The Obama administration said it has reached out to the “best and brightest” from inside and outside of government to get its health-insurance exchange up to speed, even as it faces another missed deadline for the rollout.
The promised debut this week of a Spanish-language version of its website has been delayed after an administration spokeswoman said no date had yet been set. And while repairs have allowed more consumers to register as the exchange enters its fourth week, technical flaws still slow their ability to enroll in plans or gain from add-ons like a Spanish-language site, targeted at 10 million Latinos eligible for health coverage or subsidies.
“The website that’s supposed to make it easy to apply for and purchase the insurance is not working the way it should for everybody,” President Barack Obama said today at a White House speech. “Nobody is more frustrated by that than I am.”
If a “tech surge” announced yesterday by the administration can’t turn things around quickly, the six-month enrollment period that ends March 31 may have to be extended, independent consultants and analysts said -- an idea dismissed as premature by backers of the health-care system overhaul. Republicans, meanwhile, are calling for firings over the delays.
“Somebody ought to be accountable for this mess, and if the president isn’t going to resign, it’s up to him to figure out who should,” U.S. Senator Lamar Alexander, a Tennessee Republican, said in an e-mail from a spokeswoman.
The exchanges, run by the U.S. Department of Health and Human Services, are designed to sell insurance plans to people who can’t get coverage through their employers or government programs. The federal site that debuted Oct. 1 serves 36 states, including Texas and Florida, that declined to create exchanges under the Patient Protection and Affordable Care Act of 2010.
New features appeared on the Obama administration’s health insurance website late yesterday, part of an effort to ease enrollment bottlenecks and delays.
Programmers working on the site added a prominent “apply by phone” button, a way to draw volume from the site while it’s repaired, and made it easier for people to shop for health plans without first identifying themselves. A “see plans now” button allows anonymous shopping after customers answer a few questions about where they live and their family size.
“As part of our ongoing efforts to make improvements every day, new content is being featured on healthcare.gov in response to user feedback,” Joanne Peters, a spokeswoman for the Department of Health and Human Services, said in a statement. “It’s now easier than ever to preview plan information, access a down-loadable application form and find in-person help in local communities.”
To window shop, a consumer must click through at least seven web pages before seeing plans and monthly premiums, including three pages of explanatory information. A prominent notice on every page cautions that the prices don’t include the value of subsidies to reduce premiums for people earning less than about four times the poverty level, or about $94,000 for a family of four.
About 8.6 million people visited in the first week amid software problems that led to long waits to check out insurance offerings. At one point, the site posted error messages in at least 24 states. Over the same time period, the 14 exchange websites run independently by states saw fewer problems.
Obama’s administration yesterday promised a “tech surge” to fix the exchange, in a blog post that said the site “has not lived up to the expectations of the American people.”
“Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve healthcare.gov,” according to the posting on the health agency’s website.
“While the administration’s ‘tech surge’ makes a good sound bite, it’s woefully short on detail,” said Julia Lawless, a spokeswoman for Senator Orrin Hatch, a Utah Republican, in an e-mail. “Who are they bringing in? When can Americans expect real results?”
While the HHS blog post included no details about who is now involved, Todd Y. Park, the president’s chief technology officer, has been advising the HHS officials who planned and built the site since its debut, according to Jason Young, the agency’s assistant secretary for public affairs. Park is a co-founder of medical technology companies Athenahealth Inc. (ATHN:US) and Castlight Health Inc.
HHS Secretary Kathleen Sebelius has ultimate responsibility for healthcare.gov.
The HHS blog post said that despite the technology limitations almost 500,000 Americans have now submitted applications for health insurance through all 51 exchanges. The government has promised to release enrollment data from healthcare.gov monthly, starting in mid-November.
An independent monitor of websites said that while traffic to the federal exchange site dropped by more than half “as curiosity faded” in its second week of operation, more people were able to complete applications. About half of those who tried to register were successful in the second week, said Matt Pace, a senior vice president at Millward Brown Digital, a subsidiary of WPP Plc (WPP)’s Kantar Media.
About 368,000 people began eligibility applications on the federal website, and 47,000 were completed -- 88 percent and 31 percent better than the first week, Pace wrote in an online post. The goal set by the administration for all exchanges is to sign up 7 million people by the end of March, the enrollment cutoff.
Technology experts and people familiar with the operation point to an array of possible reasons why the 14 independent state exchanges are largely working better than healthcare.gov.
First, the states have drawn $3.8 billion from the U.S. to build their sites, including more than $900 million for California alone, according to the Kaiser Family Foundation, a Menlo Park, California-based nonprofit. The federal government spent $393 million on its site through March, the latest accounting by Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services.
