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ObamaCare Clusterfuck: Pass the popcorn (part 2)

[Part 1].

Film at 11, but the administration is about to declare the most definitely not relaunched ObamaCare website ("marketplace"), healthcare.gov, a success. Pass the victory gin:

HealthCare.gov will meet deadline for fixes, White House officials say
Administration officials are preparing to announce Sunday that they have met their Saturday deadline for improving HealthCare.gov, according to government officials, in part by expanding the site’s capacity so that it can handle 50,000 users at once. But they have yet to meet all their internal goals for repairing the federal health-care site, and it will not become clear how many consumers it can accommodate [about the lowest baseline you can set] until more people try to use it.

And they also appear to be doing some not-Expedia-like, not-Amazon-like things to make the site "work" that shouldn't come under the heading of repairs. For example, the waiting area:

The administration says peak periods (2 p.m. being the pinnacle) could still be problematic for some users to log on. Starting this weekend, a new queuing system will go online to moderate the flow of traffic into the site and help avoid congestion. If there are more than 50,000 users trying to shop, people will be redirected to a waiting room, notified of the wait time and allowed to get notification by email of when to come back.

I've never heard of a kludge like this in a major public-facing system, but perhaps I've lived a sheltered life. But c'mon. What kind of system (a) puts deadlines in place and (b) doesn't scale for peak periods? For some reason, I don't hear of Amazon and Best Buy setting up waiting rooms on Black Friday, so WTF?

And as it turns out, you might not even get a real price:

Days before the Obama administration’s self-imposed Nov. 30 deadline for fixing HealthCare.gov, its technology team is scrambling [Oh, great! The internal chaos hasn't stopped!] to build a new part of the Web site as a workaround [kludge] that would enable more people to buy health insurance without relying directly on the site.

The new mechanism, EZ App [brilliant marketing!], would permit people who are eligible for financial help from the government to enroll for coverage without calculating an exact subsidy amount, which has been a major stumbling block, according to government and insurance industry officials who spoke on the condition of anonymity in order to be frank. It would allow call centers, and eventually insurance companies and brokers, to help people enroll based on estimates of what their federal subsidies would be.

But wait! EZ App is only going to work over the phone!

The concept is similar to the Internal Revenue Service’s 1040EZ form [You mean I can fill out an approximation of my "wages, salaries, and tips in the total on line 1" on the 1040 EZ? Good to know.], the shortest and simplest way to file a federal income tax return. But even getting this slimmed-down process to work online has proved difficult, one person said, so it will initially only be available to individuals who seek to enroll by telephone.

But the whole point of the website is being able to compare plans side-by-side (or "shop," as we like to say). How does that work over the phone? It doesn't work. Anyhow, what could go wrong?

But insurers are uncomfortable with the add-on because they do not want to shoulder the financial liability for customers signing up for plans with a rough estimate of their final premiums, rather than a precise figure verified through the site.

Forget about the insurers, how about the poor shlubs who buy the product through EZ App? If the "rough estimate" turns out just to be wrong, who do they appeal to? The Feds, or the insurance company? If the "rough estimate" is too high, meaning the consumers citizens poor shlubs got more subsidies than they should have, who claws back that money and how? And if the "rough estimate" is too law, meaning the poor shlubs paid more than they should have, how do they (a) claw back the excess from their insurance company and (b) make sure they're getting the right subsidy going forward, and that the their insurance company knows about it? Sure, I know a CMS spokeshole would say we just need to connect the frammis to the foo bar in the Rube Goldberg device, but who would be nutty enough to think that would be without problems?
Let's put this less politely: Obama is trying to get you to spend potentially thousands of dollars on a product that could drastically impact your health, without doing comparison shopping, and without even knowing the price, since the price to you is list price minus subidy. Can you imagine buying an airline ticket from Expedia on the basis that "Your flight to Magic Pony Land is going to cost you $2000 - $500 plus or minus $200?"

