Obamacare and the Terrible, Horrible, No Good, Very Bad Web Site

By: hawkgrrrl
October 22, 2013

He should really be wearing latex gloves.

The key driver for the Affordable Care Act was a statistic that showed that 47 million in the US (of a population of 300 million) were uninsured, many of these children.  In order for the Affordable Care Act to be financially sustainable, 30 million will need to sign up.  The goal is to have 7 million enrolled by the end of March, 2014.  How are we doing?

So far, we are just over 20 days into the enrollment process, and official numbers state that 476,000 citizens have begun the enrollment process, filling in a form partially at least.  Estimates state that 70% or more exit the site without completing a form, which makes rough sense given that 19 million visits to the site have been logged.  A phone number alternative has also been provided for those finding the site hard to navigate.

Web Design 101

Many problems with the site have been reported:  slow response times, errors, being kicked out of the site after getting so far, bad data being sent to healthcare providers (duplicate forms, missing fields and spouses being listed as children are just a few), inability to link with some healthcare providers, and state sites that differ in quality from the national site (the worst reported is Hawaii).  State web site quality correlates closely with the state’s support of ACA.  What went wrong?

The first answer to this question was pretty unsatisfying:  that due to overwhelming demand for this popular product, the site couldn’t handle the high volumes.[1] Given the goal to enroll 7 million by end of March 2014, the site should be able to handle at least double the volume that has been presented so far.  Assuming 182 days of enrollment if equally distributed (which never happens) would mean that to date, 770,000 citizens would have already enrolled, not the 467,000 who have made some partial attempt to do so.  Also, bear in mind that Amazon handles 70 million customers per day.  There are plenty of tech companies that know how to handle volume.  As Donald Trump rightly pointed out, there are many US tech companies who want this to succeed who would probably even fix it for free.

The first and most obvious scapegoat is the web developer, a French Canadian company called CGI, based in Montreal.  CGI has done a lot of government contract work, the majority of their burgeoning business since 2008.  They are a mixed bag when it comes to healthcare work.  Predictably, and probably rightly, CGI points to the fact that they met all their deadlines, and that it was the late (and perhaps inaccurate or incomplete) specs that are the culprit.  Of course, I never met a tech person who didn’t say “It’s working as designed.”  Additionally, CGI points to the difficulty of retaining top talent, a weak excuse I have used myself in business on many occasions, always unconvincingly.  CGI also pointed out the problem of changing requirements.

Just what was their responsibility?  They were the top contract (of 55 total contracts) awarded at $88 million of the total $394 million budgeted; the next highest was awarded $55 million.  A recap of CGI’s role:

Along with building sites for the states that elected to participate in the federal marketplace, it’s in charge of knitting all the pieces together, making Quality Software Services’ data hub work seamlessly with Development Seed’s sleek user interface and Oracle’s identity management software — or “designing an IT solution that is adaptable and modular to accommodate the implementation of additional functional requirements and services,” as CGI Senior Vice President Cheryl Campbell put it in a September hearing on the progress of the site.

Even Disneyland ain’t cheap.

The site serves citizens in the 36 states that opted not to do their own sites (including the populous TX and FL).  In the first week of October, 24 of the 36 states’ sites received error messages.  The remaining 14 states have varying levels of quality in their own state exchange sites.  There are plenty of potential scapegoats on this project:

  • Underfunded.  Donald Berwick, who administered the federal Centers for Medicare and Medicaid Services in 2010 and 2011, says the site failed because they didn’t have enough money to build it from the start.
  • Late specs.  Others point fingers at the Department of Health and Human Services, which took years to issue final specifications, preventing CGI from really getting started until this spring.  CGI seems to confirm this, stating that requirements were dynamic (changing) during the design process.
  • Bad build.  IT specialists who evaluated the site said it was ”built on a sloppy software foundation,” potentially due to the haste with which code was written.
  • Project complexity.  Slate described just how difficult it is to coordinate multiple contractors creating different components of a complex Web portal.

