The monthlong wait to repair the Obamacare health-insurance exchange is increasing pressure on the president to ease a key deadline for consumers to sign up.
Jeffrey Zients, the economic adviser asked by President Barack Obama to help correct the website, said the exchange is fixable and will be working “smoothly” by the end of November. That would mean two months when the consumer website at the heart of the $1.4 trillion U.S. health-care overhaul won’t be fully operating.
“If it’s going to take the White House until the end of November to get the website fixed, then the enrollment period should be extended” beyond the March 31 deadline, Senator Jeanne Shaheen, a New Hampshire Democrat who voted for the health law in 2010, said in an e-mail through a spokeswoman.
Since opening Oct. 1, the federal online marketplace serving 36 states has been plagued by delays, error messages and hang-ups that have prevented many customers from completing applications. Shaheen is among 10 Democratic U.S. senators who wrote the administration to ask that the six-month enrollment period be lengthened. Other supporters of the overhaul agree.
“To the extent that people are precluded from getting enrolled because there’s a delay in the proper functioning of the website, I think it is very much worthy of consideration,” said Ron Pollack, executive director of Families USA, a consumer group in Washington that is supporting some enrollment efforts.
The rocky debut of the insurance exchange is cutting at the heart of the Patient Protection and Affordable Care Act of 2010, Obama’s domestic policy centerpiece designed to offer medical coverage to most of the nation’s 48 million uninsured. Now, after three years of trying to dismantle the law generally known as Obamacare, Republican lawmakers are seizing on the website’s flawed debut.
“Twenty-five days after the administration launched this site, we’re supposed to believe that it will be functioning more than a month from now after they have had 3 1/2 years?” Senator Lamar Alexander, a Tennessee Republican, said in an e-mail. “This is a spectacular failure of leadership.”
Health and Human Services Secretary Kathleen Sebelius is scheduled to testify Oct. 30 before the House Energy and Commerce Committee. Marilyn Tavenner, the administrator for the Centers for Medicare and Medicaid Services, plans to appear Oct. 29 at a House Ways and Means Committee hearing.
“We as taxpayers are spending hundreds of millions, if not billions, to get this thing ready, and it’s not,” Representative Fred Upton, a Michigan Republican and chairman of the Energy and Commerce committee, said in an interview on Bloomberg Government’s “Capital Gains” program.
Zients said yesterday that the project’s management has been reorganized. UnitedHealth Group Inc. (UNH)’s Quality Software Services unit is taking over as lead contractor, “overseeing the entire operation,” Julie Bataille, a spokeswoman for the Medicare and Medicaid agency, said on a conference call.
The site previously had no lead contractor. It was built largely by a unit of Montreal-based CGI Group Inc. (GIB/A) The UnitedHealth unit, QSSI, built a service called the “data services hub” that collects information about customers from the Internal Revenue Service and other agencies, and feeds it to the federal website and health exchange websites run by states.
“With the new general contractor in place and the focus that we have and what we have seen over the last couple of days, we are confident that each week the site will get better,” Zients yesterday told reporters on a conference call.
Sebelius, who some Republicans have said should resign, blamed the website failures partly on a high volume of consumer traffic. “In an ideal world,” she said, there would have been more testing of the software before the site opened.
The secretary said extending the first enrollment period for the law could complicate 2015 planning for health insurers, who must submit rates for the second year of the program just months after the first enrollment ends.
“We would have to have a serious understanding with our insurance partners because until they know who is enrolled they really can’t even submit a bid for next year,” Sebelius said at a news conference yesterday in Austin, Texas. “Any kind of extension of what is an unusually long open enrollment period has subsequent consequences.”
Enrollment is limited in order to discourage people from waiting until they get sick to sign up for insurance. Extending the period may give healthy people “some wiggle room to see if they really need insurance,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a Menlo Park, California-based nonprofit that studies health-care trends.
The federal website healthcare.gov was intended as the main portal for millions of uninsured people in 36 of the 50 U.S. states to gain coverage from the Affordable Care Act. The remaining 14 states built and are running sites independent of the federal government.
The website was hobbled by software errors and overwhelmed by higher-than-anticipated consumer demand after it opened. About 8.6 million people visited in the first week, running into long waits that kept many from registering to check out insurance options. Difficulty creating an account was an early flaw, and at one point, the online exchange posted error messages in at least 24 states.
The government conducted final tests of the website just days before it went public, while similar projects are tested for months, the main contractors told a House panel earlier in the week. On the back end, health insurers have complained that information they receive from the government about their new customers is inaccurate or garbled.
Zients said the trouble sending data to the insurers “is at the top of the punch list” of issues with the site. He also said 90 percent of customers can successfully complete the account creation step now.
The Medicare agency, CMS, had been acting as “system integrator,” coordinating the work of 55 contractors and supervising testing before the site went live Oct. 1, Bataille said yesterday. That decision has been blamed for many of the site’s issues. Bataille didn’t directly answer a question about whether QSSI would be the system integrator, instead saying the company’s role is “akin to a general contractor.”
“QSSI is taking on an additional role in coordinating all the pieces of this puzzle, I would say, in a different way,” Sebelius said. “What’s clear is that in order to make all of these fixes happen in a very timely basis that everyone lives up to their contract. We want someone driving that process day in and day out.”
QSSI didn’t elaborate on its role, only saying in an e-mail that it “will help monitor, assess, prioritize and manage the technical operations of healthcare.gov to enhance the consumer experience.”
It wasn’t clear whether the government officials previously in charge, including Henry Chao, the deputy chief information officer at CMS, would remain as managers.
Zients, 46, now a health-care entrepreneur, was named in September to replace Gene Sperling as director of the National Economic Council starting in January, after serving the government in the past as acting director of the Office of Management and Budget. He agreed this week to take a detour to his new job by helping advise HHS on how to fix its website.
While the U.S. website has been difficult to use, about 700,000 people had completed applications for health coverage since the beginning of the month, the government said yesterday. The figure includes the exchanges in the 14 states that are running their own websites. About half the applications are from residents in states using the federal site, Bataille said.
Customers in states served by the federal exchange can apply by phone, where 17 call centers have wait times measured in seconds, according to the government. They can also apply on paper using in-person assistance at community organizations and health clinics.
Still, consumers’ initial impression of the online health-care exchanges hasn’t been good. Twenty-nine percent say they are working very or fairly well while 46 percent say they aren’t, according to a Pew Research Center poll conducted Oct. 9-13.
Several states running their own exchanges have reported fewer issues than the federal marketplace, including Kentucky and Connecticut, as well as in Massachusetts, which has operated an exchange since 2006 and revised its system to comply with the federal law.
White House officials say they expect a surge in online enrollment to begin in mid-November, meaning the administration may have only about three weeks to fix the flaws before negative public perceptions about the new program harden.
“This is your signature program, and you’re marching it onto the field and everybody stumbles,” said Peter Hart, a veteran Democratic pollster. “It’s hard to see competency, and it puts a giant question mark behind the future plans.”
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