Fixes make federal healthcare website better but far from perfect
WASHINGTON — Two months after its disastrous debut, the federal website for enrolling Americans in health insurance under President Obama’s healthcare law has improved markedly, and many consumers are now likely to be able to use it to select insurance plans.
Enrollment in health plans — the most important measure — has been accelerating.
But the performance of the troubled HealthCare.gov website, which consumers in 36 states are supposed to be able to use to sign up for health coverage, still falls well short of basic standards for Internet-based commerce.
Errors on Web pages and unscheduled outages remain far more common than on commercial sites. Some consumers still run into dead ends when navigating deep into the application and enrollment process, say advocates who work with the site to enroll uninsured Americans.
Moreover, while parts of the site that consumers use function much better, the complex systems necessary for processing applications and sending consumer information to insurance companies still don’t function properly, insurance industry officials say.
Ironically, improvements to parts of the website used by consumers could exacerbate these “back-end” problems. Many companies are nervous about being deluged by bad data if consumers flood the website in coming weeks to get coverage by Jan. 1.
“It’s a significant concern,” said Wayne Powell, vice president of Blue Cross Blue Shield of Kansas City. “If we get a deluge, assuming the website pipeline opens up, it’s going to be very challenging.”
In all, it is still unclear whether the improvements in the website have fulfilled the president’s pledge to get the primary gateway to the Affordable Care Act working smoothly for the “vast majority” of users by the administration’s self-imposed Saturday deadline.
The administration has released little meaningful data about the site’s performance, largely preventing independent assessments of whether 80% of users are now enrolling online, a goal outlined by the White House.
And administration officials won’t say what percentage of consumer applications are being accurately transmitted to insurers, a key measure of the site’s effectiveness.
Some insurance companies have largely abandoned plans to rely on HealthCare.gov. They are now focused on enrolling people directly through their own websites.
“That just makes for a better consumer experience,” said a senior executive at another major insurer, who asked not to be identified while discussing problems with the health law rollout.
In Illinois, one of the states using the federal HealthCare.gov site, state officials have advised advocacy groups to hold off on attempts to enroll people through HealthCare.gov until later in December.
There are fewer problems with most enrollment sites operated by the 14 states that do not rely on HealthCare.gov, including California. Enrollment in many of these states surged during November.
The number of people able to get health coverage through the federal site has also ticked upward, although the administration will not release November totals until later this month. Fewer than 27,000 people chose health plans in the federal marketplace in October.
The White House hopes that 7 million people will ultimately use one of the federal or state marketplaces to get health coverage for 2014.
According to accounts from around the country from insurers and groups that work with consumers, HealthCare.gov works far better than it did in October, when it was barely functional.
The University of South Florida, which is helping residents of that state sign up for health coverage, was able to use the website to enroll more than 71% of the people who got coverage in November, according to Jodi Ray, project director.
Leaders of Michigan Consumers for Healthcare and South Carolina’s Palmetto Project said advocates in those states were finally able to get consumers through HealthCare.gov by the end of November. Some, however, were still relying on outside sites to help consumers compare health plans because HealthCare.gov’s rudimentary comparison tool has not been able to generate real premium estimates.
In Texas, Legacy Community Health Services, the largest federally funded health clinic in the Houston area, can now guide people through most of site without encountering errors, Executive Director Katy Caldwell said.
“The rollout couldn’t have gone any worse,” Caldwell said, referring to the problems in October. “I was incredibly discouraged.”
But the site works much better now, she said. “I think they have turned the corner.... I’m very optimistic.”
On a conference call last week, Health and Human Services Secretary Kathleen Sebelius encouraged local officials to use the site to help their constituents get covered.
“I would urge you and your folks on the ground to not hesitate to recommend that people go to HealthCare.gov and get signed up, because that experience is currently working much better. And it will continue to work much better,” she said.
One of HealthCare.gov’s most frustrating initial problems — Web pages that were slow to load — appears to have been largely solved. Now, officials say, the average page loads in less than a second.
Administration officials say they have also substantially cut errors that consumers experience on the site, reducing the error rate to 0.75%.
While that is just a fraction of the error rate experienced in October, it can still mean that many consumers will encounter some error while using the site. Any application requires clicking on multiple pages, with the exact number depending on the complexity of a person’s situation.
Some users with relatively simple applications will experience few problems, officials say.
But filling out an application for a family of three and then comparing available health plans can require navigating through more than 100 Web pages and filling in detailed information about income, residency and family relationships.
That’s still simpler in some ways than buying health insurance on the individual market before the Affordable Care Act, which generally required people to supply extensive information about their medical histories and wait until an underwriter reviewed the application. But an average 0.75% error rate means that an applicant who had to click through 100 pages would have less than a 50% chance of making it all the way through HealthCare.gov without encountering a problem.
“That seems to be an awful lot of mistakes for a system like this.” said Bill Curtis, chief scientist at the software analysis company CAST. “That’s not good, and I doubt that’s making insurance companies very happy.”
Obama administration officials acknowledge that problems remain.
Even after doubling the site’s capacity to 50,000 users at one time, officials expect volume could still overload the site at peak times midday, said Jeffrey Zients, the former corporate executive the White House enlisted to lead efforts to rescue HealthCare.gov. Zients said consumers would then see a “customer-friendly queuing system” telling them when to return to the site.
Administration officials also acknowledge that they haven’t finished building the back end of the site — the portion that will dispense payments to insurers.
Zients said last week the administration was on track to finish that project by Jan. 1.
Peter Frost in Chicago contributed to this report.
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