President Barack Obama raised the stakes on his three-year-old health-care overhaul yesterday, declaring that fixes to his administration’s troubled insurance exchange website make it ready to sign up 800,000 people a day.
The site, healthcare.gov, is sure to be tested immediately today -- “Cyber Monday” -- when deals from online retailers draw more Americans to their computers and the Internet.
The site’s stated new capacity of 50,000 simultaneous users hasn’t been proven in the real world, and U.S. officials aren’t certain the site will hold up, according to a person familiar with the repairs who asked not to be identified because the information isn’t public. At the same time, the reduced error rate of 0.75 percent per page, down from 6 percent in October, still means many users will encounter a glitch in clicking through multiple pages to enroll in a health plan.
If consumers find continuing problems with the site “it is going to help drive this to a huge advantage for the Republican party, for a broader agenda which will not be just fixing the website; it’ll be scaling back the law,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public, in a telephone interview.
The status of the repairs may not be known until the middle of January, when the administration reports on enrollment in December. Americans face a mid-December deadline to sign up for coverage beginning Jan 1.
Software Fixes
In a report released yesterday by the Health and Human Services Department, the administration said it has fixed or improved more than 400 software issues and made the site between two and five times faster through a series of hardware upgrades, including new servers. The site’s average response time has fallen from eight seconds in October to less than one second over the past three weeks, the report said.
New monitoring tools were installed allowing technicians to keep an eye on the site’s traffic and any problems 24 hours a day, and a dedicated phone line called an “open bridge” connects programmers at different contractors’ offices to a command center in Columbia, Maryland.
“Healthcare.gov on Dec. 1 is night and day from where it was on Oct. 1,” said Jeffrey Zients, the management consultant President Barack Obama assigned to supervise repairs, on a conference call yesterday.
While the report cited the “dramatic improvements” in the website’s performance, others weren’t impressed.
‘Not Great’
“A good site will have a 100th of 1 percent error rate,” said Sucharita Mulpuru, an e-commerce analyst with Forrester Research Inc., in Cambridge, Massachusetts, in a telephone interview. “That’s not great.”
In addition, “the best sites are able to handle tens of thousands or even hundreds of thousands of sessions” by users at once, Mulpuru said.
Federal officials yesterday said they would continue working to improve the website. Technicians are now focusing on fixing the systems that send data on customers and federal subsidy payments to insurers, federal officials said on yesterday’s call. Those systems, centered on a standard transaction form known as an “834,” are used to transmit key data about new customers to insurers.
The plan is to complete repairs over the weekend on parts of the website “that will significantly address the highest priority things we know are a particular concern for those transaction forms,” said Julie Bataille, a spokeswoman for the Centers for Medicaid and Medicare Services, on yesterday’s conference call with reporters.
‘Significant Changes’
The fixes will also include “significant changes” that will make it easier for insurers to enroll customers directly through their own websites, bypassing healthcare.gov, she said.
Last month, CMS announced a pilot program with 16 carriers in Ohio, Florida and Texas to see if insurers could provide an alternative to the struggling federal site.
“We are encouraged by the feedback that we are seeing,” Bataille said. The agency “believes this is something we’ll soon see more issuers be able to utilize across the country.”
The administration is releasing enrollment data once a month, with the next report not expected until mid-December. As a result, it may be impossible to tell immediately how well the technical fixes are working. Opponents, though, are sure to look for any signs of a slowdown or continued errors.
“They clearly are reporting some important progress,” said Dan Mendelson, chief executive officer of Avalere Health LLC, a Washington-based consultant to health-care companies, in a telephone interview yesterday.
‘Process Measures’
Still, the progress report was limited to “process measures” like page-view times, Mendelson said. “Ultimately, they will have to be judged on an outcome measure and the only meaningful one is enrollment.”
It’s significant that the administration didn’t accompany its performance report with public appearances by the president or other officials to get more people to healthcare.gov, he said.
“They’re not expressing the kind of confidence that they would need to have by going out and saying, ‘OK, bring it on,’” Mendelson said. “You’re not going to get enrollment until they flip that switch and aggressively say that the government is open for business. That’s the Catch-22.”
