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InsiderOnline Blog: October 2013

The Problem with Healthcare.gov Is Policy and Politics, Not Just Software

One of the major reasons Healthcare.gov isn’t working appears to be that the Obama administration didn’t want people to know the real cost of the health insurance they were buying. As critics have been noting for months, mandating that people buy health insurance that covers more things than the plans they have been buying with their own money means they will be buying pricier insurance. As Avik Roy reports, the Obama administration wanted to make sure people saw only the discounted prices they would pay after any subsidies for which they were eligible were applied:

“Healthcare.gov was initially going to include an option to browse before registering,” report Christopher Weaver and Louise Radnofsky in the Wall Street Journal. “But that tool was delayed, people familiar with the situation said.” Why was it delayed? “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.” (Emphasis added.) […]

The federal government’s decision to force people to apply before shopping, Weaver and Radnofsky write, “proved crucial because, before users can begin shopping for coverage, they must cross a busy digital junction in which data are swapped among separate computer systems built or run by contractors including CGI Group Inc., the healthcare.gov developer, Quality Software Services Inc., a UnitedHealth Group Inc. unit; and credit-checker Experian PLC. If any part of the web of systems fails to work properly, it could lead to a traffic jam blocking most users from the marketplace.”

Not only that, the Obama administration had plenty of warning that Healthcare.gov was going to be a disaster, but appears to have been determined to avoid delaying the launch because it didn’t want to give Republican critics any ammunition:

“We foresee a train wreck,” said another executive in a February interview with the Times. “We don’t have the IT specifications. The level of angst in health plans is growing by leaps and bounds. The political people in the administration do not understand how far behind they are.” Richard Foster, the former chief actuary at the Centers for Medicare and Medicaid Services, said last week that “so much testing of the new system was so far behind schedule, I was not confident it would work well.”

Henry Chao, the deputy chief information officer at CMS who made the “third world experience” comment, was told by his superiors that failure to meet the October 1 launch deadline “was not an option,” according to the Times. [Forbes, October 14]

Worrying about the politics has made the situation even worse, health care industry consultant Robert Laszewski tells Ezra Klein:

They were paranoid because Obamacare was under siege. I understand that. If they were open with their partners there would’ve been criticism, but it would’ve been constructive criticism. None of us had any idea that the government Web site would require security sign-ins before browsing. Why did that have to be a secret? No one will read a newspaper article about that. If it had been transparent I think most of this would’ve been caught upfront. That really hurt them. […]

The problem with the Obama administration keeping this open is its five times harder to fix something like this on the run. If it would’ve taken a month to fix it during the shutdown, it’ll take three or four or five months to fix it while it was running. [Washington Post, October 15]

Posted on 10/16/13 04:36 PM by Alex Adrianson

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