OBAMACARE DECEMBER 2, 2012
In the weeks leading up to October 1, Obama Administration officials predicted that healthcare.gov would be functional but glitchy. It didn't happen then but it appears to be happening now. On Monday, the website for purchasing Obmacare insurance policies seemed to work and, for much of the day, it seemed to work well. But technical difficulties and errors stopped at least some users, performance overall lagged when traffic surged, and serious "back end" issues still need attention.
Drawing definitive conclusions about the state of healthcare.gov is difficult and will remain so for some time. (That's why I keep using words like "seems" and "appears.") But it's obvious the site is working much, much better than it did at the launch. For all of October and most of November, it was difficult to find stories of people successfully navigating their way through the system. Now, those stories are popping up everywhere—on social media, in blog posts, and, yes, even in the comments section of newrepublic.com. Phil Galewitz of Kaiser Health News spoke to handful of people who were able to complete applications, including some who had been trying unsuccessfully for weeks:
Gina Holub, 47, of Richboro, Pa., said healthcare.gov also worked for her Sunday, after her application had been hung up since October. “I figured I would give it another try, given that they said the fixes would be done by end of November,” said Holub, a freelance market research analyst.
It took her 15 minutes to complete a new application and another 45 minutes to choose a plan from Independence Blue Cross, which includes dental coverage — and she will pay $750 a year less than she does now. Her old insurer was canceling her policy as of Jan. 1. “It’s so exciting to get better insurance at a lower price,” she said.
Sarah Kliff of the Washington Post picked up some similar stories:
Ihad Issa lost count of the number of times he's tried to buy insurance through HealthCare.gov weeks ago, although he knows it's likely somewhere in the triple digits.
The 48-year-old psychotherapist in Fort Lauderdale, Fla., started logging into the Web site when it launched in October. Since then, he has faithfully visited the site once or twice a day, only to find a different obstacle.
"Early on it would think my daughter was my wife, or it would think my wife was my sister," said Issa, who was shopping for a family policy. "At one point I was getting stopped at the end. I couldn't click on the button that said, 'see what's available.' It would get bogged down."
This made it all the more surprising for Issa that, when he sat down at his computer Dec. 1 — after 61 days of trying to buy insurance — the system actually worked.
"I was thrilled," Issa says. "I had to be at work, but I just wanted to sit there and look at all the different options."
Stories like these are consistent with earlier reports from the states where functioning websites were already allowing successful enrollments. National Public Radio had a few from California last week:
Jane Bradford, 52, is a stay-at-home mom in Pasadena. She's losing the HMO insurance she has for herself and her three kids, who are 16, 21 and 23. Her policy offers low copays for doctor visits and a relatively low $3,000 family deductible, but she'll shed no tears to see it go. Bradford says that's because she has found several plans that will cost hundreds less in monthly premiums — even though her husband's income is too high for the family to qualify for a federal subsidy.
"Saving possibly $400 or more a month is awesome, so I'm not sad at all," Bradford says.
Anecdotes alone don’t prove anything. But the available statistics suggest they are indicative of a broader trend. Internal metrics on healthcare.gov, which the Department of Health and Human Services released on Sunday, suggest errors are far less frequent, pages load more quickly, and capacity is double what it was in early October. The site also has some new features, including, at last, a sophisticated “window shopping” option that allows users to shop for plans without first creating full accounts. The previous, more primitive version could provide estimates only for for 27-year-olds and for 50-year-olds. (Insurers may vary rates for these plans by age.) The new version offers age-specific estimates along with more detailed information about the available plans.
And interest in Obamacare’s insurance options appears to remain high, despite all of the well-publicized problems with the site. Bloomberg News has reported that, according to anonymous administration sources, approximately 100,000 people had enrolled in private plans through healthcare.gov in November. That included periods when the site was still having many more technical problems.
On Monday, according to the Administration, more than 375,000 people had used healthcare.gov by noon. That pace is more than twice what a normal weekday would bring, officials said and, by 10 a.m., it had threatened to overwhelm the site's capacity. But here, too, the system performed better than it had previously. In October and November, traffic surges would cause the system to shut down completely. This time, HHS officials were able to deploy a new queuing system. When that system is operating, visitors who don't want to wait for traffic to subside can simply leave an email address. The system contacts them once traffic has subsided.
But healthcare.gov's new capacity is supposed to be 50,000 users. HHS officials engaged the queing system well before traffic reached that level, because the page response rate had slowed and the error rate had ticked up. Among those who had difficulty was ProPublica senior editor Charles Ornstein, who decided to try the system for himself:
What I found was hardly encouraging — long delays loading pages, an endless circle of tasks (some already completed) and ultimately an error message.
The load-time issues (sometimes more than a minute) reminded me of the problems users encountered in the very first days of the Web site, which handles health insurance enrollment for residents of 36 states. …
Additionally, once I had completed and submitted my application and verified my identity, the site told me that I was missing information and had to review it again. Nothing was missing. Ultimately, I got an error message telling me to come back later.
Some of the users Kliff interviewed had similar experiences:
Kathy Coombs, 61, of Alexandria has been trying to see the results of her application, including what she thinks will be a hefty subsidy. Coombs was one of the lucky few who logged on to the site on the first day, created an account, put in her information and received an e-mail back saying her results had been processed.
“I was so excited about it, I’m a huge liberal and big proponent of all this, and as a recent widow, I could really benefit,” she said. Her income is well below $45,000. But since then, she has been unable to “view results” to see her private insurance options with the amount of subsidy included.
She tried Monday at 1:30 p.m., but because of heavy volume on the site, she got a notice saying too many people were logged on and to try later. “It moved much more quickly,” she said Monday, “but I still hit a dead end.”
Other problems lurk in the parts of healthcare.gov that consumers don't see or use directly. Chief among them is the now-infamous “834” communications that the system sends to insurers, so that the carriers know who has enrolled in their plans. On the daily operations press call, HHS spokesperson Julie Bataille announced that officials had repaired a problem that was responsible or 80 percent of the errors. But, despite multiple questions from some (understandably) frustrated reporters, she couldn’t say how widespread the 834 problem was overall. (On Monday evening, Amy Goldstein and Juliet Eiplerin of the Post reported that 834 communications for about one-third of all enrollments to date contained errors. The administration disputed that figure but did not provide its own.)
Whether all of this is good news or bad depends on your perspective and expectations. But it's worth noting that, on Sunday, Administration officials more or less predicted the day would unfold this way, particularly given the likliehood of a post-holiday traffic surge. Here's how I summarized their outlook at the time:
…most people can log onto the system, create accounts, complete applications to obtain insurance and financial assistance, and then choose an actual plan. "Most" people is not all people, obviously: Some will still encounter errors, because of technical problems, and some will need human assistance (via a call center of navigator) simply because their personal or economic circumstances are complicated. In addition, administration officials warned that the site remains a work-in-progress. The "834" data that healthcare.gov sends to insurers, in order to confirm enrolments, still has an unacceptably high error rate. It's still possible that surges in traffic could overwhelm the system, preventing people from completing the application and plan selection process.
When healthcare.gov launched in October, it didn’t work at all and the officials in charge seemed lose and a little panicked. Now the site working for at least some and quite possibly most people, while the officials in charge seem to have a pretty firm grasp on what's actually happening. It remains to be seen whether they can fix the remaining problems by the end of the year—and, if not, what they will do for people whose coverage is set to expire then. But the progress is real, many more people are using the site to get insurance, and it would seem the question about full functionality is "when" rather than "if."