Jeff Zients, former director of the Office of Management and Budget and current leader of the “tech surge” team to fix healthcare.gov, has drawn a line in the sand: Nov. 30. That is the date by which “healthcare.gov will be smooth for a vast majority of users,” he said on a press call last week.
I don’t think Zients set that date. Here’s why. Dec. 15 is the deadline for people to sign up in order to have insurance by Jan. 1, which is when marketplace coverage begins. Obviously the earlier more people sign up, the better. But past Jan. 1, you then have three months—until March 31—to get insurance before you’re penalized under the mandate.
The administration does not want to change these dates any further, and they definitely want coverage to start on Jan. 1. Insurers are already warning of premium sticker shock if open enrollment goes beyond March 31—whether their warnings are legitimate or not, I don’t think the administration wants to find out. So for all of Zients’ prestige and authority, I’m assuming the administration’s response to any request for time beyond Nov. 30 was: “But it’ll work on Dec. 1, right?”
On his Friday call, Zients differentiated between healthcare.gov’s “scale” issues and its “functionality” issues. I believe this marks the first time that the administration has admitted that healthcare.gov’s problems went far beyond the site being overloaded. Zients said that account creation had now been fixed, with more than 90 percent of users now able to create accounts. But only 30 percent have been able to complete an actual insurance application. And that’s not even to say that the application is correct, owing to reports of children getting listed as multiple spouses and the like.
If only 30 percent of people can actually complete an application on a website, why on earth is the website still up? So people can play insurance-application roulette with 7–3 odds against them? Why not take the site down until it works?
Well, remember how there was very little testing done on the system? It seems that not only was very little testing done, but testing frameworks weren’t set up. That means the team fixing healthcare.gov not only has a lot of bugs to fix, but they don’t have infrastructure in place to identify and reproduce the bugs, which are the first step to fixing them. Under a tight deadline, any such infrastructure will be ad hoc and inadequate. So it’s important that healthcare.gov stays open simply so that potential applicants can run into bugs and report them.
In effect, the uninsured are now serving as alpha testers—i.e., guinea pigs—of a mostly untested system. As they are now serving as de facto government workers, I think they deserve a discount on their premiums, preferably taken out of the contractors’ fat paychecks.
Nonetheless, Zients’ stats and admissions of reality were refreshing and bode well. I am more ambivalent about the promotion of data-hub contractor QSSI, owned by insurer UnitedHealth Group, to the role of “overseeing the entire operation.” QSSI is one of those contractors that "have not met expectations," to borrow a line from Department of Health and Human Services Secretary Kathleen Sebelius, who testifies on healthcare.gov before the House on Wednesday. As we saw, QSSI admitted that their $85 million component broke down on Day One. QSSI also screwed up Housing and Urban Development’s reverse-mortgage HERMIT system in 2009–2011, for which they were paid a cool $32 million.