How Will We Know the Obamacare Site Is Fixed?

With the administration’s deadline a week away, enrollment and website are improving — slowly.

Office of Management and Budget Deputy Director for Management Jeff Zients (L) speaks on the budget impasse during a briefing in the Brady Briefing Room April 7, 2011 at the White House in Washington, DC.
National Journal
Sam Baker
Nov. 24, 2013, 10:29 a.m.

With the ad­min­is­tra­tion’s dead­line to fix the Obama­care web­site less than a week away, one ques­tion is bound to weigh heav­ily on the de­bate over the sys­tem: How well does it have to op­er­ate to be con­sidered “fixed”?

The truth is, the sys­tem is get­ting stronger as it re­cov­ers from its dis­astrous launch, but ex­perts say it still has a long way to go. The prob­lems that con­tin­ue to plague it could con­tin­ue the tor­rent of cri­ti­cism, mak­ing it tough­er for the ad­min­is­tra­tion to re­hab­il­it­ate the im­age of its sig­na­ture law.

“There won’t be a suc­cess un­til the web­site is work­ing,” said Bob Laszewski, a health care con­sult­ant who works closely with in­surers.

Nov. 30 will mark the ad­min­is­tra­tion’s self-im­posed dead­line to have Health­Care.gov work­ing, as well as the end of the second full month of en­roll­ment. And ex­pect­a­tions for both of those mile­stones are mod­est.

In­surers say they’ve seen en­roll­ment pick up in Novem­ber as the ad­min­is­tra­tion made gradu­al im­prove­ments to the site, which serves 36 states. Health­Care.gov pro­cessed a paltry 25,000 sign-ups in Oc­to­ber, but in­surers say the pro­cess has gained steam over the course of this month.

They are con­cerned, however, about linger­ing prob­lems. The site is still send­ing in­cor­rect or in­com­plete in­form­a­tion to in­sur­ance com­pan­ies about the people who choose a plan, and in­dustry of­fi­cials are afraid the ad­min­is­tra­tion is about to flood them with more bad data than they can man­age.

“There’s still a lot of work to do to get the back-end pro­cesses work­ing,” said Robert Zirkel­bach, a spokes­man for Amer­ica’s Health In­sur­ance Plans.

Jeff Zi­ents, the former White House budget dir­ect­or lead­ing the Health­Care.gov re­pair ef­fort, said Fri­day that by Nov. 30, the site will be able to handle 50,000 users at once, the tar­get it was sup­posed to meet when it launched last month.

Zi­ents has also re­peatedly said that is­sues with the in­form­a­tion sent to in­surers were at the top of his “punch list” for site re­pairs. But in­dustry of­fi­cials say those prob­lems haven’t been fully ad­dressed — so the pro­spect of hand­ling 50,000 people at a time is a scary one.

Bob Laszewski, a health care con­sult­ant who works closely with in­surers, es­tim­ated that the site’s back-end er­ror rate is 5 per­cent. It needs to be lower than 1 per­cent for the site to be con­sidered fixed, he said.

“They’ve made some pro­gress on the back end, but it’s still not where it needs to be,” Laszewski said.

Some health policy ex­perts also ques­tion the ad­min­is­tra­tion’s defin­i­tion of suc­cess for the site’s user ex­per­i­ence.

Ad­min­is­tra­tion of­fi­cials have said they ex­pect the site will work for about 80 per­cent of users by Nov. 30. Yet a 20 per­cent fail­ure rate wouldn’t be con­sidered suc­cess in most in­dus­tries, and it also might not be good enough to stem the tide of neg­at­ive an­ec­dotes about Obama­care en­roll­ment.

“Twenty per­cent still leaves a lot of noise in the sys­tem “¦ that leaves a lot of people with a bad ex­per­i­ence,” said Car­oline Pear­son, vice pres­id­ent at the con­sult­ing firm Avalere Health.

Jonath­an Gruber, a health eco­nom­ist at MIT who helped design the Af­ford­able Care Act, said the prob­lems with an 80 per­cent suc­cess rate could go bey­ond op­tics.

If the ad­min­is­tra­tion means that 80 per­cent of people who want to ac­tu­ally en­roll will be able to, that’s “more than enough,” Gruber said — once you’ve picked a plan, it’s not a big deal to have to call the in­sur­ance com­pany to sign up. But if only 80 per­cent of people are able to use the site to shop for cov­er­age, he said, the ad­min­is­tra­tion will have a prob­lem.

“I think vir­tu­ally every­one who needs to shop on the web­site should be able to,” Gruber said.

Be­cause Health­Care.gov has been un­der re­pair throughout Novem­ber, en­roll­ment will likely still lag well be­hind the pace needed to hit the bot­tom-line goal of sign­ing up 7 mil­lion people by the end of March.

Some state-based in­sur­ance ex­changes have seen their en­roll­ment num­bers surge as they over­came their ini­tial tech­nic­al prob­lems. Cali­for­nia is now sign­ing up 2,700 people per day, up from about 700 in the first week of en­roll­ment. Even be­fore that surge, though, Cali­for­nia had en­rolled more people than all 36 states that rely on Health­Care.gov.

The ad­min­is­tra­tion will re­lease Novem­ber’s en­roll­ment stat­ist­ics in mid-Decem­ber. Ex­perts de­clined to make pre­dic­tions about the num­bers, but in­surers gen­er­ally say they’re see­ing the pace of en­roll­ment pick up mod­estly.

To hit the 7 mil­lion goal, en­roll­ment will need to make up the ground it lost in Oc­to­ber and most of Novem­ber, a chal­lenge that Cali­for­nia’s surge sug­gests is pos­sible — with a func­tion­al web­site.

But be­cause many people — es­pe­cially the young, healthy con­sumers so crit­ic­al to the law’s suc­cess — are ex­pec­ted to sign up later in the six-month en­roll­ment win­dow, Gruber said, Novem­ber’s fig­ures won’t say much about wheth­er the ad­min­is­tra­tion is on track.

“I think they’re pretty use­less un­til close to March,” he said.

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