At the same time, an extra $1.5 billion sought by the administration for exchanges and other provisions of the law has been largely blocked by Republicans in Congress.
Design and management differences also took a toll. At least 48 companies were involved in building healthcare.gov, according to the Government Accountability Office, and programmers were still coding the site in September.
By comparison, Connecticut hired a single company to handle its marketplace for individual coverage and stopped writing code by July to begin testing, according to Kevin Counihan, chief executive officer of the state’s Access Health CT exchange.
Finally, state-run exchanges enjoy at least one other advantage: they only have to worry about serving the residents of one state, not 36, as the federal exchange does. Political opposition to the law meant that states led by Republicans refused to create an exchange website, while other states simply fell short in their efforts to create one.
Federal administrators, “originally thought they would be implementing, I don’t know five, six, seven states,” Counihan said in a telephone interview. “The scale of the implementation from the beginning was much greater than they expected.”
A single website to serve almost three-quarters of states is impractical, Cheryl Smith, a consultant for Deloitte Consulting LLP, said in a telephone interview.
“Even a couple years ago, when I’d go from place to place to talk about exchanges, I’d say ‘when you call an ambulance do you call one locally or do you call Washington, D.C., and have them patch you through?,’” Smith said in a phone interview. “When it’s built by the states, it’s not a one-size-fits-all. It’s more customizable, more manageable.”
Getting additional sites up for Spanish-speaking users and small business employees may be the next key test for the Obama administration.
Hispanics have been key supporters of both Democrats and the 2010 health-care law. Spanish-language speakers, though, will have to wait a longer before a site for them is ready.
The administration told the National Council of La Raza, which calls itself the U.S.’s largest Hispanic advocacy group, that the Spanish-language site wasn’t going to be ready this week, after already being delayed once before, said Jennifer Ng’andu, director of health policy.
“We did not get anything in terms of promises about when the website would be ready,” Ng’andu said in a telephone interview from Washington, where she attended Obama’s speech at the White House. “They’re not going to roll out anything until they’re comfortable with the product.”
Latino voters backed Obama over Republican challenger Mitt Romney 71 percent to 27 percent in the 2012 presidential race. More recently, about 61 percent of Hispanics said they approved of the health law, compared with 29 percent of whites and 91 percent of blacks, according to a Pew Research Center and USA Today survey conducted Sept. 4-8.
Last month, just days before the main exchange opened, the administration said it was delaying until this week the start of its Spanish-language version. Advocates for Latinos, who make up one-third of the uninsured U.S. population, said they haven’t seen a test version of the site since before the original planned start date of Oct. 1.
Ng’gandu said her group and others will continue to push alternative sign-up methods, like a toll-free telephone number and paper application forms. Obama spoke about the other ways to enroll in today’s speech. “That was a good thing about the president’s speech for us,” Ng’andu said.
La Raza had events planned this week to promote the Spanish-language site, to be called CuidadoDeSalud, because of previous administration statements about the rollout date, she said.
The length of the enrollment period may quickly become an issue if the site’s technical flaws last into November, said Dan Schuyler, a consultant to insurers at Salt Lake City-based Leavitt Partners. Americans must sign up by Feb. 15 under the law to avoid facing fines.
“If there’s not going to be a substantial enrollment by March, it’s very likely they will push the deadline back,” he said by telephone. “You’ve promised consumers the chance to enroll. If there are obstacles preventing them, the administration may feel it has to make that change.”
The Obama administration and federal contractors are making progress, said Senator Max Baucus, a Montana Democrat who was one of the law’s authors. That includes fixes to the troubled account-registration process required before customers can start shopping, Baucus said in an Oct. 18 interview in Washington.
With an enrollment period that runs through March 31, there’s time to make fixes, Baucus said. “It’s still early,” he said. “The focus should be on getting the bugs out of the system. It is getting better.”
The Spanish-language site isn’t the only add-on waiting for a delayed site to be instituted. The Small Business Majority, an advocacy organization for companies, and the Main Street Alliance, a network of 15,000 small employers, both said federal officials told them that the exchange being created to cover their workers would be ready on time in November.
The administration has already ratcheted back plans for the small-business site, intended to serve employers with 50 or fewer workers. Even when it’s up and running, workers won’t immediately be able to pick any health plan they want, as the law intended.
Instead, they’ll have to sign up for a plan selected by their employers because of logistical delays announced in April.
“We’re gearing up not necessarily for Nov. 1, but mid-November,” said John Arensmeyer, chief executive officer of the Small Business Majority. “You’re not going to get the numbers you need until it’s all working online.”
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