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HealthCare.gov’s Failure to Launch

The views expressed are those of the author and are not necessarily those of Scientific American.


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Image: iStock/Thinkstock

For a president who sailed into office on a digital-heavy campaign that helped engineer his victory, the crippling glitches plaguing the October 1 HealthCare.gov rollout were a rare mar on the administration’s tech-savvy record. Now the website snafu is fostering an intense hatred of the word “glitch” and fueling a steady stream of vitriol at Capitol Hill hearings.

To date, nearly 700,000 applications have been submitted to the federal and state marketplaces, and more than 20 million unique visits have been tracked by HealthCare.gov, the Web site that facilitates the program. But on Tuesday the administration remained mum on how many applicants were eligible for coverage or will ultimately enroll, saying such data will be available in mid-November. Officials also remain tight-lipped on what specific debugging fixes are taking place. Thanks to the provision of the Affordable Care Act which set up a new Health Insurance Marketplace, three dozen states currently depend on exchanges run by the federal government while 14 states have set up their own state-run marketplace.

Top lieutenants from the Centers for Medicare and Medicaid Services and Health and Human Services have been called before Congress this week to defend the problem-laden federal Web site. So far technical answers have not been forthcoming. First up on the Hill this morning was Marilyn Tavenner, the administrator for the Centers for Medicare and Medicaid Services.

“I want to apologize to you that the Web site is not working as well as it should,” she told the House Ways and Means Committee. It is fixable, she said. Still, technical details revealing the issues were scant. In her prepared testimony she spoke of updating the site “several times with new code,” adding more capacity, and putting in place “tools” to monitor where consumers are encountering errors. The site is working, she said. “Just not at the speed we want.” She pinpointed two general problem areas: the exchange’s issues stem from the volume of interest and flaws in the site that can and will be worked out by the end of November, she says. And while consumers can still sign up for services with a paper application or enroll through a call center, the public and political focus has been on the flagship online exchanges that would allow consumers to price-shop and scour side-by-side plan information at their computers.

A complex web of contractors and subcontractors were paid to create the technical scaffolding for the health insurance exchange launch, but the buck stops with the Obama administration. Although Tavenner is the official in charge of the insurance marketplace and offered the most complete administration apology to date, HHS Secretary Kathleen Sebelius has borne the brunt of criticism of the rollout, with Republicans calling for her ouster. Thirty-three GOP congressmen have signed a letter calling for her resignation. “The scope of the problem is so great that were this a private company or military command, the CEO or general would have been fired,” the letter reads. Republicans’ treatment of Tavenner today provided a glimpse of what Sebelius will face tomorrow.

But hopes are not high that real answers on the site’s issues will be forthcoming this week. At each of the Capitol Hill hearings thus far, technical experts who could provide the real answers for exactly what caused the “glitches” in the system were not the ones that lawmakers are hearing from. As David Auerbach astutely noted in Slate.com last week, the contractor representatives last week were neither techies nor project managers. And the chorus of nonanswers continued this week.

Meanwhile the bad press keeps piling up. A major data hub that routes applicant information to the federal Web site and similar state-based sites failed on Sunday, and consumers trying to enroll were faced with a note saying the system was down. And the December 15 deadline for people to enroll for health coverage without receiving tax penalties was just clarified to say that as long as consumers buy health insurance by March 31 they will avoid any penalties. The Obama administration has also brought in a fleet of tech experts to fix the problems and handed over oversight of fixing the site to UnitedHealth’s QSSI, a role formerly filled by officials at the Centers for Medicare and Medicaid Services.

Few bright spots emerged in today’s hearing before the House Ways and Means Committee–for the administration or consumers. One helpful hint was offered in response to questioning from Representative Kevin Brady (R-Texas). Consumers who are nervous about a health care gap come January 1 (when prior coverage may lapse) because they are still struggling to use the exchange online should use the call center to enroll or sign up with local help in person, Tavenner says. “There are more methods than the Web site, and I think that’s important.”

About the Author: Dina Fine Maron is the associate editor for health and medicine at Scientific American. Follow on Twitter @Dina_Maron.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. rkipling 5:36 pm 10/29/2013

    Obama voters, look upon your works and despair.

    Link to this
  2. 2. rkipling 8:38 pm 10/29/2013

    Oh come on! Please defend your fearless leader!

    Link to this
  3. 3. abolitionist 6:06 am 10/30/2013

    Patience, we are taught, is a virtue.

    Link to this
  4. 4. msadesign 7:30 am 10/30/2013

    There was a similar bump when Medicare Part D was being implemented. This was a Republican initiative. As I recall, those on the other side of the aisle were patient while the kinks were worked out.

    Link to this
  5. 5. Mcorbett 9:17 am 10/30/2013

    Let’ review:

    We forced doctors to use electronic medical record systems to reduced costs and improve outcomes – FAIL

    We spent billions building health information exchanges to make medical records sharable – FAIL

    … and we’re surprised the web site doesn’t work??

    Link to this
  6. 6. Eliot 11:09 am 10/30/2013

    I live in Kentucky and our exchange is up and working flawlessly. Also, Kentucky is not waiting for people to find their way to the website, they are setting up a network of people to help those who do not understand the ACA or do not have internet access. This is being done through churches, schools, hospitals, community groups and the media. It is nice for Kentucky to be known for something other then Bourbon and horses.

