HealthCare.gov 'fixable,' but bumps abound as many try to sign up

Last week was a rough one for Obamacare, and this coming week may be no different.

Americans continued to struggle to sign up for coverage on the federal HealthCare.gov online marketplace serving 36 states, though there were reports that it got a little better. Some of the state-run exchanges were doing much better, though several struggled with problems as severe as the federal site. Insurers said the enrollment data they were getting from the federal exchange were often inaccurate and incomplete because of glitches in the electronic transmission forms.

President Barack Obama held a news conference to announce a “tech surge” enlisting top IT experts to fix the exchange problems quickly. The White House named Jeffrey Zients, a businessman who is slated to take over as director of the National Economic Council in January, to manage the site overhaul. Obama also gave out a toll-free phone number for people to call for help in signing up for coverage.

Zients announced Friday that the CMS has chosen Optum/QSSI, a subsidiary of UnitedHealth Group, to serve as general contractor in fixing the problems with the federal site. “There is a lot of work to do, but HealthCare.gov is fixable,” he said. “We are confident that by the end of the month of November, HealthCare.gov will run smoothly for the vast majority of users.”

The Obama administration said it would start offering regular blogs and CMS press telebriefings on the status of HealthCare.gov technical fixes. Also last week, 14 insurance industry heavyweights were called to the White House on Wednesday to advise the administration on how to fix the federal exchange. High on the agenda was the lack of coordination on enrollment data standards connecting the exchange and insurers.

Meanwhile, the House Energy and Commerce Committee held a hearing on the disastrous rollout of the exchange, and Republicans demanded that Obama fire HHS Secretary Kathleen Sebelius. Some Democrats joined in the criticism. Sebelius and CMS Administrator Marilyn Tavenner will face congressional grillings at hearings this week. Administration officials have ducked questions about whether Sebelius knew of major technical problems before the launch.

The administration, worried about consumers not being able to sign up for coverage in time to avoid the healthcare reform law's tax penalty for not obtaining insurance, announced last week that it would extend the deadline for enrollment six weeks to March 31 for avoiding the penalty.

At the House hearing Thursday, Republicans and Democrats questioned representatives of the major contractors that worked on the HealthCare.gov site, but the contractors mostly said it wasn't their fault. Cheryl Campbell, senior vice president of CGI Federal, the prime contractor, said CGI went through eight technical reviews before the system went live Oct. 1 and delivered the functionality that the CMS required to allow consumers to enroll. But she also acknowledged that website issues have made it difficult for consumers to navigate, and that her company quickly shifted to optimizing performance for users.

Witnesses said changes in the batting order of functions accessible by website users, such as enabling consumers to shop for health plans before fully registering, were made just weeks before its Oct. 1 launch date. Full end-to-end testing of HealthCare.gov also was delayed until a few weeks before its rollout, they said.

But Campbell said the health plan shopping and enrollment system is steadily improving every day and that her company continues to review system logs, fine-tune servers, analyze code for any anomalies and make corrections. “People are enrolling,” she said. “But people will be able to enroll at a faster pace. The experience will be improved as they go forward, and people will be able to enroll by the Dec. 15 timeframe.”

“I'm concerned about what happens next,” said committee chairman Fred Upton (R-Mich.). “Will enrollment glitches become provider payment glitches? Will patients show up at their doctor's office or hospital to be told maybe they aren't covered or even in the system?”

Several Republican committee members tried to elicit details about the fateful decision to require HealthCare.gov users to create an account before they could shop and compare health plans. They asked Campbell and Andrew Slavitt, group executive vice president of Optum/QSSI, who exactly made the decision to require registration before consumers were allowed to browse plan options. Republican critics of the system have alleged the batting-order decision was made so consumers would know whether they were eligible for federal premium tax credits before seeing rates, shielding them from “rate shock” if they first saw the full, unsubsidized premium.

“We weren't made aware of this until the final days before the launch,” Slavitt said of the batting-order change. “We don't know when the decision was made or why the decision was made.”

Campbell said she wasn't certain, but thought the decision was made by Henry Chao, deputy chief information officer and deputy director of the Office of Information Services at the CMS.

Rep. Greg Walden (R-Ore.) asked when the entire system was tested end-to-end to determine whether the component parts would work as a complete system. “It started in the last weeks of September,” Campbell said.

Walden then asked what would be the industry standard. “Months would have been nice,” Slavitt said.

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