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President Barack Obama steered Americans away from his administration’s malfunctioning health insurance website Monday, at least for now, suggesting they use call lines and in-person navigators to sign up instead. And he admitted it’s a mess.
The latest fix, Obama says, is an update on Healthcare.gov telling people how they can buy insurance "the old-fashioned way — offline."
“So you'll find information about how to talk to a specialist who can help you apply over the phone or to receive a downloadable application you can fill out yourself and mail in,” Obama said.
His administration has been tight-lipped on just what the problems are with the website, which was originally billed as something resembling Travelocity for health insurance — a place online where people could go to compare one plan to another and get a price.
But experts point out that HealthCare.gov was never that simple. While most in the industry are confident that Obama can keep his promise to eventually fix the site, they say there are multiple places where things may have gone wrong.
“Buying a health plan is a lot more complicated than buying a flight," says Brandon Cruz, president of GoHealth, a private health insurance marketplace. “When you’re buying a health plan, you need to know all the doctors in the network, what you deductible will be, what your co-insurance will be. And the terminology is so foreign.”
Customizing is complicated
Not only that, but an airline seat is a fairly generic commodity. Health insurance is personal, says Caroline Pearson, a vice president at consulting firm Avalere Health. “What’s available for purchase and the price they are going to offer to you for is completely customized on an individual basis,” she says.
“So in order to give people an accurate shopping experience with accurate pricing, you had to enter a lot of personal information about where you live, your income, the size of your family, and then the government has to verify that data. There’s been a lot of up-front electronic verification, which seems to be where a lot of the website snafus occurred.”
The consensus: the federal website has tried to offer too much, too fast, to too many people.
The federal government is running websites for 36 states that didn’t want to do their own, or couldn't manage it right away. Each state has its own insurance regulations, and each has its own list of providers offering plans — from 16 different insurance companies in New York, to just one for people in some counties in West Virginia.
Before you can even begin to shop, the website has to know what county you live in. And it needs to check your income to make sure you shouldn’t be on Medicaid instead, and to check to see if you qualify for a federal subsidy and if so, how much it would be.
Oh, and it has to check with the Department of Homeland Security to make sure you really are a legal resident — all this while you’re staring at the screen, waiting.
States let users window-shop
Pearson says some of the 15 states offering their own websites — Kentucky is an example — have sped up things for users by letting them window-shop first. "Many of the state websites, though not all, elected to simplify the process and allow you to shop without creating a login and submitting all your personal information,” she says.
At first, the Obama administration blamed the website hangups on a crush of new users. That's no surprise as the White House says nearly 20 million people have visited the site so far and 500,000 have started the application process.
But Obama has now admitted it was worse than this and says he has “the best and the brightest” working to fix it.
Cruz says there are lots of places where the site could be hanging up. “I don’t think the code was bug-free when the time came to launch,” he says. “If the code’s not written properly, you can have bottlenecks.”
Databases — and there are lots of them on the federal website — are one big potential blockage. “If everyone’s trying to access the database at the same time, it locks up,” Cruz says.
They’re usually designed to freeze while someone is putting information in, so that the next person to access it has the most up-to-date information. To use the Travelocity analogy, think about choosing your seat on a flight. You’d want to be sure someone didn’t snatch the seat you wanted at the same time you were on there.
It's not as simple as adding servers
Simply adding servers — a computer or system of computers that increases capacity — won’t help if there’s a bottleneck that keeps people from even reaching the server, Cruz points out.
Many experts have said the government did not test the system thoroughly enough before launch. And having literally millions of people jump onto a new website on the very first day is a recipe for a mess, says Chet Wisniewski, senior security adviser for IT security firm Sophos Inc.
“When you think about Twitter, only a few thousand people knew about it, then tens of thousands of people. And after a year, when everybody was using it, Twitter started to break,” Wisniewski says.
The Pew Research Center reports that 14 percent of adults report having visited an exchange, and another 23 percent say they intend to.
Cruz and Pearson think the problems are fixable. So does Tom Scully, who was administrator of the Centers for Medicare & Medicaid Services (CMS), from 2001 to 2004 and who now is a healthcare expert at law firm Alston & Bird.
Although much criticism has focused on a Canadian firm, CGI Group, that did some of the work for the federal government, Scully says the administration probably should have contracted out even more of the work. CMS was never equipped to do the work in-house, he says.
“They are just slow-moving, bureaucratic, lovely people,” Scully said. "It's just not a core competency of CMS."
The agency likely feared it would be impossible for a company outside the federal government to get the cooperation it would need with the internal Revenue Service, Social Security Administration and other federal departments, Scully says.
Will the phones be just as slow — or slower?
And, by the way, says Pearson, sending people to the phone might not be effective, either.
“People have had a hard time getting through on the phone," she says. “There have been really long waits on the call center.”
Avalere staffers have tried, she says. “We have spoken to the call center several times. They haven’t been volunteering to help us enroll,” she said.
Maybe that will be one of the improvements that Obama has promised, she said.
And sending in too many of the “best and the brightest’ might not be the right fix, either, software experts note. They often cite Brook’s Law, which holds that adding people to a project slows it down.
"It's not like a construction project, or an auto assembly line, where more hands on deck mean more results," said Bob Sullivan, a technology and consumer expert and author of “The Plateau Effect: Getting from Stuck to Success. ”With software, adding people at the end of a project to fix things that are broken or unfinished, can actually do more harm than good."