Henry Chao? This midlevel Department of Health and Human Services bureaucrat helped the Bush administration muddle through its messy 2006 launch of the Medicare drug benefit. But the exchange website job required a CEO type with Obama’s ear to whom White House staff and HHS leaders would defer. Obama relied heavily on trusted political aides who skillfully negotiated the health care law through Congress and thought they could manage HealthCare.gov into being, too. Todd Park, a high-energy, talented tech entrepreneur was on the government payroll, but contractors CGI and QSSI reported to other government officials.
4. Weren’t there warnings signs that could have prevented this?
Many. Most telling were the administration’s vague replies when asked for more details about the planning and testing of HealthCare.gov.
Its message was: Don’t worry about the details; the site will be ready by Oct. 1. But Montana Democratic Sen. Max Baucus, a leader in negotiating the health law, almost pleaded with a Centers for Medicare and Medicaid Services official at a February hearing to keep him better informed. And Chao raised eyebrows at an insurance industry conference in March.
“I’m pretty nervous,” he said. “Let’s just make sure it’s not a third-world experience.”
Six months before the launch, McKinsey & Co. consultants told administration officials they had not set aside enough time for testing the whole system, according to documents released by the House Energy and Commerce Committee. The consultants said the site should be designed, built and tested sequentially after its requirements were defined — but it was built at the same time requirements were changing.
5. What’s working better now?
Like new car buyers, consumers weren’t ready to whip out their checkbooks on Oct. 1. First, they wanted to kick the tires, check out what plans they could buy and how much they cost. But few could even look through the showroom window. Consumers had to create accounts that required getting their identities verified online and got frozen screens and error messages.
Now, new pages pop up in less than a second, not eight seconds or longer. It’s easier to create accounts. A “See Plans Before I Apply” button permits window shopping without an account. And if site visitors have all their information ready, 80 percent of them can now enroll in a single sitting, up from just 30 percent in October, a federal official said.
7. What are biggest technical problems now and how fast will they be fixed?
Most are invisible to consumers — for now. These back-end problems include incomplete, inaccurate or duplicate enrollment data that HealthCare.gov sends each day in “834 forms” to insurers telling them who signed up for their plans. Insurers worry most about “ghost” files that vanish instead of being received by insurers.
About 30 percent of the website isn’t even built. Still missing is a tool to compare the enrollment lists of HealthCare.gov with those of insurers. Left also on the to-do list: a way to transmit federal subsidy payments to insurers and user fees from insurers to the feds. No one is saying when the fixes will be ready. And Web developers need to add a way to transfer payments in 2015 from insurers with healthier-than-average customers to insurers with sicker-than-average patients.