| Notes |
Statistics
Analysis by the Reuters news agency in mid-October stated that the total contract-based cost of building HealthCare.gov swelled threefold from its initial estimate of $93.7 million to about $292 million.[9] In August 2014, the Office of Inspector General released a report finding that the cost of the HealthCare.gov website had reached $1.7 billion.[14] As pointed out later by commentators such as Mark Steyn, the CGI company has already been embroiled in a mid-2000s controversy before over contract payments. While devising the Canadian Firearms Registry, estimated costs of $2 million ballooned to about $2 billion.[25]
On March 25, 2019, the Centers for Medicare and Medicaid Services reported that 11.4 million Americans had selected enrolled in or automatically renewed their Exchange coverage during the 2019 Open Enrollment Period.[26]
Concerns about the website
Issues during launch
Health insurance exchange functionality by state:[27]
Creating state-operated exchanges
Establishing state-federal partnership exchanges
Defaulting to federal exchange
The HealthCare.gov website was launched on the scheduled date of October 1, 2013. Although the government shutdown began on the same day, HealthCare.gov was one of the federal government websites that remained open through the events. Although it appeared to be up and running normally, visitors quickly encountered numerous types of technical problems,[11][28] and, by some estimates, only 1% of interested people were able to enroll to the site in the first week of its operations.[2] Even for those that did manage to enroll, insurance providers later reported some instances of applications submitted through the site with required information missing.[29]
In Bloomberg Businessweek journalist Paul Ford summed up the issue by remarking, "Regardless of your opinions on the health-care law, this is the wrong way to make software." He also wrote, "In the meantime, it’s clear that tens of millions of dollars have been spent to launch something broken."[2] A ConsumerReports.org article re-iterated previous advice, with the group recommending for people to stay "away from HealthCare.gov for at least another month". The group stated as well, "Hopefully that will be long enough for its software vendors to clean up the mess they've made."[29]
In its third week of operations, technical problems continued. A CNN.com article highlighted the "maddeningly long wait times" as an issue.[9] A variety of other problems included broken pull-down menus that have only worked intermittently, for example.[17]
Todd Park, the U.S. chief technology officer, initially said on October 6 that the glitches[clarification needed] were caused by unexpected high volume when the site drew 250,000 simultaneous users instead of the 50,000-60,000 expected. He claimed that the site would have worked with fewer simultaneous users. More than 8.1 million people visited the site from October 1 to 4.[17] White House officials subsequently conceded that it was not just an issue of volume, but involved software and systems design issues.[4] For example, consumers are required to create an account before being able to compare plans, and the registration process may have created a bottleneck that led to the long wait times.[30] Also, stress tests done by contractors 1 day before the launch date revealed that the site became too slow with only 1,100 simultaneous users, nowhere near even the 50,000-60,000 expected.[31]
Despite later comments, concerns about the readiness of the exchanges had been raised in March 2013, by Henry Chao, the deputy chief information officer at the Centers for Medicare and Medicaid Services (CMS), who had said that "let's just make sure it's not a third-world experience". A colleague of his, Gary Cohen, had also remarked, "Everyone recognizes that day one will not be perfect." Even by 2011, when the CMS awarded its private sector contracts, most of the PPACA regulations and implementation measures were still in flux.[9]
The New York Times and The Washington Post reported in November 2013 that the Obama administration brought in consulting firm McKinsey & Company to assess the website. Their report, delivered in March 2013, warned that the effort to build the HealthCare.gov site was falling behind and was at risk of failure unless immediate steps were taken to correct the problems.[32][33]
On October 21, 2013, President Barack Obama addressed the technical problems and other issues in a thirty-minute press conference at the White House Rose Garden, saying that there was "no excuse" for them. He remarked, "There's no sugar coating: the website has been too slow, people have been getting stuck during the application process and I think it's fair to say that nobody's more frustrated by that than I am." He also stated that a "tech surge" was underway to fix the problems.[4] The President additionally pointed out that people could instead apply through a call center or in person.[29]
White House Press Secretary Jay Carney said more time was needed to get the website working properly. Carney also hinted that if the problems remained unresolved for such a long time that it prevented people from meeting their legal obligation to obtain insurance in time for the February deadline, the legal penalty for not obtaining insurance would not be applicable because the Obamacare law states that if affordable care is not available, the penalty will not be payable.[29]
So, shortly after HealthCare.gov's launch, the problems still did not affect the legal requirement for Americans to have health insurance by December 15, which remained on the books as stated.[11] However, on October 23, the effective legal deadline for applying for health insurance via HealthCare.gov without getting a penalty via the individual mandate was extended to March 31, 2014, possibly because of the problems with HealthCare.gov and some of the state healthcare exchanges (but without a de jure explanation as such given).
The Obama administration appointed a contractor, Quality Software Services, Inc (QSSI), to coordinate the work of the fixing of the website problems. The company had already worked on the website's back-end before the website went live. As stated before, prior to the launch, the Centers for Medicare and Medicaid Services (CMS) had been playing the role of coordinator, but critics charged that it was ill-suited for such a systems integration role. The administration appointed Jeffrey Zients to act as their adviser in the matter.[34]
On October 25, Zients promised, in a conference call to the media, that the site would be working well "for the vast majority of users" by the end of November. He also claimed that 90% of visitors are now able to complete the account-creation process and actually used HealthCare.gov to compare plans. Perhaps the largest issue he faces, as he acknowledged in the call, are the error-riddled reports given to insurers, often messing up basic details such as an individual's gender.[34]
As stated before, HealthCare.gov problems have persisted even weeks after the launch. For example, a networking failure error at the related data services hub killed the website's functionality again October 28. This occurred the exact day after Health and Human Services head Kathleen Sebelius had highlighted the design of that data hub as a government success. However, state-based exchanges have mostly worked well in registering individuals during this time period, with CNN.com describing them as "largely error free".[6]
A large number of technical fixes took place through October and November, with an NPR.org report later remarking that the website seemed to be "working more smoothly." Yet, on November 13, the Obama administration revealed that fewer than 27,000 people had signed up to private health insurance through the site.[35] By November 30, more than 137,000 people had obtained health insurance through the federal website. That figure represented a strong increase, but enrollment figures were still vastly below past U.S. government forecasts.[36]
Accenture was chosen to replace CGI Group as the lead contractor for the website in January 2014.[37]
A large issue with future enrollments is dealing with the accuracy of HealthCare.gov information sent to insurance companies. As stated in an NPR.org article citing "continuing problems" with HealthCare.gov, about one in ten enrollment notices have contained a significant error.[36]
A hacker broke into part of the HealthCare.gov insurance enrollment website in July and uploaded malicious software, according to federal officials.[38] |