One staffer at CGI complained that the pressure within their company to address these issues has been enormous:  ”There’s a lot of frustration.  People are getting sick, fainting in conference calls.” [2]  Hopefully, they have good health insurance to help these distressed employees out.

If We Build It, Will They Come?

Harry Potter? He’s also not an American, so he doesn’t need it. Plus, he’s a wizard.

When polled, an estimated half (47%) of the uninsured said they were “not at all familiar” with the health-care exchanges (71% said they were “not too familiar” or “not at all familiar” when combined).  Those numbers have been static since before the Oct. 1 start date.

There are some among the uninsured who prefer to pay the fine rather than enroll, banking on continued good health.  A Gallup poll from September showed that 65% of the uninsured planned to get insurance vs. 25% who planned to pay the fine.  That poll is going the wrong way with October results showing only 56% now plan to get insurance while 34% are prepared to pay the fine.  But perhaps this will change over the coming months:

The best evidence we have about enrollment patterns comes from a New England Journal of Medicine paper written by economists Amitabh Chandra, Jonathan Gruber, and Robin McKnight. They examined the Massachusetts reforms, during the first year, to see who signed up and when. Most people waited until the last minute—the point at which delay meant incurring financial penalties under the mandate. Relatively speaking, the latecomers were more likely to be young and healthy people, the ones whose support the system needs to function properly. That’s good news, because it suggests the most tentative consumers—the ones least likely to wait out website delays—haven’t started shopping yet.

My own experiences abroad have varied when it comes to health care.  I found other countries to be competent and reliable, but wait times to be longer with more onus on the patient and less expectation that money can cheat death.  Medications and services are generally incredibly cheap compared to the US, based on my time in Spain and Singapore, although one medication I bought in Singapore for S$60 a tube was  available in both Nepal and India over the counter for less than a dollar!  I have found care to be generally quite good in the US with more open discussion of issues and more options given to the patient, but overall incredibly expensive.  However, at least one UK woman found US care to be sub-par compared to her expectations in a hilarious and horrifying article.

  • Do you plan to use the health-site exchange to get a better rate?
  • Do you know people who plan to pay the fine rather than get insurance?  Do you agree with their decision or disagree?
  • Will the ACA improve health care overall in the US or merely address the issue of the uninsured?
  • Could these web site issues have been avoided?  Who bears the responsibility?

Discuss.

_____________________________________________

[1]   I’ve worked in 20+ years running call center operations, and I know this line.  It’s pulled out to deflect valid criticism of your faulty systems by pretending it indicates high interest in your product, never mind the fact that the faulty systems are often generating a lot of the volume through repeat attempts.

[2]   Honestly, I’ve never heard this “employees are fainting” excuse in the US, but I have heard it plenty in India and Canada; I am always skeptical.  I had colleagues who watched planes crash into the twin towers who calmly gathered their belongings and left the building.  Fainting because you built a crappy web site?  Really?  Drink a Red Bull, people.  While you’re at it, get over yourself.

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18 Responses to Obamacare and the Terrible, Horrible, No Good, Very Bad Web Site

  1. Hedgehog on October 22, 2013 at 2:43 AM

    Will that be US optimism about public sector IT projects? They always take time to bed in and iron out difficulties, if they aren’t abandoned as being too complex…
    http://www.computerweekly.com/blogs/public-sector/2013/05/pull-out-and-keepyour-guide-to.html

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  2. Seeking Goodness (@seekgood) on October 22, 2013 at 7:12 AM

    I’ve worked with CGI in the past and they’re horrible to work with.
    I think we’ve taken a step in the right direction but I knew when the ACA passed that it would be a work in progress. Unfortunately, while we’re still bickering over whether or not we even need to reform, we won’t have a chance to refine the bill that has already been passed.

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  3. Will on October 22, 2013 at 8:38 AM

    What a disaster.

    Unfortunately, it is exactly what they want. They don’t care about the web-site, or the roll out, or even how many American’s sign up. This is not the goal. The goal is to INCREASE insurance costs and break employer funded insurance plans. The ultimate goal of the Obama and the progressive movement is to nationalize health care and they are on their way to succeeding.

