From The Editor | October 22, 2013

The Obamacare Train Wreck

By Ken Congdon, editor-in-chief, Health IT Outcomes
Follow Me On Twitter @KenOnHIT

Ken Congdon, Editor In Chief of Health IT Outcomes

Follow Me On Twitter @KenOnHIT

There’s really no other way to describe the rollout of Obamacare to date than disastrous. Since its launch on October 1, the HealthCare.gov website has been plagued with problems including site crashes, infinite applicant wait times, and a faulty patient identity verification algorithm. The security of the patient data submitted during the application process has also been called into question due to the manner in which some of the code used to build the website was obtained.

Initially, high-ranking government officials claimed the problems with HealthCare.gov were primarily related to the astronomical amount of traffic the site was receiving (HealthCare.gov has had more than 20 million unique visitors to date). HHS Secretary Kathleen Sebelius asked the American people to “give us [the US government] the same slack you give Apple” for a technology rollout of this magnitude. But, as Washington Post columnist Ezra Klein states in his article Five Thoughts On The Obamacare Disaster, “Can you imagine how many people Steve Jobs would've fired by now if he'd launched a new product like this [HealthCare.gov]?” To date, none of those primarily responsible for the rollout of Obamacare have been terminated.

More recently, government officials have owned up to significant technical problems with the configuration of HealthCare.gov. In a public address on Monday, President Obama admitted the website is not working as it should and vowed to get it fixed. Key in this repair effort is the assembly of a “tech surge” team that consists of the “best and brightest” technical minds both inside and outside of government (including entrepreneur and US CTO Todd Park).

While the Obamacare rescue mission is now under way, one still has to question how we got into this mess to begin with. According to an article in The Washington Examiner, an anonymous source close to the Obamacare project says federal officials did not permit testing of the HealthCare.gov website or issue final system requirements until four to six days prior to launch. “Normally, a system of this size would need four to six months of testing and performance tuning, not four to six days,” the individual says.

Obviously, some may question the validity of these anonymous claims. However, if you ask me, the testing timeframe is not the biggest issue here — it’s the archaic and close-minded way that the federal government purchases IT services (and other products and services for that matter). In the federal government, the GSA (General Services Administration) rules all. It is the appointed procurement arm for projects like HealthCare.gov, and the GSA-approved vendor pool is limited. In fact, some say that CGI Federal (the company awarded the contract for the bulk of HealthCare.gov) was the sole bid considered for the project. HHS denies this claim, but even in the best case scenario, CGI was one of a limited few in the GSA inner circle that was considered for the job. At the very least, the Obamacare debacle should shine a big bright light on the ineffectiveness of purchasing IT services in this manner.

OBAMA ADMINISTRATION NEEDS TO ‘WALK THE WALK’ WITH HEALTH IT

So here we are. Currently, the functionality of HealthCare.gov is hit or miss. The user experience seems to be improving daily, but there are still a ton of glitches to contend with. The good news is there is undeniable public interest in obtaining affordable health insurance through the federal exchange. As mentioned, more than 20 million unique visitors have logged onto HealthCare.gov since its launch, and more than 500,000 applications for health insurance have been successfully submitted online. However, it is reported that the vast majority of these applications are from people that are chronically ill. For Obamacare to be considered a success, more healthy individuals will need to sign up for health insurance via the exchange.

With all the bugs in the web portal, President Obama has also urged Americans having difficulty obtaining health insurance via HealthCare.gov to enroll the old-fashioned way — over the phone or via face-to-face visits with a local Obamacare navigator. In my opinion, this simply isn’t good enough. The online technology needs to work — not only for the sake of convenience and expediency, but also for the message it sends to healthcare providers across the country.

Think about it. The Obama administration has always stood on a soapbox preaching about how indispensable IT is to lowering costs and improving patient care (a sentiment I wholeheartedly agree with and am passionate about, by the way). The federal government has even gone so far as to incentivize healthcare facilities to restructure their clinical systems around health IT. What kind of message does it send to providers if the federal government can’t even get its own health IT system to work correctly?

Granted, healthcare providers aren’t bound by the same stringent GSA purchasing protocols as the federal government, but the Obama administration needs to set an example here. It needs to show the public and health providers the good technology can bring to healthcare — particularly with something as high-profile as Obamacare. If it fails, then not only does the federal government look hypocritical, but it may even serve to stall the momentum of health IT initiatives throughout the U.S.

Moreover, the longer problems exist with HealthCare.gov, the more it will weaken physician support of exchange products. According to a recent survey by MGMA (Medical Group Management Association), nearly half of US physician groups surveyed are still trying to decide whether or not to participate in or accept new insurance plans available via the exchanges. HealthCare.gov needs to work seamlessly in order to encourage physician participation. Physician support is crucial as ACA already promises to flood the market with newly insured patients, which could lead to a physician shortage.

The clock is ticking for the Obama administration to fix HealthCare.gov. Resolution or ultimate failure is imminent. According to several experts, HealthCare.gov needs to be fixed by Thanksgiving. This would still give folks plenty of time to enroll. If problems continue to persist with the site beyond this date, it could shrink public participation in the program and overall health insurance expansion, lead to higher insurance premiums in the second year of ACA, and cause more Americans to be penalized for violating the health insurance mandate. I, along with most of the country, will be watching with great interest to see how it all shakes out over the next few weeks.

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