Obamacare Web troubles: what’s known so far – and what big questions remain

A committee in the Republican-led House will question federal contractors Thursday morning, in an effort to understand why the online debut of Obamacare has gone so badly.

Lawmakers on the House Energy and Commerce Committee are likely to ask some pointed questions that will shed light on a debacle that prompted President Obama himself to declare Monday, “Nobody is madder than me.”

The technical problems emerged with the Oct. 1 rollout of HealthCare.gov, thwarting Americans’ efforts to navigate the new online marketplace for health insurance.

Thursday’s hearing will be the first but not the last on this subject. Here’s a look at what’s already known, as well as what everyone from politicians to voters would like to know:

What we know: The website’s performance has been poor.

In testimony prepared for the Thursday hearing, one of the lead software contractors, CGI Federal, says that from the get-go, problems with creating user log-ins led to “a bottleneck that prevented the vast majority of users from accessing” the health-insurance exchange. As that problem was mitigated, more problems cropped up downstream, according to Cheryl Campbell of CGI.

What we’d like to know: Why has it been so bad? How much might the problems be rooted in decisions made for political reasons, and how much in poor project management or the sheer complexity of the challenge?

The website is the public face of a mammoth law cherished by Democrats and reviled by many Republicans. According to some accounts, a key flaw was a late-in-game decision to funnel people through the process of setting up accounts prior to shopping for plans. A Wall Street Journal story cited a Health and Human Services (HHS) spokeswoman saying the agency wanted to ensure that site users knew of their eligibility for subsidies before seeing insurance prices.  

For her part, Ms. Campbell of CGI noted that the Obama administration put the Centers for Medicare & Medicaid Services (CMS) in the role of overall “quarterback” for the website project, with the job of ensuring that a system built by multiple contractors and spanning vast databases would function smoothly. Some critics are saying CMS wasn’t up to the task, but it’s a job that would have been challenging for any company or agency.

What we know: Some basics appear bungled.

One example: The Obama administration has said the government built HealthCare.gov with the expectation of about 60,000 users at a time, and then it was surprised when usage reached about five times that level. To many outside observers, this sounds like a significant failure to envision how high the site’s traffic might go.

What we’d like to know: Did Team Obama underestimate the magnitude of its task? This is the highest-profile legislative achievement of the Obama administration, and the law could result in as many as 7 million insurance enrollments between the Oct. 1 launch and late winter.

What we know: Mr. Obama was more a cheerleader than a manager of this rollout.

Since the law’s passage in 2010, Obama has regularly championed the Affordable Care Act (ACA) as bringing health insurance to millions of Americans who now lack it – regardless of their health condition or access to employer-based coverage. But just how involved he was in details of implementation is less clear at this point.

HHS Secretary Kathleen Sebelius told CNN this week that the president didn’t hear about key challenges in the website rollout – including a crash during testing and complaints from insurance companies that must rely on HealthCare.gov – until the site launched on Oct. 1.

What we’d like to know: Was Obama too hands-off when it came to implementing the ACA? Or was he engaged enough, but poorly served by lieutenants including Secretary Sebelius, who might have given earlier warning about some of the problems? 

What we know: A “tech surge” is happening and “alpha teams” are working.

The Obama administration says it’s working to fix problems day by day, drawing on government agencies, private contractors, and insurance companies that represent vital parts of the online marketplace. When a citizen enrolls for coverage on the site’s “front end,” they’re choosing an insurer that needs to get information on the “back end.” In many cases that information, contained in a transmission called an “834,” is coming through with serious errors.

What we’d like to know: Will there be full disclosure going forward? It will take time, technology experts say, to find patches for the various problems in the HealthCare.gov system. But it’s not clear how long. That could make it important, for the sake of public trust in both the health law and the US government, to have clear and frequent communication about how things are going.

That may be about to happen. The White House says CMS – the “quarterback” agency for the website – will start holding daily briefings on its progress.

Having good information will be vital as Americans consider things such as when to try to use the website and whether to try other paths – for example, calling an Obamacare hot line to learn about insurance coverage. Realistic information will also help inform the debate over whether the law’s deadline to enroll in coverage should be extended.