    Link to this
  7. 7. rkipling 11:14 am 10/30/2013

    abolitionist,

    I invite you to patiently watch how this all works out. The website will be the least of the flaws. Free insurance sells quickly. Where Obamacare will fail is selling insurance for money. People expected to pay for insurance will decide they are financially advantaged by penalty option.

    The Obama campaigns in ’08 and ’12 relied upon the stupidity of voters. What the Obama administration hasn’t understood is that voters are not so stupid as to pay out their own money to no advantage.

    No need to discuss how this law would have degraded healthcare. It won’t last that long. I think Obama’s goal was not to provide healthcare to the uninsured. It was to make the quality of healthcare uniform, even if that meant lowering quality for most.

    Watch how this unfolds and abandon all hope for the change you seek.

    Link to this
  8. 8. rkipling 11:23 am 10/30/2013

    Eliot, You should phone home.

    This was from two days ago. Looks like KY may have signed up 4,692 paying customers. Great work. Keep it up.

    “In Kentucky, for example, 82 percent, or 21,342, of those enrolling in new insurance plans under Obamacare are signing up for Medicaid, the Journal reported. In Washington, it’s 87 percent of 35,528; and in New York, 64 percent of some 37,000.

    Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newsfront/Obamacare-Medicaid-young-sign-ups/2013/10/28/id/533419#ixzz2jDd2SQoy

    Link to this
  9. 9. rkipling 11:24 am 10/30/2013

    msadesign,

    Right. Hardly more than a hiccup. It should all work out peachy keen.

    Link to this
  10. 10. Eggnogstic 11:57 am 10/30/2013

    I think a scientific, evidence-based analysis of historical Progressive promises and existing sustainable outcomes will result with a description of overall Progressive failure to live up their promises.

    Link to this
  11. 11. ssm1959 2:38 pm 10/30/2013

    The ACA launch is a classic case of motivated reasoning and confirmation bias. Rather than assessing the project critically and taking corrective action the administration blinded itself to the glaring problems. This same problem plagues federal involvement in healthcare in general. An unshakable belief in righteousness of cause has burdened the system to the point of breaking it. As we see all the other federalized health care systems of the world severely scaling back their programs we should take heed No centralized plan can successfully replace the individual when making healthcare decisions.

    Link to this
  12. 12. rkipling 2:58 pm 10/30/2013

    Ssm1959,

    Motivated reasoning and confirmation bias accurately describe the afflictions of the current administration. Back where I came from folks would describe them as “eat up with the dumba**.”

    Link to this
  13. 13. sault 5:56 pm 10/30/2013

    LOL, rkipling regurgitates a bunch of right-wing nonsense on these boards all while claiming to be an “independent”. Directing people to the wingnut political rag known as Newsmax just takes the cake! Why do you feel the need to lie on these anonymous comment boards? If you take in right-wing propaganda without question and think Newsmax is a reputable source, then by all means, tell us what you are.

    Link to this
  14. 14. sault 5:58 pm 10/30/2013

    “As we see all the other federalized health care systems of the world severely scaling back their programs…”

    What in the heck are you talking about? Where in the world is this actually happening?

    Link to this
  15. 15. sault 6:08 pm 10/30/2013

    Eggnostic,

    First of all, you aren’t our departed friend Nagnostic, are you? Secondly, you don’t see the following things as successes?

    - The 40-hour workweek with overtime benefits for those that want to work more hours

    - The end of child labor

    - Workplace safety and the reduction of hazzards that cause on-the-job mortality

    - The massive reduction in poverty among seniors to a fraction of what it once was before Medicare and Social Security came along

    - Numerous environmental improvements like taking lead out of gasoline and reducing acid rain, ozone depletion, etc.

    - Dismantling segregation and lowering disrimination with the Civil Rights Act and the Voting Rights act

    There are many other examples, but these are some of the greatest achievements of progressives in the USA. The regressives in this country have tried their hardest to undermine or even destroy all of them with varying levels of success (especially now with an extremely activist Supreme Court), so if you lament the stagnation on these issues, your beef is with them. However, you sound like the type of person who thinks most of the items on this list were bad ideas, so maybe I’m just wasting my time here.

    Link to this
  16. 16. rkipling 6:42 pm 10/30/2013

    I had not been to the newsmax site before. Didn’t know their politics. The story didn’t originate with them. It was the first one I came to when I did a search.

    Here is basically the same report from Forbes. Is that a right wing rag?

    http://www.forbes.com/sites/dandiamond/2013/10/14/how-many-people-have-enrolled-in-obamacare-an-early-look/

    Say what you will. Wait to see what happens.

    Link to this
  17. 17. rkipling 6:45 pm 10/30/2013

    sault,

    I don’t need to bother with insults. Your own words indict you more than anything I could write. Please record here your grand expectations for Obamacare.

    Link to this
  18. 18. rkipling 10:06 pm 10/30/2013

    Here is the problem for Obamacare.

    When preconditions no longer restrict health insurance purchase, people will only buy in when their costs exceed the annual premiums plus deductible. With no preconditions, what exactly are they insuring against if they are healthy? People will figure this out.

    Anyone care to argue with that?

    Link to this
  19. 19. rkipling 10:41 am 10/31/2013

    Looks like no one is willing to argue the point.

    There are those of us who didn’t need to wait until Obamacare became law to know what was going to happen.

    Guess what Obama voters? The joke is on you.

    Link to this

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