White House reports progress, but will HealthCare.gov keep up with demand?

December 2, 2013 at 12:00 AM EST
US-POLITICS-HEALTH
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GWEN IFILL: This week marks the beginning of an important enrollment period for the health care law and its battle-scarred federal website. but, for now, the Obama administration says it has good news. Although performance can still be spotty, things are better than they were.

The White House and the nation’s top health agency say users shopping for insurance on healthcare.gov are having far more success today than a month ago. The troubled site, officials said, is working nearly 90 percent of the time for consumers, and that today, there were 375,000 people visits by noon.

JAY CARNEY, White House Press Secretary: We believe we made the important progress that we set out to make by November 30, but, as we said in November, and as I have said just now, the work continues to make improvements that still need to be made to the website.

GWEN IFILL: Officials say the site can now handle 50,000 users at one time and up to 800,000 each day.

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The Health and Human Services Department also said the site’s so-called back end, which delivers information to insurers, had been largely repaired. But problems persist. Insurance companies remain unhappy. And increased volume could provide new tests as the December 23 deadline for enrollment nears.

Tennessee Republican Senator Bob Corker said Sunday, even if the site gets fixed, the law that spawned it remains deeply flawed.

SEN. BOB CORKER, R-Tenn.: The fundamentals of this, to me, were done in a way, a chaotic way much like we’re seeing the rollout. It was done in a way that, really, there wasn’t a vision at the end. It was just an amalgamation of legislation that didn’t have a central focus.

GWEN IFILL: Meanwhile, the cost of fixing healthcare.gov has reached $600 million and counting.

By the end of the day, the White House was reporting there were 750,000 visitors to HealthCare.gov. That’s just today.

We get more information on all this from two people watching the rollout from behind the scenes, Mary Agnes Carey of Kaiser Health News, an independent news organization, and John Engates, the chief technology officer at Rackgates, a server and software company. He’s been inside the government website’s command center.

Welcome to you both.

Mary Agnes Carey, 750,000, well on its way to the 800,000 number that the White House was talking — that the White House was talking about today, by 5:30 p.m. Eastern. How is that different from what we saw a month ago?

MARY AGNES CAREY, Kaiser Health News: They say that it’s more than double the usual traffic for a Monday. And, of course, there has been a lot of news coverage of the changes they made on the website. So maybe they are getting some people back who had some problems before.

GWEN IFILL: But there are still problems. And, first, I want you to explain what people mean when they say the front end and the back end of the site. And then we can get to what the problems were.

MARY AGNES CAREY: Right.

The front end is the consumer experience, consumers logging on to healthcare.gov, shopping or purchasing insurance. The back end is information that goes to the health insurers, how many people are enrolled, do they have a subsidy, how much and so on.

GWEN IFILL: So the back end is the remaining problem right now. Even though we assume that the patches that are made today will hold at the front end, nine back end is where the insurers are not so happy.

MARY AGNES CAREY: Right. They are very unhappy about — they are saying they are not getting accurate enrollment information. They don’t know if someone qualifies for a subsidy, how much of a subsidy that they’re receiving.

Consumers are calling health insurers and asking if they are enrolled. Insurers in many cases are saying they don’t have any record of this. And even with the fixes announced today, the insurance industry was telling me tonight that they still see significant enrollment challenges the way they’re getting data right now.

GWEN IFILL: And yet today on this call — you were on this call that the White — that the Health and Human Services officials gave — they said 80 percent of that back-end insurer’s problem had been improved, but they didn’t say over what.

MARY AGNES CAREY: Exactly right.

They’re not giving the error rate. Reporters kept asking repeatedly, how many of these forms sent to the insurers had bad information? They’re not answering that question. And insurers are saying tonight even the fix that was proposed today hasn’t been tested. They don’t know whether it’s going to work on not.

GWEN IFILL: What was it fixing? What was the source of the problem?

MARY AGNES CAREY: They said 80 percent of the problem dealt with a snafu that — on the Social Security number, entering that into the form, and that created part of the problem.

GWEN IFILL: And are the fixes you’re talking about, whether it’s on the front end or on the back end, are they permanent fixes they are putting in place or are these just Band-Aids to get us over this deadline?

MARY AGNES CAREY: The assumption is that they are permanent fixes, but they have made it very clear, as Jay Carney said, they need to do more and monitor and do more work as they need to going along.

GWEN IFILL: John Engates, I said you were with Rackgates, but you are from Rackspace.