So, summing up: The administration has brilliantly moved the goalposts, in software ("code is law"). And the website provides an "optimal user experience" although (a) you might have to wait an unknown amount of time to actually log onto the site, and (b) they're going to try to sell you a product without giving you a firm price on it. Unbelievable? All too believable!

* * *

Of course, all of this assumes that you can prove your identity to healthcare.gov in the first place, because despite all the hype about "shopping" you've got to clean up your records with Experian before trying to get a real price, should that be possible (see above):

Just days before the Obama administration’s self-imposed deadline to fix the troubled federal health insurance website, officials said Monday that they were aware of another problem that has prevented thousands of people who were unable to verify their identity from shopping for health plans.

"Thousands" may not seem significant in a country of what? 300 million, but it is significant for ObamaCare, since thousands is all they have been able to sign up.

People who cannot establish their identity by answering certain questions at HealthCare.gov are instructed to call the help desk at Experian, a credit reporting agency, for “ID proofing.”

Customer service representatives for the federal marketplace and for Experian said they had received calls from many people who were unable to verify their identity, and internal government documents show that lower-level federal employees have known of a problem for weeks.

“However,” she said, “some consumers whose information does not match records, such as when an alternate name is used or their address does not match, may be referred to a call center” for identification verification, and in complicated cases they may experience “a wait time before receiving a determination.”

If "the wait time" mean people don't make the enrollment deadline, that's going to cost them on their 1040 -- and through no fault of their own. I hope somebody's sues the Fed's ass on this; it's not fair to make people meet a deadline under penalty, and then put obstacle in the way of their meeting it.

Joanne Peters, a spokeswoman for the Department of Health and Human Services, said that 90 percent of consumers were able to create accounts and complete “identity proofing” online.

So 10% can't, meaning that, if ObamaCare by some happy mischance manages to hit it's already lowballed target of 7,000,000 enrolled, 700,000 people will have been trapped in ID validation hell, located somewhere in the netherworld between HHS and experian. Sure, they're probably low information voters who did something silly like move to a new address, but still, this attitude, that "Oh, it work for most everyone, so let's throw the rest of 'em under the bus" seems to be pervasive not only in the administration, but among Obots as well; they use precisely the same argument with people whose promised policies were cancelled on the individual insurance market. The mantra of "Suck it up for the greater good" is particularly unfortunate when those who deploy it don't, personally, have to do any sucking up, which seems to be 100% of the time.

* * *

Then there's what happens on the back end. Remember the 834s? An 834 is an electronic form that healthcare.gov (or any of the state sites) sends to your insurance company with all the information they need to issue you a policy; it summarizes the information you filled out on the site, but in a format that computers can understand. If the 834s are screwed up, your policy is screwed up. As we have seen, that will cause the insurance companies to have a sad because they'll have to fix the forms manually, assuming they can, and if your enrollment is delayed, you may take a hit on your 1040 (not to mention not being covered, if that matters). The 834s have been screwed up from the beginning, and it's not clear whether they've been fixed. Sarah Kliff, November 19:

Most of the high-priority problems with the "834 transmissions" have been fixed. Spokeswoman Julie Bataille kicked off the call by announcing that her agency has "completed fixes for two-thirds of the high priority bugs responsible with issues with 834 transactions." 834 transactions, as you might recall, are the forms that the exchange is supposed to send to insurance plans when someone signs up for a plan. But ever since HealthCare.gov launched, it has been spitting out inaccurate forms that make it difficult for insurers to know who has actually purchased their plan.

Unfortunately, there was no follow up question on the error rate for 834 transmissions; we don't know, right now, how many of those are buggy.

Obviously, as Kliff points out, Bataille is bullshitting. The metric that matters is clean, error-free 834s, not bugs in the system that pumps them out. What if one bug causes 90% of the problems? So, if we don't have an error rate, that means either that Bataille know the rate, but it's bad, so she's hiding it, or they don't know what the error rate is, which means that testing is still inadequate. Not good either way! And Kliff again:

And Kliff again, on November 25:

Mum is the word on 834 transmissions. Back when Jeff Zients came on board with Health and Human Services, he described fixing the 834 transmissions — the files that insurance plans get sent when someone signs up — as the very top item on the administration's "punch list." How well HHS is doing on that very important item is, however, difficult to know.

