Health exchange website fiasco links and discussion thread (updated)

Three weeks into the launch of exchanges where millions of Americans are supposed to shop for private health insurance, the federal Healthcare.gov website is still a disaster. At a White House press conference today, President Barack Obama promised a massive effort to fix the problems and highlighted other benefits of the 2010 Affordable Care Act.

After the jump I've posted news and analysis related to the botched rollout of the health insurance exchanges. Any comments related to the 2010 health care reform law are welcome in this thread. It's worth noting that Democrats in the Iowa legislature favored creating a state-run exchange, which would have eliminated the need for Iowans to purchase insurance through the screwed-up federal website. But Governor Terry Branstad insisted on a state-federal partnership, under which the federal government would administer the website for finding health insurance.

Health and Human Services officials were fortunate that for the first half of October, the federal government shutdown and debt ceiling cliffhanger overshadowed the health insurance exchange rollout. But the website is barely working any better now than it was on October 1. Glitches are common when a website debuts, but there's no excuse for these massive problems with the design and execution. I don't know whether the wrong contractors were hired or whether federal IT policies are largely to blame, but the Obama administration had years to get this right. Millions of consumers will conclude that the government is too incompetent to handle health care. The Healthcare.gov website isn't working well for the insurers either.

Like millions of other people, I have not managed to successfully navigate Healthcare.gov. While I only tried a few times to set up an account, many people more persistent than I haven't had better luck.

Instead, I decided to look up individual and family health insurance options through the two companies serving Iowa, Coventry (owned by Aetna) and the non-profit health insurance cooperative CoOpportunity Health. I was disappointed to learn that Coventry hasn't published details on 2014 insurance policies on its website yet. On the plus side, I was able to browse more than 30 plans on CoOpportunity's website. Details on premiums and coverage can be downloaded through the site, or consumers can call a toll-free number to speak with someone who will e-mail that information to you.

Even the most expensive policies available through CoOpportunity would be substantially cheaper than what we currently pay Wellmark Blue Cross/Blue Shield, which has a near-monopoly on individual and family policies in Iowa. I would strongly encourage any Iowans who pay for their own health insurance to shop around.

Clearly not everyone who currently has health insurance will find a better deal on the exchange. Anecdotally, it seems that people who already have relatively inexpensive employer-provided insurance would have to pay more for one of the new policies. Some people are unable to renew their cheap "catastrophic" policies, because of the health care reform law's regulations on minimum coverage for services like preventive care.

On the other hand, those who are paying for individual policies seem to be finding the same thing I did: they stand to save a lot of money on the exchange. Iowa's Insurance Commissioner Nick Gerhart has pointed out that the cost of insurance will remain relatively low in our state compared to other parts of the country.

I also know people who will now be able to afford health insurance for the first time in many years. They have been uninsured either because of pre-existing conditions or because they couldn't find anything affordable in the individual market.

The "best and brightest" team now being assembled to fix Healthcare.gov has a huge amount of work to do. As of October 10, only seventeen Iowans had managed to sign up for health insurance policies through the federal website, according to Tom Alger, communications director of the Iowa Insurance Division. That is embarrassing and unacceptable. By all accounts, the Iowa Insurance Division has done a good job preparing for the exchange to open, but they are not in control of the website.

I contacted Alger again today, seeking updated totals. He said the Iowa Insurance Division doesn't have any current numbers, but that the informal word is that only a few more customers have been able to sign up. Cliff Gold, chief operating officer of CoOpportunity, estimated that only around 60 people in Iowa and Nebraska have enrolled through the federal website since October 1. Speaking to me today, Gold likened those people to the lucky "20th caller" who wins a radio station contest. He estimated that about 300 people have enrolled with CoOpportunity through other means.

Americans wanting coverage that begins on January 1, 2014 have until December 15 to sign up for health insurance. While it's possible to enroll through a paper application, most people will need to go through Healthcare.gov in order to receive the subsidies and tax credits associated with the new policies.

P.S.: For a while this summer, it looked like CoOpportunity might be the only group offering individual health insurance statewide in Iowa. Wellmark decided not to participate in the exchange until 2015, and UnitedHealthcare also opted out of our exchange. After being purchased by Aetna, Coventry chose not to participate in several other states' exchanges. However, Coventry eventually opted to offer health insurance to Iowans through the exchange.