JOHN ENGATES, Rackspace: That’s right.

GWEN IFILL: But I want to start by asking you what you saw when you went backstage, as it were, at the command center?

JOHN ENGATES: Sure.

So we got a peek behind the curtain last Monday. We got invited up to Washington, D.C., to go to the exchange operation center, where these fixes are being orchestrated. And they have a team of people up there that sit in a command center. Everybody’s got computers on their desk. Everybody has got a phone. And there is sort of this air of sort of a, you know, kind of like a control room you would think of at NASA or some sort of launch center.

It’s much smaller, certainly. But they are monitoring the site very carefully. They have screens on the wall with, you know, data about how the website is performing. They have people in the front of the room that are sort of bringing together all of the different vendors and contractors to make sure that they’re on the same page when they institute these fixes and upgrades.

GWEN IFILL: Is the problem, as you see it, about scale, the volume of people who are trying to get on the site, or is it about the performance of the site itself?

JOHN ENGATES: Well, I mean, those are two sides of the same coin.

If the site is designed to perform at a certain level, and you have too many users, the site falls over, I mean, basically has a real problem performing. On the flip side of that, if the site was designed for an extraordinarily large number of visitors, then the traffic that we’re seeing today or previously wouldn’t be a problem.

GWEN IFILL: Is what you saw in Washington that part of the tech surge that we heard about right after the first problems were discovered?

JOHN ENGATES: We did.

We saw the people that were part of that surge. And the surge was basically an addition of more contractors to do sort of these fixes. But it was also an infusion of outside expertise. And so they brought in a gentleman that is on leave from Google. He’s now leading — he was leading the way when I was there that day last week.

He was in the front of the room sort of running the conference call in the morning. They have a twice-daily conference call to sort of decide what’s going right, what’s going wrong, what they need to do for that day. And so some of the surge is basically enhancing the level of expertise, bringing in outsiders, but also just ramping up the number of people that are on board from the contractors.

GWEN IFILL: Without getting too technical, are the problems that you have seen hardware problems or software problems?

JOHN ENGATES: It’s actually been both.

I mean, we did talk about some of the things that they had done. They did upgrade hardware. They added more hardware. They made settings, changes to the settings on certain pieces of hardware that were potentially configured — or misconfigured. Then they also made software upgrades to help streamline the system.

There are elements of this website that, you know, prior to the surge, prior to the fixes, they were doing some complex database look-ups that would take an extraordinarily long period of time on a per-user basis. Some of the changes they made will allow for some of that data to be stored locally, cached, if you will, and make the look-ups a lot faster and make — that streamline — or streamlining the process that a user goes through as they’re looking at the site.

GWEN IFILL: And, finally, I want to you ask you this and then I will ask Mary Agnes. What is the next big problem that they need to solve, assuming that the problems that they have already fixed hold?

JOHN ENGATES: Right.

So you alluded to this in the beginning of the chat here. The front end is what they have been focused on. The front end is what the user experiences when they’re browsing the site or filling out information on the site. The back end is sort of the completion of that transaction to take the sign-up process to completion and sort of feed that data over to the insurance carriers.

I think that part of it is sort of — remains to be seen whether they fixed that, whether it’s working well. There’s another aspect of this that seems to come up from time to time on conversations that I have heard, is the security aspect. And it sort of again remains to be seen whether that was a big element of the focus or whether that got sort of pushed aside as they were working on the performance.

GWEN IFILL: Mary Agnes, what do you — today, they say they put in a shopping winnow feature, all these little bells and whistles. But is that the problem that they are facing in the next month or so?

MARY AGNES CAREY: They have to make sure they can handle the demand. They say they built the site to handle 800,000 people in one day. People need to have a good experience, especially people who have stayed away, are now coming back to be able to process their application.

There was some mixed experience today on Twitter. Some people had a good experience. Some didn’t. They have also got to fix this problem with health insurers. Coverage starts January 1. People have until December 23 to enroll. If insurers don’t know that you’re in the system, imagine what’s going happen when you go to the doctor or the hospital and they have no record of your insurance coverage.

GWEN IFILL: A big challenge still ahead.

MARY AGNES CAREY: Absolutely.

GWEN IFILL: Mary Agnes Carey, Kaiser Health News, as always, thank you so much.

MARY AGNES CAREY: Thank you.

GWEN IFILL: And John Engates of Rackspace, thank you so much.

JOHN ENGATES: Thank you.