As I noted in my post last week, I've been trying to shop for a health-insurance plan on the new Affordable Care Act (ACA) online marketplace HealthCare.gov.
I've tried to remain patient and work through the myriad system crashes and cul-de-sacs. The government has admitted that it didn't have enough capacity to deal with tens of millions of people searching for policies. In a way, that's good for the future of the ACA, since it shows robust demand. But not being able to get into the HealthCare.gov system is both frustrating and politically volatile. The ACA will live or die based on whether Americans can eventually obtain affordable coverage that serves their needs.
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For me, as I've previously stated, this isn't an academic or journalistic exercise. I really want to find affordable coverage for my family since we've been buying catastrophic policies – which cover little and carry a $6,000 deductible – for the last decade or so. My wife has been treated for cancer, so shopping for private insurance outside of the exchange is not a viable option. I'd like to pay less than the (up to) $15,000 we shell out for out-of-pocket health expenses every year.
The first two weeks of the HealthCare.gov site haven’t gotten me closer to that goal.
AN INEVITABLE CONCLUSION
I tried logging in during various times of the day, but the system consistently crashed, saying it was "unavailable." When I finally did get to the next level beyond the log-in, another message bounced me to an "identity verification" tier that was handled outside the system by Experian, the giant credit-reporting firm perhaps better suited to handle this task.
When I finally got through to an Experian representative on a separate toll-free number, I was told I needed a "verification code," which I did not have, so I called back HealthCare.gov's toll-free line.
"You'll have to get that from the system; we can't give it to you," the representative said.
Upon trying to log in and getting whacked with another system meltdown, I called it a night. This was one week after HealthCare.gov opened for business.
Since then, I've continued to try several times a day, including at 4:45 a.m yesterday morning. Same result: "error" at the log-in. Two weeks after the debut of HealthCare.gov, my conclusion is simple: You can't use this system if you can't access it.
While the government is loathe to say that HealthCare.gov is buggier than a flophouse above a greasy spoon, one unofficial estimate shows that the actual log-in and application rate is awful. According to an October 11 post on Bob Laszewski's "Health Care Policy and Marketplace Review" blog, "not more than 5,000 individuals and families signed up for health insurance" in the 36 states the federal exchange serves. Although I can't independently verify these numbers, that translates into roughly 50 enrollments per day.
Most troubling to me was that the government based its projected volume on Medicare.gov volume, which ran up to 30,000 users a day. Why compare a semi-technical user population to up to 30 million people searching for a policy at the same time? Somebody wasn't thinking logically.
"These bugs were functions of volume,'' U.S. Chief Technology Officer Todd Park told USA Today several days after this site’s launch. "Take away the volume and it works.''
Multiple reports suggest the problems with the site go well beyond those server capacity issues.
I asked U.S. Health and Human Services (HHS) spokesman Brian Cook what the agency was thinking when they designed the HealthCare.gov system. He had contacted me upon seeing my first post on this subject last week. I sent him a list of questions about why the system was so bug-ridden and the actual number of people getting through, but received no reply.
PRECEDENTS FOR BOTCHED ROLLOUTS
There seems to be a precedent for bad rollouts of new government programs. The opening of the Medicare Part D drug plan was confusing and messy, as was the introduction of the Massachusetts state health plan under GOP Governor Mitt Romney.
Officials in the Bay State botched a projection of the number of people who would be eligible for free and subsidized health coverage. In 2006, that number was pegged at 140,000. But the state vastly underestimated the demand; by 2007 there were 367,000 newly insured citizens.
Did the officials at HHS take a cue and learn from the introduction of "Romneycare," officially known as the "Connector?" It doesn’t look like it.
According to the Associated Press, millions of Americans have tried getting into HealthCare.gov – HHS isn't saying how many have actually been able to submit online applications – but only 7 percent have "tried to sign up for insurance." That's more than 20 million Americans or roughly the total population of the top six cities in the U.S.
If the tech issues with the site reflect the federal government's general tendency to buy and implement outdated and buggy programs, then the Congress needs to audit and overhaul the $80 billion spent on information technology (IT) every year. As has been documented before – from antiquated counter-terrorism IT before 9/11 to Pentagon procurement systems – it's possible that the government is wasting billions on junk technology. If this country can afford to have the best IT in government and created a vast system to spy on its citizens, why isn't it spending our money wisely?
If and when the government gets HealthCare.gov up and running, it may face yet even more complications. As part of a proposed Senate deal to re-open the government, income certifications and audits might be required.
The first audit should be focused on the tech team. Technical ineptitude may succeed in doing what anti-Obamacare Republicans largely failed to do when they forced a government shutdown: Keep people out of a system designed to initially provide insurance for more than 7 million people.
The window is fast closing for our collective patience. As much as I want this system to work, it needs some competent engineering and immediate quick fixes.
When the nation and media shift their gazes back to the ACA once the debt-ceiling drama is over, the HealthCare.gov show must go on or far too many people will leave the theater.
