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“I've been warning that a train wreck is coming with this law, but the truth is that no train wreck has ever had this many warning signs.” – Lamar Alexander 

WASHINGTON, Oct. 8 – The Obama administration persisted with the roll out of the Obamacare exchanges on October 1, despite countless warning signs that the exchanges were not ready to handle the millions of Americans required to purchase health insurance or face tax penalties from the individual mandate.

As Senator Lamar Alexander (R-Tenn.), the senior Republican on the Senate committee overseeing private health insurance, said in August: "I've been warning that a train wreck is coming with this law, but the truth is that no train wreck has ever had this many warning signs. The avalanche of last-minute delays should make every American anxious about the quality of the health care they'll be able to purchase in October and the security of the information they'll have to provide—proving again that this law must be repealed so that we can pass step-by-step reforms that transform the health care delivery system by putting patients in charge, giving them more choices, and reducing the cost of health care so that more people can afford it."

Here are answers to some of the biggest questions about the rollout of the insurance exchanges:

With three years to prepare, why wasn’t the administration ready for this?

• They figured the American people wouldn’t mind:
  • “Aneesh Chopra, who preceded Mr. Park as the federal government’s chief technology officer and helped create an earlier version of healthcare.gov, said he was confident that the system would be working effectively in the coming weeks…. ‘This is par for the course for large-scale I.T. projects,’ Mr. Chopra said. ‘We wish we could launch bug-free, but in reality that’s not that easy to do. The reality is that if you have a product that people want, people will tolerate glitches because they expect them.’” http://www.nytimes.com/2013/10/08/us/health-exchange-delays-tied-to-software-crash-in-early-rush.html?hp

Why is it taking so long to get an application started?

• System failure:
  • “The website is troubled by coding problems and flaws in the architecture of the system, according to insurance industry advisers, technical experts and people close to the development of the marketplace…Information technology experts who examined the healthcare.gov website at the request of The Wall Street Journal said the site appeared to be built on a sloppy software foundation…So far, many tens of thousands of people had started the application process but the number of those who were able to create accounts and shop for coverage is likely in the low thousands.” http://online.wsj.com/article/SB10001424052702304441404579119740283413018.html?mod=ITP_pageone_0
  • “The technical problems that have hampered enrollment in the online health insurance exchanges resulted from the failure of a major software component, designed by private contractors, that crashed under the weight of millions of users last week, federal officials said Monday.” http://www.nytimes.com/2013/10/08/us/health-exchange-delays-tied-to-software-crash-in-early-rush.html?hp
  •  “Based on my experience, the challenges look like glitches in software code… Most of the problems like these are in the software. Hardware is the easy part. You can add more hardware and do it easily. Software takes more time. In the rush of getting this out, it seems like testing wasn’t done completely…It’s not a performance or scalability issue,” Jyoti Bansal, founder of AppDynamics. http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/05/a-techie-walks-us-through-healthcare-govs-two-big-problems/ 
  • Flawed estimates from the administration:
    • “U.S. Chief Technology Officer Todd Park said the government expected HealthCare.gov to draw 50,000 to 60,000 simultaneous users, but instead it has drawn as many as 250,000 at a time since it launched Oct. 1…The administration built the site's capacity based partly on the all-time high of 30,000 simultaneous users for Medicare.gov.” http://www.usatoday.com/story/news/nation/2013/10/05/health-care-website-repairs/2927597/

Why is it so hard to complete an application?

• Bad software:
  • “As few as 1 in 100 applications on the federal exchange contains enough information to enroll the applicant in a plan… ‘This is not a traffic issue,’ [said Dan Mendelson, CEO of consulting firm Avalere Health]. ‘Right now, the systems aren't working.’” http://www.cnbc.com/id/101087965#_gus

Why is the application so confusing?

• Poor wording:
  • “Because of the complexity of enrolling millions of people in many different locations who speak a number of different languages, healthcare.gov is complicated and because of this, messaging must be clear. Instead, the wording throughout the site is often inconsistent or redundant.” http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/06/a-design-critique-of-healthcare-gov/

Why is it so hard to determine my Medicaid eligibility?

• Technical problems:

• “[A] system that determines whether people are eligible for federal subsidies to buy insurance, or Medicaid… continued to make some inaccurate determinations, despite improvements, people familiar with the matter said. By late last week, officials worried they may have to notify some applicants that they weren’t eligible for programs they enrolled in, one person said.” http://online.wsj.com/article/SB10001424052702304441404579119740283413018.html?mod=ITP_pageone_0
• “The federal website won’t be able to communicate with state Medicaid agencies until at least Nov. 1 due to technical issues, federal officials said…Nine of the 36 states that are using the federal exchange are expanding Medicaid under the law.” http://www.washingtonpost.com/national/health-science/federal-insurance-marketplace-cant-yet-and8216talk-to-state-medicaid-agencies/2013/10/04/37e1169c-2d36-11e3-b141-298f46539716_story.html  

How many people have been affected by exchange “glitches”?

• Almost everyone who tried to use the exchanges:
  • From comments posted on Healthcare.gov:
    • “What an exercise in complete stupidity. I've spent days trying to just log on. I go from one ‘downstream error’ screen to another ‘oops, we're sorry’ screen.”
    • “15 tries (with 3 different browsers) to actually get registered; 5 tries to, once registration complete, to get to the log in screen; 4 tries to get the login screen to accept info; 7 tries on an application submittal which then led to a phone verification effort…I give up.”
• “Carl Bidleman made his first attempt at buying insurance under the health law at midnight on Tuesday, the moment the marketplaces opened. He couldn't get the site to load and the representative at a call center suggested trying again in the morning. So he did, at 8 a.m., after walking his dog and brewing a cup of coffee. And again that afternoon. And that evening. Twenty-one attempts tries and 36 hours later, Bidleman had found the holy grail: Successfully purchasing a health insurance policy.”  http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/04/for-some-shoppers-buying-obamacare-is-turning-into-a-marathon/
• “[F]ederal officials could face a situation in January in which relatively large numbers of people believe they have coverage starting that month, but whose enrollment applications have not been processed.”  http://www.cnbc.com/id/101087965#_gus

Will the security of my information be in danger on these systems?

• Possibly:
  • “[F]ederal officials admitted that healthcare.gov would require both code-level improvements as well as increased server capacity. … To that list of fixes, however, the federal government … might want to add a handful of information security improvements. Here are five top concerns…” http://www.informationweek.com/security/attacks/5-obamacare-health-site-security-warning/240162322  

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