The last time the government expanded health care, it was also kind of a disaster

October 11, 2013

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

If you think the launch of HealthCare.Gov isn't going so well, consider this: When online shopping for prescription drug programs launched back in 2005, things went so badly that the federal government didn't even get off the ground until three weeks after its scheduled launch.

The first obstacle was one of scheduling: Officials had initially scheduled the launch shopping component of the Web site on the Jewish holiday Yom Kippur.

PartD October14

The Centers for Medicare and Medicaid Services decided to delay the launch, per then spokesman Gary Karr, as to "respect all partners out there and their religious beliefs,"

But even after that, the site where seniors were supposed to compare drug prescription insurance plans didn't launch until November.

partd

"The Medicare folks have had some trouble getting the tool up and running," then-Washington Post reporter Chris Lee wrote on Nov. 8, 2005. "The original debut date was Oct. 13, but officials delayed it, citing the Jewish holiday Yom Kippur. Next it was promised on Oct. 17, but that day, too, came and went without personalized plan comparisons being available."

A news briefing promised the site would be up and in the afternoon. It didn't happen. "Visitors to the site could not access it for most of the first two hours,: Lee reported. "When it finally did come up around 5 p.m., it operated awfully slowly."

"Certainly I remember, thinking back to 2005, that the launch of the Web site was challenging," says Jack Hoadley, a researcher at Georgetown University who has studied the Part D program since before its launch. "It was pretty regularly a source of frustration just like what we're experiencing now."

What Hoadley says surprised him though, reading back through old news clips over the past few days, is just how challenged the program's digital launch was. "I look back and remember it was rocky," he says, "But I don't think I remember the degree of the rockiness that was the case."

There were other challenges too. As Hoadley and his colleagues wrote in a recent paper on Part D's launch, when seniors called the 1-800 Medicare phone number for help, a review found the agency "only responded to calls accurately and completely only about two-thirds of the time."

Lee reported that an annual booklet sent out to seniors called "Medicare & You" contained "inaccurate details about some of the prescription plan choices." CMS later had to post a chart on the Web site with the accurate information.

The delays of the Medicare.Gov Web site weren't as big news as the glitches with HealthCare.Gov. Both of the stories above ran on page A17 of the news section, unlike the HealthCare.Gov stories that have regularly been landing on the front page.

Gary Karr, who served as a spokesman for Medicare during the rollout, doesn't remember the initial enrollment period being especially difficult. It was right after people signed up that was the real crunch time.

"The enrollment felt pretty good," he says. "The first three weeks of the actual benefit did not feel so good, especially the first week and a half. Every glitch was a problem that got reported in the local papers. That's how it felt to us."

What does seem similar, between the Part D launch and the health law's, is the quick rush to jump to conclusions about success or failure.

"There was also a rush to conclude something is good or bad really fast," Karr says. "That's not different than it was in 2005. Generally, the political system is not patient."

The data suggests that perhaps it should be: Medicare Part D, which is now wildly popular with seniors, had horrible approval ratings when it launched.


These days, about 90 percent of seniors say they are satisfied with their Part D coverage.

"The coverage that people ultimately get is the kind of coverage that they're looking for," Hoadley said of the Part D program. "They don't remember the glitches in the first weeks of getting coverage. It's the coverage that sticks with people."

 KLIFF NOTES: Top health policy reads from around the Web.

The feds are trying to figure out how to fix HealthCare.Gov. "Government officials are considering rebuilding some parts of the federally run health-insurance marketplace that have been identified as the key flaws that blocked many consumers from getting coverage. Much of the problem stems from a design element that requires users of the federal site, which serves 36 states, to create accounts before shopping for insurance, according to policy and technology experts. The site, healthcare.gov, was initially going to include an option to browse before registering, but that tool was delayed, people familiar with the situation said." Christopher Weaver and Louise Radnofsky in The Wall Street Journal

In Mississippi, trying (and trying, and trying) to enroll. "Robbie Gowdy, a 25-year-old uninsured bartender in Jackson, says he wants to enroll but when he attempted to use the site he found repeated errors, redundant requests for information, and long waits. He tried to use the website, but after an hour, he called it quits. 'Usually when you have to jump through this many hoops you are at least going to have cable at the end,' Gowdy said. But he also plans to keep on trying." Jeffrey Hess in Kaiser Health News.

Hawaii's marketplace still hasn't started selling health insurance. 

"Hawaii’s health insurance marketplace is hoping to turn around a stalled start by providing plans and pricing to consumers by Oct. 15 — but there are no guarantees, its executive director said Wednesday. Coral Andrews, executive director of Hawaii Health Connector, told state lawmakers Wednesday that getting the marketplace running properly has been a fluid situation, with circumstances changing every day." The Associated Press.

SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Comments
SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Show Comments
October 11, 2013

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

If you think the launch of HealthCare.Gov isn't going so well, consider this: When online shopping for prescription drug programs launched back in 2005, things went so badly that the federal government didn't even get off the ground until three weeks after its scheduled launch.

The first obstacle was one of scheduling: Officials had initially scheduled the launch shopping component of the Web site on the Jewish holiday Yom Kippur.

