part because they dragged their feet on the process to begin with. Deadlines for key regulations—rules that were essential to creation and design of the exchange—were consistently late. As early as the summer of 2010, HHS had already missed multiple implementation deadlines. Warnings about regulatory holdups persisted through November 2012 as the administration delayed the release of yet more rules required to keep the exchange process on track.
Delay after delay piled up. And the system’s most technologically challenging component sat not just unfinished but essentially unstarted for more than a year after the contract to build it was awarded. CGI Federal was awarded a $94 million contract to build the data hub and back end of the federal exchanges in December of 2011, but did not even begin to write code until spring of 2013, according to The New York Times.
Frustrated, anxious health insurers knew it was a mess. So did federal officials. “Confidential progress reports from the Health and Human Services Department show that senior officials repeatedly expressed doubts that the computer systems for the federal exchange would be ready on time,” according to the Times.
But rather than admit their problems, the administration offered confident spin. “States and the federal government will be ready in 10 months,” Gary Cohen, the federal official overseeing implementation of Obamacare’s exchanges said at the end of 2012. The exchanges “will be ready,” he promised members of Congress again a month later in response to skeptical questioning.
Those promises continued throughout the summer. In July, HHS Secretary Sebelius offered yet another assurance that all was well. “We are on track to flip the switch on October 1st and say to people come on and sign up.” In August, she did it again. “In every state in the country, regardless of what you hear, in every state in the country, there will be a new health marketplace open for business on October 1. There will be online availability that now is up and running.”
Technically, it’s up. But it’s hardly running. Local news reports from across the country indicate that many enrollment centers have not been able to sign up anyone at all. Some of the 36 states with federal exchanges may have enrolled no one.
The problems aren’t confined to the federal exchanges either. Maryland’s system, which President Obama praised a week before the exchanges opened, is still broken. Hawaii’s system, built by the same contractor that built the federal exchange, was shut down on October 1 after crashing, and did not reopen until October 15, at which point it briefly went down again. Oregon delayed online enrollment even before opening, and was still stymied by technical glitches at the beginning of the week.
Some dedicated people have recently reported progress in getting into the system after numerous tries. But even then there are errors. And the system can’t really be said to be working if it requires most people to engage in repeated attempts to sign up.
Even as the exchanges opened to widespread inoperability, the administration continued to insist that all would soon be fine. “We expect to resolve these issues in the coming hours,” one federal health official told Reuters on the day the exchanges opened. The enrollment system was taken offline for several hours during the first weekend, with HHS promising “significant improvements in the online customer experience” by the next Monday. Suggestions that major improvements were just around the corner continued for more than a week.
The pattern here is unmistakeable: The administration insists that work on the law’s exchange system is going fine — and sooner or later it becomes apparent to all that it is not.
It’s no wonder the administration is suddenly so disinclined to talk about Obamacare’s faltering exchanges. The rollout so far has proven it both incompetent and untrustworthy. At this point one has to presume that the administration’s unwillingness to answer questions about the exchanges does not arise out of a desire to hide some buried good news. Their silence, in other words, is as revealing as anything the administration might now say.
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Peter Suderman is a senior editor at Reason magazine and Reason.com, where he writes regularly on health care, the federal budget, tech policy, and pop culture.