The irony is rich. President Obama told Maryland college students just days before the launch of his healthcare “marketplace” that it would take just a few keystrokes to compare prices and policy details.
“Don’t take my word for it, go on the website,” Obama told a crowd at Prince George’s Community College in Largo, MD, five days before the launch. “See for yourself what the prices are. See for yourself what the choices are and then make up your own mind. That’s all I’m asking.”
But the bureaucrats in his administration clearly weren’t listening. They created a website that is calamitously cumbersome and is not at all like the typical online shopping experience that lets people browse for products and prices before making a purchase. Instead, the Healthcare.gov website demands an extraordinary amount of personal information from “shoppers” before they can find out their health insurance options and prices.
Why would they design a site this way? Because the administration didn’t want people to get sticker shock by seeing the full cost of the insurance policy upfront. And since subsidies depend upon a number of factors, including income, family size, and health habits, the administration decided to require every potential applicant to enter that information before they could “shop” for policies.
With a product that had an advertising campaign bigger than Apple or Microsoft ever could envision, it was not surprising that ten million people logged on to Healthcare.gov in the first week to check it out.
Put that volume on top of what is reported to be sloppy and poorly-coordinated software, and you have a disaster on your hands.
The disaster can be traced to two key strategic but avoidable mistakes in creating the Healthcare.gov website that the Obama administration runs to serve the 36 states that decided not to create their own health insurance exchanges. (People must apply for insurance through the exchanges in order to qualify for their share of the $1 trillion in ObamaCare health insurance subsidies.)
Mistake #1: Bureaucrats working for Health Secretary Kathleen Sebelius decided that they would oversee development of the Healthcare.gov website rather than hire an experienced lead contractor to manage more than 50 software companies involved in writing code for the federal site. This is an extraordinarily complex network of interacting systems, and it’s clear now that government employees did not have the experience or expertise to manage such a process, especially on extremely tight deadlines.
A lead developer also would likely have issued strong warning against Mistake #2 – the administration’s threshold decision to require people to fill out an application for coverage before they could browse the website.
Administration officials were insistent that they wanted to require consumers to create online accounts and apply before they would be able to check out prices and plan options. Last month, Gary M. Cohen, the federal official in charge of health insurance exchanges, told Congress that on Oct. 1, “consumers will be able to go online, they’ll be able to get a determination of what tax subsidies they are eligible for, they’ll be able to see the premium net of subsidy.” The strategy was clear from the beginning.
The administration only wanted people to know their subsidized price. Instead of seeing that the health insurance policy they selected costs $500 a month, the White House only wanted them to see the premium they would pay – $100 a month, for example. (Taxpayers, of course, foot the rest of the bill.)
But having so many people putting in so much information into the system at once caused an epic crash – especially with software that many technical experts say was poorly designed in the first place.
Colorado, one of the 15 states that designed its own health insurance exchange, made a deliberate decision to allow browsing first.
Colorado officials didn’t want to “spook” consumers, said Gary Schneider, IT program manager for Connect for Health Colorado, the state’s exchange. “We were trying to be less intrusive and create a more consumer-friendly experience.” Consumers are allowed to set up their accounts after they’ve narrowed their options. Colorado has had a much smoother launch.
Millions of consumers trying to create their accounts on the federal website, however, caused long waits and exasperation. The technological logjams, along with frustrated consumers, have kept enrollment to a trickle.
The Healthcare.gov website must knit together data for each applicant from numerous agencies — including the Internal Revenue Service, Homeland Security, the Social Security Administration, HHS, the Defense Department, and even the Peace Corps — each of which marches to its own IT specifications. Healthcare.gov must also interact with states to check Medicaid eligibility and then the package of data is sent to the insurers.
Avik Roy at Forbes’ Apothecary Blog has a detailed description of the epic gridlock.
Even the in-person “navigators” and the contractors working the telephone application lines are flummoxed. They, too, have had trouble accessing the website, and are instead filling out paper applications for applicants, which means the information still must be entered electronically to check eligibility. That, too, will significantly delay processing and enrollment and likely will require follow-up contacts for corrections and additional information.
As much of a disaster as this is, flawed software can be fixed over the long term. ObamaCare’s faulty policy can’t. Many, many more problems are waiting in the wings.
Posted on Forbes: Health Matters October 14, 2013