PartD October14

The Centers for Medicare and Medicaid Services decided to delay the launch, per then spokesman Gary Karr, as to "respect all partners out there and their religious beliefs,"

But even after that, the site where seniors were supposed to compare drug prescription insurance plans didn't launch until November.

partd

"The Medicare folks have had some trouble getting the tool up and running," then-Washington Post reporter Chris Lee wrote on Nov. 8, 2005. "The original debut date was Oct. 13, but officials delayed it, citing the Jewish holiday Yom Kippur. Next it was promised on Oct. 17, but that day, too, came and went without personalized plan comparisons being available."

A news briefing promised the site would be up and in the afternoon. It didn't happen. "Visitors to the site could not access it for most of the first two hours,: Lee reported. "When it finally did come up around 5 p.m., it operated awfully slowly."

"Certainly I remember, thinking back to 2005, that the launch of the Web site was challenging," says Jack Hoadley, a researcher at Georgetown University who has studied the Part D program since before its launch. "It was pretty regularly a source of frustration just like what we're experiencing now."

What Hoadley says surprised him though, reading back through old news clips over the past few days, is just how challenged the program's digital launch was. "I look back and remember it was rocky," he says, "But I don't think I remember the degree of the rockiness that was the case."

There were other challenges too. As Hoadley and his colleagues wrote in a recent paper on Part D's launch, when seniors called the 1-800 Medicare phone number for help, a review found the agency "only responded to calls accurately and completely only about two-thirds of the time."

Lee reported that an annual booklet sent out to seniors called "Medicare & You" contained "inaccurate details about some of the prescription plan choices." CMS later had to post a chart on the Web site with the accurate information.

The delays of the Medicare.Gov Web site weren't as big news as the glitches with HealthCare.Gov. Both of the stories above ran on page A17 of the news section, unlike the HealthCare.Gov stories that have regularly been landing on the front page.

Gary Karr, who served as a spokesman for Medicare during the rollout, doesn't remember the initial enrollment period being especially difficult. It was right after people signed up that was the real crunch time.

"The enrollment felt pretty good," he says. "The first three weeks of the actual benefit did not feel so good, especially the first week and a half. Every glitch was a problem that got reported in the local papers. That's how it felt to us."

What does seem similar, between the Part D launch and the health law's, is the quick rush to jump to conclusions about success or failure.

"There was also a rush to conclude something is good or bad really fast," Karr says. "That's not different than it was in 2005. Generally, the political system is not patient."

The data suggests that perhaps it should be: Medicare Part D, which is now wildly popular with seniors, had horrible approval ratings when it launched.


These days, about 90 percent of seniors say they are satisfied with their Part D coverage.

"The coverage that people ultimately get is the kind of coverage that they're looking for," Hoadley said of the Part D program. "They don't remember the glitches in the first weeks of getting coverage. It's the coverage that sticks with people."

 KLIFF NOTES: Top health policy reads from around the Web.

The feds are trying to figure out how to fix HealthCare.Gov. "Government officials are considering rebuilding some parts of the federally run health-insurance marketplace that have been identified as the key flaws that blocked many consumers from getting coverage. Much of the problem stems from a design element that requires users of the federal site, which serves 36 states, to create accounts before shopping for insurance, according to policy and technology experts. The site, healthcare.gov, was initially going to include an option to browse before registering, but that tool was delayed, people familiar with the situation said." Christopher Weaver and Louise Radnofsky in The Wall Street Journal

In Mississippi, trying (and trying, and trying) to enroll. "Robbie Gowdy, a 25-year-old uninsured bartender in Jackson, says he wants to enroll but when he attempted to use the site he found repeated errors, redundant requests for information, and long waits. He tried to use the website, but after an hour, he called it quits. 'Usually when you have to jump through this many hoops you are at least going to have cable at the end,' Gowdy said. But he also plans to keep on trying." Jeffrey Hess in Kaiser Health News.

Hawaii's marketplace still hasn't started selling health insurance. 

"Hawaii’s health insurance marketplace is hoping to turn around a stalled start by providing plans and pricing to consumers by Oct. 15 — but there are no guarantees, its executive director said Wednesday. Coral Andrews, executive director of Hawaii Health Connector, told state lawmakers Wednesday that getting the marketplace running properly has been a fluid situation, with circumstances changing every day." The Associated Press.

SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Comments
SECTION: {section=business, subsection=null}!!!
INITIAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!!

UGC FROM ARTICLE: !!!

FINAL commentConfig: {includereply=true, canvas_permalink_id=washpost.com/8bvh5zpd9k, allow_comments=true, commentmaxlength=2000, includeshare=true, display_comments=true, canvas_permalink_app_instance=m6yzjj840m, display_more=true, moderationrequired=false, includefeaturenotification=true, defaultsort=reverseChronological, canvas_allcomments_id=washpost.com/km4ey0dajm, comments_period=14, includevoteofftopic=false, allow_videos=false, includesorts=true, markerdisplay=post_commenter:Post Commenter|staff:Post Writer|top_commenter:Post Forum|top_local:Washingtologist|top_sports:SuperFan|fact_checker:Fact Checker|post_recommended:Post Recommended|world_watcher:World Watcher|cultuer_connoisseur:Culture Connoisseur|weather_watcher:Capital Weather Watcher|post_contributor:Post Contributor, childrenitemsperpage=3, includeheader=true, includeverifiedcommenters=true, defaulttab=all, includerecommend=true, includereport=true, maxitemstop=2, source=washpost.com, allow_photos=false, maxitems=7, display_ugc_photos=false, includepause=true, canvas_allcomments_app_instance=6634zxcgfd, includepermalink=false}!!
Show Comments
Next Story
Neil Irwin | October 11, 2013