Exactly how bad are things on the federal health-care exchanges? The working assumption among most journalists, including me, is that they would be fixed in a few weeks -- that is, by the end of this week. But yesterday’s New York Times brought a deeply reported piece from Robert Pear, Sharon LaFraniere and Ian Austen. There is too much information in the piece for an excerpt to do it justice, so I’ll summarize, with some editorial comments -- but you should read the whole thing to get the full flavor:
-- One person familiar with the project says it’s only about 70 percent of the way there, and has heard estimates of somewhere between two weeks to two months to fix it. As a programmer I know points out, “two weeks to two months” is the programming equivalent of “40 days and 40 nights”: “A long time, but I have no way of knowing how long.” When I used to hear estimates like that, I used to assume it would be coming in on the late end of that range, earliest.
-- The administration delayed writing major rules until after the 2012 election, because it didn’t want to give Republicans any ammunition for their campaign. (This actually was noted at the time: “When it comes to health care, delaying regulations could help the president politically by avoiding discussion of the controversial health reform law. But that makes life difficult for states and industries that need to prepare for the coming changes,” wrote the National Journal. But most of us didn’t understand just how badly this was affecting implementation.)
-- Despite evidence to the contrary, the administration kept insisting that everything was absolutely on track to launch Oct. 1.
-- This passage is so extraordinary that it requires excerpting:
-- The Centers for Medicare & Medicaid Services inexplicably decided to take on the role of central project manager itself, assuming responsibility for integrating all the various software pieces they’d subcontracted, rather than assigning that role to a lead contractor. CMS is not known to maintain a pool of crack programming talent with extensive project management experience that can be deployed to this sort of task.
-- Henry Chao, the Health and Human Services Department's digital architect of the insurance marketplace, seems to have been sounding the alarm bells internally. (He certainly was externally; he famously told a group of insurers in March that “I’m pretty nervous -- I don’t know about you. … Let’s just make sure it’s not a third-world experience.”) Chao was worried that the systems wouldn’t work, a concern to which higher-ups apparently responded by basically telling him in effect that, according to the Times piece, “failure was not an option.”
-- Neither the consumer side nor the insurer side is working. A New York Times researcher made more than 40 attempts from Oct. 1 to Oct. 12 to log in, with no luck. Meanwhile, the Times confirms Bob Laszewski’s report that insurers are getting virtually no usable data from the exchanges. As the Times puts it, “just a trickle of the 14.6 million people who have visited the federal exchange so far have managed to enroll in insurance plans, according to executives of major insurance companies who receive enrollment files from the government. And some of those enrollments are marred by mistakes. Insurance executives said the government had sent some enrollment files to the wrong insurer, confusing companies that have similar names but are in different states. Other files were unusable because crucial information was missing, they said.”
Insurers began warning in 2012 that they were worried about these systems making their delivery dates, a concern that the Government Accountability Office echoed in June. Now we know why: The systems weren’t on track to meet their delivery dates.
This is stunning. It’s far worse than I imagined, and I am pretty cynical. The law’s supporters are engaged in some high-speed blamestorming: It’s the Republicans' fault for not giving the law more money, or it’s the fault of Republican governors who didn’t build their exchanges, or maybe it’s one of the vendors -- CGI, the firm with the largest contract, is the most favored target, but at various times, the administration has clearly been teeing up to blame Experian or Oracle. Or perhaps the fault lies in federal procurement rules, which prevented the government from getting the right kind of staff and service. A lot of that shows up in the article; there’s a long prelude about the political barriers that the administration faced. But ultimately, the litany of mistakes that the administration made overwhelms these complaints.
(read the rest at link): http://www.bloomberg.com/news/2013-10-14/obamacare-needs-a-drop-dead-date.html
-- One person familiar with the project says it’s only about 70 percent of the way there, and has heard estimates of somewhere between two weeks to two months to fix it. As a programmer I know points out, “two weeks to two months” is the programming equivalent of “40 days and 40 nights”: “A long time, but I have no way of knowing how long.” When I used to hear estimates like that, I used to assume it would be coming in on the late end of that range, earliest.
-- Despite evidence to the contrary, the administration kept insisting that everything was absolutely on track to launch Oct. 1.
-- This passage is so extraordinary that it requires excerpting:
“Deadline after deadline was missed. The biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring, according to people familiar with the process. As late as the last week of September, officials were still changing features of the Web site, HealthCare.gov, and debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.”Suddenly, two months sounds optimistic.
-- The Centers for Medicare & Medicaid Services inexplicably decided to take on the role of central project manager itself, assuming responsibility for integrating all the various software pieces they’d subcontracted, rather than assigning that role to a lead contractor. CMS is not known to maintain a pool of crack programming talent with extensive project management experience that can be deployed to this sort of task.
-- Henry Chao, the Health and Human Services Department's digital architect of the insurance marketplace, seems to have been sounding the alarm bells internally. (He certainly was externally; he famously told a group of insurers in March that “I’m pretty nervous -- I don’t know about you. … Let’s just make sure it’s not a third-world experience.”) Chao was worried that the systems wouldn’t work, a concern to which higher-ups apparently responded by basically telling him in effect that, according to the Times piece, “failure was not an option.”
-- Neither the consumer side nor the insurer side is working. A New York Times researcher made more than 40 attempts from Oct. 1 to Oct. 12 to log in, with no luck. Meanwhile, the Times confirms Bob Laszewski’s report that insurers are getting virtually no usable data from the exchanges. As the Times puts it, “just a trickle of the 14.6 million people who have visited the federal exchange so far have managed to enroll in insurance plans, according to executives of major insurance companies who receive enrollment files from the government. And some of those enrollments are marred by mistakes. Insurance executives said the government had sent some enrollment files to the wrong insurer, confusing companies that have similar names but are in different states. Other files were unusable because crucial information was missing, they said.”
Insurers began warning in 2012 that they were worried about these systems making their delivery dates, a concern that the Government Accountability Office echoed in June. Now we know why: The systems weren’t on track to meet their delivery dates.
This is stunning. It’s far worse than I imagined, and I am pretty cynical. The law’s supporters are engaged in some high-speed blamestorming: It’s the Republicans' fault for not giving the law more money, or it’s the fault of Republican governors who didn’t build their exchanges, or maybe it’s one of the vendors -- CGI, the firm with the largest contract, is the most favored target, but at various times, the administration has clearly been teeing up to blame Experian or Oracle. Or perhaps the fault lies in federal procurement rules, which prevented the government from getting the right kind of staff and service. A lot of that shows up in the article; there’s a long prelude about the political barriers that the administration faced. But ultimately, the litany of mistakes that the administration made overwhelms these complaints.
(read the rest at link): http://www.bloomberg.com/news/2013-10-14/obamacare-needs-a-drop-dead-date.html
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