    Before you start accusing me of crying conspiracy, consider the following:

    1) Under Obama Care, you can buy insurance at anytime AND BE COVERED IMMEDIATELY. By way of comparison, it is like buying automobile insurance at the scene of an accident. Or, buying fire insurance as your house is burning down. This means the insurance companies will substantially increase their payouts, but will not have the corresponding premiums needed to fund said disbursements.

    2) The counter is people will be ‘fined’ if they don’t by Obama Care. Baloney. The fine is minimal (by design). So, if I’m a healthy student age 19 to 28, why would I pay $300 a month, when I can pay an annual fine of $95 or whatever it is.

    The real problem is that the ‘fine’ is a myth due to the hardship clause, which is designed to get people out of paying the fine. Seriously, one of the hardships (that gets you out of paying the fine) is: “you received a shut-off notice from a utility company (look it up on Healhcare.gov)” So, to get out of paying the fine, I simply quit paying my gas bill (in the summer) until I receive a shut off notice. I then hurry down to Questar and pay the bill to avoid shut off and use the shut of notice to avoid the fine.

    Increased expense and decrease revenue means the insurance companies will look to their existing customers who are already near a breaking point. As more companies drop their plan, the problems become worse for the insurers until they eventually bust.

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  4. fbisti on October 22, 2013 at 11:44 AM

    Not that this post regarding politics, bad software design, or the ACA seems at all relevant to this venue…the one thing that seems to be missed by all visible commentators (Newspaper, Internet, TV) is that everyone’s health insurance rates are going up due to the ACA. It is simple actuarial math: If 30 million healthy people don’t sign up and add their low risks into the actuarial pool, the enormous risks added by eliminating pre-existing conditions and no annual (or lifetime) maximum benefit into premium determinations means that the premiums for everyone have to go up or the insurance companies will go bust.

    And, given the low penalties and ease of getting around them for the aforementioned 30 million, nearly all objective analysts predict that is exactly what is going to happen. Further, add in the mixed bag of currently insured employees whose companies will drop their insurance and pay the much lower fines. THAT is the big lie of the ACA.

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  5. Douglas on October 22, 2013 at 5:20 PM

    This administration repeated the mistake of sourcing a FRENCH company for a large and mission-critical contract (the Bush administration used one for military food service in Operation Iraqui Freedom). Incroyable! J’ai pense que utilser de une source ‘pas-Americaine’ etait un violation des regulees d’Aquisition.

    Neither Bush nor Obama seem to have read their history books regarding the French and technology. Maginot Line for starters. Took up 40% of French defense spending 1934-1939. Was captured from the rear by Panzergruppe Guderian June 1940, with the surrender of 400,000 French soldiers, for the loss of 185 German soldiers and 11 tanks. Most of the French Air Force sat out the battle of France due to bad engines and lack of spare parts. Their navy’s flagship, the Richlieu, had only one of its three engines operative when evacuating from Toulon to Dakar, Senegal, and even that gave out en route and a tow to port was needed. Post-war, their attempts at an indigenous tank were so awful that the Army kept some 200 captured German Panther and Mark IV tanks in service until 1961, and DeGaulle had to eat crow and beg Gen. Maxwell Taylor (SHAFE CiC) for surplus Sherman and M-47 tanks. Their first fighter, the Ourugan, had an engine with a MTBF of 55 hours and initially a combat range of only 175 miles. Does this sound like a country with a proven track record (TGV notwithstanding) of excellence in engineering?

    This false start ought to be instructive of whfy NOT Obamacare.