Timothy Jost, a law professor at Washington & Lee University in Lexington, Virginia who has tracked the law’s implementation said expectations about the enrollment numbers from the website will now be higher.
‘Huge Hit’
“The president has taken a huge hit,” Jost said in a telephone interview. “The Affordable Care Act has taken a huge hit. It’s going to take some time to work out of this.”
Over the last two weeks, groups known as navigators, who help people use the site, have said it was getting easier, though the progress was slow and there were frequent outages.
The site is “kind of hit and miss,” said Karen Basha Egozi of the Epilepsy Foundation of Florida, a U.S.-designated navigator, in an interview last week. “There have definitely been more hits lately than in the past. But I know there are cases where people still get locked out when they try to purchase a plan.”
“Dramatic progress has been made on improving healthcare.gov,” the administration said in its’ eight-page report. “There is more work to be done to continue to improve and enhance the website and continue to improve the consumer experience in the weeks and months ahead.”
Sluggish Site
The site seemed to be working better toward the end of last week, said John Foley, a supervising attorney with the Legal Aid Society of Palm Beach County, a navigator group in Florida. About a half dozen customers came to the group’s offices on Nov. 29 and all of them successfully navigated the site, although Foley said he wasn’t sure how many enrolled.
Yesterday, though, the site was sluggish and Foley encountered an error as he browsed health plans while speaking to a reporter.
“It’s still waiting. That was 20 seconds or 30 seconds. It just froze up; I’m done,” he said. “It’s still kind of glitchy. Now it just kicked me out. It went back to the front page. I’ve been here all afternoon and it’s been like that.”
The site wasn’t experiencing broad errors or outages on Sunday, Aaron Albright, a spokesman for the U.S. Centers for Medicare and Medicaid Services, said in an e-mail.
The goal of having the site “work smoothly for the vast majority of users” was set by Zients after its calamitous Oct. 1 debut. Technicians supervised by Zients fixed or improved more than 400 items on a “punch list” that grew quickly starting the week of Nov. 9, according to the report.
Dec. 23 Deadline
Uninsured Americans, or those losing coverage at the end of this month, have until Dec. 23 to sign up for plans effective Jan. 1. The federal website serves 36 states, including Texas, Florida, Illinois and Pennsylvania, while 14 states including New York and California run their own.
The state sites for the most part have not encountered the technical problems of healthcare.gov.
The federal website, though, is a crucial piece of the 2010 healthcare law and its success -- or failure -- will have implications for the nation’s $2.7 trillion health-care system. The outcome will help define Obama’s legacy and influence the legislative agenda in a divided Congress, where Senate Democrats facing re-election next year have called for changes in the law.
“The administration has hit the big benchmarks they set out, 50,000 people at one time, 800,000 people a day,” Representative Chris Van Hollen, a Maryland Democrat, said on NBC’s “Meet the Press.”
Security Issue
Representative Mike Rogers, a Michigan Republican, said the healthcare site’s security remains a problem. “It still doesn’t function right,” he said on the NBC show. “The security of this site and the private information does not meet even the minimal standards of the private sector.”
Ahead of the Dec. 23 deadline, the government plans to focus on helping people who’ve already tried to enroll complete the process, Bataille said. About 975,000 people completed applications for coverage in October and were determined eligible to make a purchase, but didn’t select a plan, according to enrollment data released in November.
“While we certainly want to and will invite new consumers into the site, our focus is on making sure those who have tried to enroll in the past several weeks are able to successfully complete that process,” she said.
The site is “in the zone of about 80 percent of users being able to do that same process successfully,” Bataille said. White House press secretary Jay Carney on Nov. 18 that the administration wanted about 80 percent of people in states covered by the federal exchange who need insurance to be able to use the website.
The website attracted 2.8 million on its first day Oct. 1 and, initially, the administration blamed the large turnout for the site’s problems. Since then, the government has cited significant problems in the site’s development and software as leading to the breakdowns.