Healthcare.gov:You Can Be Mad Now

Tuesday, October 08, 2013 - 09:40 AM

Ah, last week. We were so young. So naive. Seven days ago I wrote about how conservatives who were jumping up and down with excitement about bugs in the Healthcare.gov rollout were getting ahead of themselves. I argued that any massive tech rollout is bound to have errors. It was just too early to say whether Healthcare.gov's problems were nature (bad design) or nurture (good design that was temporarily failing because of sheer demand).

A week later, it does not seem too early to say. Healthcare.gov is failing, and the problems are self-inflicted. Reuters convened a panel of IT experts to weigh in on why the site was so buggy. They agree that it's a lemon, and they're not optimistic about anything getting better soon.

"Adding capacity sounds great until you realize that if you didn't design it right that won't help," said Bill Curtis, chief scientist at CAST, a software quality analysis firm, and director of the Consortium for IT Software Quality. "The architecture of the software may limit how much you can add on to it. I suspect they'll have to reconfigure a lot of it."

One possible cause of the problems is that hitting "apply" on HealthCare.gov causes 92 separate files, plug-ins and other mammoth swarms of data to stream between the user's computer and the servers powering the government website, said Matthew Hancock, an independent expert in website design ... "They set up the website in such a way that too many requests to the server arrived at the same time," Hancock said. He said because so much traffic was going back and forth between the users' computers and the server hosting the government website, it was as if the system was attacking itself.

So it's not working for the simplest reason: bad design. Compounding that, the tech support is shockingly awful. Over at Slate, John Dickerson posted a transcript with a woman who spent about half an hour waiting to talk to an online tech support person, who hung up on her and told her to call the toll free number. That sentence doesn't convey the sympathetic frustration you will feel reading the transcript. Here's a sample of the conversation between Alice (Dickerson's source) and her friendly government representative, PGSTX0534 (his friends call him TX0534 for short): 

[4:31:12 pm]: Alice
My information is not recording correctly in the summary of my application

[4:31:35 pm]: Alice
I have tried to edit it multiple times and it is still wrong

[4:32:21 pm]: PGSTX0534
Thanks for your interest in the Health Insurance Marketplace. We have a lot of visitors trying to use our website right now. That is causing some glitches for some people trying to create accounts or log in. Keep trying, and thanks for your patience. We'll continue working to improve the site so you can get covered

[4:32:40 pm]: Alice
what does that mean?

[4:32:52 pm]: Alice
It says my application is "in Progress"

[4:33:12 pm]: Alice
Does that mean it is not completed and I can continue to try to edit it?

[4:33:55 pm]: Alice
Hello??

[4:34:14 pm]: PGSTX0534
Thank you. One moment please while I look that up.

[4:36:19 pm]: PGSTX0534
The only way we can see your application is you will have to call The Health Insurance Marketplace Call Center at 1-800-318-2596. We are open 24 hours a day, 7 days a week to assist you.

[4:36:47 pm]: Alice
What does the Chat Service do then?

She received no response to her last question.

Coverage doesn't start until January 1st, and open enrollment won't close until March 31st. The administration has time to fix this, but they've already damaged people's confidence in a system that those people are being compelled to rely on. Government healthcare shouldn't be like the DMV -- a Kafka-esque bureaucracy that makes your stomach churn when you imagine it. We're entitled to a basic confidence that Healthcare.gov will work, and that if it doesn't, that we'll be able to talk to a human being who can walk us through it. Right now, that's not the case.

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Comments [5]

SeparateChurch AndState

My understanding of the Affordable Care Act (Obamacare) and the health insurance marketplace is there are a few insurance plans offered called a platinum, gold, silver, bronze, and catastrophic. All health insurance plans offered on the marketplace must offer as a minimum the same set of services called the “essential health benefits”. The silver plans are the plans which offer any tax credits for which the person may qualify. The plan level guidelines are platinum is for someone in poor health, gold is for fair health, silver for good health, bronze for excellent, and catastrophic for persons 30 years of age or younger.

Platinum is lowest deductible and highest premium, bronze lowest premium and highest deductible. Several private insurance companies will offer the various plans to the individual. Inquiries about specific plan coverage or premiums to be paid are made directly to the private insurance company. The person should select a plan based on the network of doctors, services, and hospitals offered and not the lowest premium. Based on household income and family size, many people are expected to qualify for tax credits. If a person qualifies for a government sponsored plan like Medicaid or Chips, those will also be offered to the individual as an insurance plan option.

The “essential health benefits” offered by the Affordable Care Act includes prescription drugs, lab work and blood tests, preventive services like counseling, screenings, and vaccines, doctor and clinic visits, emergency services, overnight stays in the hospital, prenatal, maternity and pediatric services (including kids dental and vision), habilitative and rehabilitative services for persons with disabilities and chronic conditions, and mental health and substance use disorder services.

Persons offered insurance coverage through their employer can shop the health insurance marketplace in search of a plan which might be deemed as a more “affordable” plan. Open enrollment dates are October 1, 2013 through March 31, 2014. “Exemptions” from health insurance coverage are available for those that qualify. All of this information is available on the healthcare.gov website.

Oct. 22 2013 03:53 PM
Edward from NJ

+1 for Owen from Athens, OH

It's pretty much impossible to tell what's broken by looking at the front end of the web site. And no one is letting anyone look at the backend. Slate has had good coverage on this, and the bottom line seems to be that building robust, usable websites and getting government contracts are mutually exclusive skill-sets.

Oct. 16 2013 10:11 AM
Russell from Dallas

There is a reason “Department of Motor Vehicles” is used as a customer service pejorative rather than, say, “McDonalds”. The best thing about the free market is not that it rewards success. The market punishes failure swiftly & harshly. Failure must be punished or you will get more of it. No one at the DMV ever loses their job because the line for service was hours long. Who will be punished for the current state of “Healthcare.gov”?

The Slate Business article is just amazing.
http://www.slate.com/articles/business/bitwise/2013/10/what_went_wrong_with_healthcare_gov_the_front_end_and_back_end_never_talked.html

Oct. 09 2013 07:23 PM
Owen from Athens, OH

"92 separate files" qualifies as "mammoth swarms of data?" The OTM home page loads 161 separate files. Sorry, did I just DDOS you? That expert's complaint can't be taken as valid without knowing more about how the site works and what kind of server it's running on.

Oct. 08 2013 03:10 PM
Dan Tienes

Great headline, and great tags..."kafkaesque nightmares." It seems maybe the whole software development and procurement process is at fault here. http://wp.me/p2HCRB-3J

Oct. 08 2013 10:16 AM

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