Why would Coventry play here but not in other states? One rumor going around Des Moines connects the corporate decision to Iowa's unique Medicaid expansion compromise. Instead of being enrolled in traditional Medicaid, Iowans with incomes between 100 percent and 138 percent of the federal poverty level will receive government assistance to purchase private insurance through the exchange. That program, the Iowa Health and Wellness Plan, creates a guaranteed customer base for the corporations participating on Iowa's exchange. Speaking by telephone today, CoOpportunity Health's Cliff Gold told me that thousands of Iowans will be automatically enrolled in either Coventry or CoOpportunity health insurance plans. They will receive information about both options and will be able to switch companies if they like, or stay where they were assigned. Gold estimated that CoOpportunity will enroll roughly 5,000 Iowans through the Iowa Health and Wellness Plan, the official name for the alternative to expanding Medicaid.

I still think Governor Branstad was wrong to dig in his heels against expanding Medicaid as the Affordable Care Act intended.  The irony is that his intransigence may have helped make more options available to Iowa consumers shopping for health insurance.

UPDATE: According to twitter user jbelcap, many people are able to get the Healthcare.gov website working by using the Chrome brower "with incognito mode."

The Des Moines Register ran a piece on "semi-retired computer programmer" Edward Voss of Iowa City, who was the first Iowan to purchase a policy from CoOpportunity Health through the federal website. Even though he enrolled in a plan at the most expensive "platinum" level, he and his wife will receive better coverage with fewer out of pocket costs than they currently have through their Wellmark Blue Cross & Blue Shield insurance policy.

Voss said the website was one of the worst he'd seen in years. He said it looked like something from the 1990s. The glitches shouldn't be fatal, however, he said. "It looks fixable. But it's hard to fix things while you're up and running," he said. "I wonder if they wouldn't be better off shutting it down for a week or so," while they take care of it. [...]

Voss said he believes Iowa would have been better off setting up its own health-insurance exchange website, as some states did. If it had done that, he said, the site would not have been hit by millions of people, and any glitches could have been addressed more easily.

SECOND UPDATE: Here's a story about using Google Chrome browers in incognito mode to get past the Healthcare.gov website problems.

Former Iowa Insurance Commissioner Susan Voss told the Des Moines Register that she had advocated for Iowa to build its own health insurance exchange.

Spokesman Tim Albrecht released a statement Monday saying the decision was "consistent with Iowa's common sense approach to health care reform."

"Gov. Branstad explored all options when it came to the health insurance exchanges, ultimately deciding against a state-based exchange or a federal takeover of our state health insurance system," Albrecht wrote.

"The simple truth is that Gov. Branstad believed a partnership model, where Iowa maintained control over areas we have traditionally overseen like health plan regulation, was the best path for Iowa. That choice kept Iowa out of the business of building a costly, cumbersome and catastrophically flawed website that as we see on the federal level was a tall task at best, despite their time and resources."

Voss, a Democrat, soon will start work as an executive for the American Enterprise Group insurance company. She said Branstad seemed on board with a proposal about two years ago to have Iowa set up its own exchange. But she said Republicans controlling the Iowa House snubbed the plan.

House Speaker Kraig Paulsen, R-Hiawatha, declined to comment directly Monday on Voss' recollection. When asked if Iowa would have been better off with its own version of the health insurance exchange, Paulsen responded: "I think we would have been better off without socialized medicine."

Why does Albrecht think Iowa couldn't have built a functioning website like the ones working well in several other states?

Why does Paulsen think a website that allows people to shop for private insurance is "socialized medicine"?

THIRD UPDATE: On October 22, Health and Human Services Secretary Kathleen Sebelius revealed more details about the "tech surge to continue to improve the consumer experience on HealthCare.gov."

First, I am very pleased to announce we are bringing management expert and former CEO and Chairman of two publicly traded companies Jeff Zients on board to work in close cooperation with our HHS team to provide management advice and counsel to the project.  Jeff has led some of the country's top management firms, providing private sector companies around the world with best practices in management, strategy and operations.  He has a proven track record as Acting Director at the Office of Management and Budget and as the nation's first Chief Performance Officer.  Working alongside our team and using his rich expertise and management acumen, Jeff will provide short-term advice, assessments and recommendations.

We've also brought in additional experts and specialists drawn from within government, our contractors, and industry, including veterans of top Silicon Valley companies.  These reinforcements include a handful of Presidential Innovation Fellows.  This new infusion of talent will bring a powerful array of subject matter expertise and skills, including extensive experience scaling major IT systems.  This effort is being marshaled as part of a cross-functional team that is working aggressively to diagnose parts of HealthCare.gov that are experiencing problems, learn from successful states, prioritize issues, and fix them.

In addition to our efforts to ramp up capacity and expertise with the country's leading innovators and problem solvers, we have secured additional staff and commitments from our contractors, including CGI, the lead firm responsible for the federally facilitated marketplace technology.  They are providing and directing the additional resources needed for this project within the provisions of their existing contract.

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