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  6. Douglas on October 22, 2013 at 5:47 PM

    Re: Fibisti. It’s already happened under Federal Employees Health Benefits over the past two years. My biweekly plan with Kaiser has risen from $184 in 2012 to $268 in CY14, about 47% in two years. We Federales are still doing better; my son’s plan also with Kaiser through a private employer is $345 semi-monthly, and he has a deductible where I don’t. Those promilgating Obamacare seem to disregard the fundamentals of why health care paid for, all or in part, via an employer-sponsored group plan, is economically feasible in the first place. One: the value of the labor of a steady and skilled workforce justifies the real wages necessary to fund the health plans, be it by deductions from their gross pay or imputed wages (“employer pays”), and Two: the selection process for a productive workforce ensures as low a loss rate that their premiums will cover. Insisting that employers cover all “full-timers” for employees of marginal worth forces the employer to either fire them incrementally (e.g. reduction of hours to meet exception criteria) or dismiss them altogether, via downsizing, automation, and outsourcing. And those that would not be otherwise brought in wil not be able to pay for it themselves, so their costs must come from elsewhere. Ah, the essence of liberal phoniness: measuring their compassion by how generous they are with other people’s money instead of their own.

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  7. Jeff Spector on October 22, 2013 at 5:53 PM

    two things occur to McGee having been ibn high tech for more than thirty years.

    1. large projects never work right from the beginning.They have to be iterated over time to cover design issues, software bugs and capacity issues. ever try to buy tickets to a hot event online? typically the websites are overwhelmed.

    2. Government projects are notorious for being under spec’d. They want the least cost, not a successful one. but they are always willing to pay to get it right.this is where companies make their money on change orders.

    it’s a laugh t that republicans are complaining about bad IT implementation since their own bad IT helped cost them the presidential election

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  8. Rick B on October 22, 2013 at 7:40 PM

    Ogden Man Bypasses ACA bug

    Bennett said before signing up for health insurance under the Affordable Care Act, he was paying a $420 monthly premium with a $2,000 annual deductible. Now he’ll be paying a $720 premium and a $500 deductible, but his family also will be getting maternity and dental coverage — something the Bennetts couldn’t get before.

    “The process to even get insurance before was so difficult that surprisingly, even with all the bugs, I still find HealthCare.gov more simple,” Bennett said. “So for us this is a huge win, because we’re paying what we think is fair. And yes it’s more than before, but we actually have coverage that we like now.”

    http://www.deseretnews.com/article/865588851/Ogden-man-bypasses-Affordable-Care-Act-website-bug.html

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  9. will on October 22, 2013 at 8:45 PM

    Rick,

    CNN is reporting a diaster:

    http://ac360.blogs.cnn.com/2013/10/22/obamacare-who-pays-more-who-pays-less/

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  10. Douglas on October 22, 2013 at 11:07 PM

    #8 – depends on the details of the maternity and dental coverage. The former should have been a no brainer for the insurance company to fund; costs are fairly predictable in most cases. Have to see what the dental “coverage” entails – as a Federale I have a dental plan but per Federal law (applies to stateside military dependents as well) there is no Government contribution into the plan; e.g., it’s funded entirely from Employee paid premiums. But he’s paying $3600 more out of pocket (should be entirely pre-tax if he’s paying his premiums via payroll deductions) for $1,500 less deductible. I dunno. Depends on his family’s projected medical needs, if he does better than the $2,100 extra for premiums, good for him.
    I still would like an explanation from the ObamaCare camp as to how the added costs of forcibly adding marginal people will be handled. Direct taxation, fees levied on health insurance companies, or some other scheme that serves to hide the true cost? Fbisit, the 30 million that you quote aren’t foolishly or selfishly holding out from signing up for health care. For most young singles that get a decent job, the actual health care costs are fairly minimal through an employer, and I don’t know of any employer-provided plan that structures premiums on age or even whether the client is a tobacco user, unlike life insurance. In fact, many employers cover the premiums altogether for a single employee; it’s only the addition of a spouse or insignificant other that starts to add the deductions, and then, of course, children or other dependents. Most of the thirty million aren’t making enough to elect a health plan even if the employer offers it. Some qualify for Medic-Aid (in CA, it’s Medi-Cal, and my daughter and her husband, together earning about $55K/yr, qualify with their two kids). And one other thing smacks entirely wrong with this supposition: assume that indeed in the USA working population there are 30 million “holdouts” that aren’t paying in premiums w/o contributing much risk. Well, hello, if either they have coverage through a spouse, or prior employment, or if they simply want to self-insure (a course of action I don’t recommend), then isn’t that called ‘freedom’? Why must their wages be treated as public property, to be penalized if they don’t spend them how Barack Obama or anyone else who presumes to manage their lives better than they can? For example, in less than two years, I can retire in two years from Uncle Sam. Considering the support payments that I’ll still have for a few years yet, I’ll still need to work (and I’m too young for the golf course anyway). I’ll have what any relatively young retiree who started young in his career and stuck it out would have: marketable skills, experience, and being able to sit on a modest pension and benefits. So, I can either work strictly for cash, preferably in a self-employment arrangement (reasons too long to outline), or, if it must be a formal employment, use where possible a ‘Section 125′ benefit plan and forget the health care plan that I don’t need. In that scenario, why, if I’m already paying into a health plan as a retiree which I contributed to for over 30 years since a young man, should my further wages be taxed for health care again? It’s a force-fitted solution that contributes nothing.

