Rachana Pradhan and Brett Norman: Behind the Curtain, Troubles Persist in HealthCare.gov

Behind the scenes, HealthCare.gov is still a mess.

The “back end” of the Obamacare website still isn’t properly wired to the health insurance companies. It’s slow going for health plans to make sure the 11.4 million people who have signed up end up in the right plan. Subsidy payments aren’t automated, so the insurers get payments based on estimates. And adding information like a marriage or the birth of a child is a convoluted, multi-step process.

Even though consumers had a largely smooth enrollment experience this year, the fact that these gaps persist behind the scenes 18 months after HealthCare.gov launched shows that the system is still not working as intended. Instead of a swift process, health plans use clunky workarounds and manual spreadsheets. It takes time and it costs money.

“You’re not going to find a lot of customer-facing issues,” one insurance industry official said. “It’s more like you lift up the hood, and that’s where the problems are.”

“All of these things, it’s sort of the cost of doing business right now. And it’s not cheap,” the insurance official added, referring to the ongoing administrative expenses of doing so much of it by hand.

The back end isn’t broken so much as it’s unfinished. It wasn’t constructed in time for it to be part of the botched website launch in the fall of 2013; one administration official told a congressional hearing that it was 40 percent incomplete. And it’s not totally done now, although it’s gotten closer.

“CMS has focused on improving operational efficiency and the consumer experience while building the back-end system. We continue to add new back-end functionality, and we are closely managing the work to ensure it is completed in 2015,” CMS spokesman Aaron Albright said.

Because consumers aren’t having such a tough time, the website hasn’t been in the political crossfire so much this year. Obamacare is still facing a Supreme Court challenge, and Republicans are still trying to repeal it. But they’ve focused on confusion during tax season, cost, access to doctors and the heavy government role in health, not so much the technology.

President Barack Obama has declared this year’s enrollment a success. The White House on Tuesday night announced that 11.4 million people had signed up or re-enrolled — though not all of them have paid yet, so the true coverage number will be lower. Still, sign-ups exceeded the administration’s estimates.