Both myself and another reporter asked questions today about what the error rate was for the 834 transmissions. Here's what I got in response.

"We continue to be in active conversation [BWA-HA-HA-HA-HA!!!!] with the issuers and make sure we understand what they are seeing," Bataille said. "We believe that we have made progress. We know there are still some more things to do and we will report on overall enrollment numbers when we have all of those details available."

When another reporter followed up, pressing on why there was no error rate provided, Bataille followed up that "I can tell you we are making progress improvements to 834. I don't have numbers to share with you, we will have enrollment numbers for you next month."

If we do get an 834 error rate, we'll be sure to share it here.

If the data about your policy is screwed up, then your policy is screwed up.

If people can't get into the Web site, then they simply have to come back later. But if they believe they've signed up for a plan but their 834 is a garbled mess -- or, even worse, clear but wrong -- it could mean chaos when they actually go to use their health insurance. For that reason, inside the health-care industry, the 834 problems are the glitch that is causing the most concern.

An 834 transmission contains enrollment data like an individual's social security number, their dependents and the plan that they picked. That data is, obviously, critical: If it comes in wrong, an applicant may not get the right plan, or family members may not be covered, or identity may not be verifiable.

Bottom line:

1) 834s are the only valid enrollment number: "The question to ask: “How many uncorrupted, valid, unique 834s per day over the last week?". So, if, on November 1, the administration doesn't give 834 numbers, the administration shouldn't claim success -- though you know they will.

2) 834s are at the top of HHS's famous punch list.

So, if the administration on November 1 (or, to be fair, the following Monday) doesn't give an 834 number, then it hasn't accomplished its #1 priority (and you know if the number are good, they'd give them), and no matter how many people enroll, a larger number of enrollments are going to be fucked up.

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Submitted by lambert on

But it's just a huge avalanche (mostly from where I set, an avalanche of badnes, starting from the simple premise that it's a program that shouldn't exist). For example, I'm not looking at the effects on hospitals, or on ACOs (rebranded HMOs), or on doctor, or how Medicare and Medicaid will be effected. I can cut through the bullshit on the tech stuff on the political economy stuff, but there's so much more....

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

jo6pac's picture
Submitted by jo6pac on

http://www.rawstory.com/rs/2013/11/30/online-sales-soar-during-black-fri...

Then it is Please Hurry Up and Die I love it. I was wondering can it get any worse, well it seems to be the program that Never Stops Giving. The new talking point of the so-called elected govt. should be Trust Us We Know What You Want even if you don't. The price will be taken from you in the very near future. It's nothing to worry about go shopping;)

Submitted by gmanedit on

If the coverage is restricted by county, what happens to someone who needs care while traveling? What about college students on their parents' policy--are they out of network at school?

Submitted by lambert on

... but while no doubt policies can vary, you're likely to end up with balance billling on your out-of-network treatment. (This was the issue the woman who had cancer treatments at two widely separated hospitals in CA.)

On college kids.... What a great question ;-)

First they ignore you, then they ridicule you, then they fight you, then you win. -- Mahatma Gandhi

quixote's picture
Submitted by quixote on

(December 1st, right? Not November 1st?)

(More developing cliché allergies: punch list. That one is getting under the skin I'm supposed to be having in this "game." What is this BS? What happened to "todo list"? Now they hang the list up like a big old boxing training bag and punch it?)

Anyway. On to the actual topic. An article in today's LATimes:

Administration officials also acknowledge that they haven't finished building the back end of the site — the portion that will dispense payments to insurers.

Zients said last week the administration was on track to finish that project by Jan. 1.

That's at the very end. Sounds like yet another problem in addition to the InsureCos not knowing which poor schlubs have signed up for what. Sounds like the gov has no idea how much they owe the poor InsureCos even when the customer data is good. I wonder if the gov will set up a call center for the InsureCos to get lost in while they don't get paid?