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  11. hawkgrrrl on October 23, 2013 at 2:48 PM
  12. Will on October 23, 2013 at 7:41 PM

    LOL on the Jon Stewart.

    Honestly, after seeing this I am further convinced they planned the glitches, There is no way you can take three years, spend 100 million and have a product that is this bad. No way, it is just not that difficult.

    This leads to the only logical conclusion that they planned the glitches knowing 1) the people that are desperate (high risk) would find another way to sign up (mail, phone, etc) 2) the 19 to 30 year olds that they need to make this work financially would lose interest and not sign up.

    Again, the objective is to break private insurers to nationalize healthcare. This is all part of the plan.

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  13. Rigel Hawthorne on October 24, 2013 at 12:54 PM

    Tagging on a bit to Will’s burning house analogy is the Native American options with ACA. Indian Health has had (inadequate but existing) funding all along and Native Americans are not required to purchase insurance under the ACA. Nevertheless, they can buy coverage and if they do, they are not required to share costs such as copays and deductibles. The government picks those up. So, Tribal health organizations can use their federal health funding to purchase ACA insurance plans selectively for their sickest/costliest patients. This then shifts the full cost of their health care off of the limited Indian Health funding and onto Obamacare, with taxpayers bearing the costs that Native Anmericans are not responsible for paying. This cherry-picking of clients with more expensive health-care costs onto the plan without representation of the healthier population buying into the plan is another set-up for failure.

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  14. h_nu on October 24, 2013 at 7:42 PM

    @Will,
    Never underestimate the sheer idiocy of all democrats. You’ve seen it demonstrated here by MH. You’ve seen it demonstrated by Obama. The stupidest people in the world.

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  15. Douglas on October 25, 2013 at 10:09 PM

    #14 – please don’t stoop to ad hominems and name-calling, especially of fellow LDS. While I don’t pretend to even understand where MH or Harry Reid get their ideas from, I do accept that they’ve done so in sincerity and according to their respective consciences. Leave the mud-slinging to liberal and ‘gay-friendly’ sites like on Yahoo! (or what it’ll link to). Did not the Savior HImself say, “come, let us reason together” via scripture?

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  16. Mormon Heretic on October 26, 2013 at 10:51 AM

    @h_nu,
    Never underestimate the sheer idiocy of all [tea party members]. You’ve seen it demonstrated here by [h_nu]. You’ve seen it demonstrated by [Mike Lee]. The stupidest people in the world.

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  17. hawkgrrrl on October 26, 2013 at 12:16 PM

    People, I’m with Douglas on this one. I have no love for extremist opinions either, but talking never hurt anyone. Sticks and stones, people. Calling others stupid wasn’t OK in Kindergarten, and it still isn’t.

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  18. h_nu on October 28, 2013 at 10:44 AM

    Douglas, there’s no reasoning with the unreasonably, hysterics of liberalism… They are Mormons in Name Only. I don’t extend fellowship to apostate liberals. Game over. If I won’t extend fellowship to apostate-liberals in person, why would I on the internet?

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