HealthCare.gov goal is for 80% of users to be able to enroll for insurance

The law has more headaches than just HealthCare.gov. "In Play" asks some of The Washington Post's top political reporters to explain. (The Washington Post)

The Obama administration will consider the new federal insurance marketplace a success if 80 percent of users can buy health-care plans online, according to government and industry officials familiar with the project.

The goal for how many people should be able to make it through the insurance exchange is an internal target that administration officials have not made public. It acknowledges that as many as one in five Americans who try to use the Web site to buy insurance will be unable to do so.

The measure is the first concrete performance standard in the 31/2 years since the government began to design the health exchange, and was defined by a group of federal officials and technical experts in late October. It is now guiding the work of hundreds of government employees and contractors racing to try to repair the balky Web site by the administration’s Nov. 30 deadline.

Whether the government meets the benchmark — and whether the public regards it as adequate — will be a central factor in President Obama’s efforts to increase support for the controversial health-care law and lure customers to the federal insurance marketplace.

The goal is that 80 percent of people going to HealthCare.gov should manage to enroll electronically — but that means that many others, perhaps tens of thousands, will not succeed. It puts more pressure on the administration to fix technical problems that have made it difficult for people to sign up for coverage by other routes, including federally sponsored call centers and the insurers themselves.

President Obama explained how Americans who wish to keep their health plans can work to do so under his signature health-care law during a speech Friday. (The Washington Post)

Administration officials acknowledge that until recently, they had no concrete definition for how well HealthCare.gov should work, but they say one would not have made sense before the site went live Oct. 1.

“We are very focused on measuring performance of the site now and moving forward and making sure we have ways to demonstrate progress,” said Julie Bataille, communications director for the Center for Medicare and Medicaid Services, a branch of the Department of Health and Human Services with responsibility for the insurance exchange. “That is a focus of the team that is in place now.”

The internal 80 percent target is the basis of a promise that has become an administration mantra in recent weeks: HealthCare.gov will “work smoothly for the vast majority of users” by the end of November.

The catchphrase was coined by former presidential management official Jeffrey Zients shortly after the White House assigned him to oversee the Web site’s repairs, according to a government official with knowledge of the project who spoke anonymously about matters that are not public.

To assess progress toward the goal, administration officials have developed two new measurements, appearing in reports generated each morning, that show how long consumers must wait for pages to load on HealthCare.gov and how often they get error messages, government and industry officials said.

The “vast majority” phrase has been invoked repeatedly by Obama, Zients and other administration officials, with little explanation of what it means. In a news conference Thursday, while apologizing for the health-care law’s rollout problems, Obama said that the target was to ensure that by the end of the month that “the majority of people who use it will be able to see it operate the way it was supposed to.”

Zients, in a conference call with reporters the next day, elaborated on that by saying, “most users will be able to navigate the marketplace from account creation, through the application, all the way to enrollment.”

But Zients also said that “new bugs and other glitches will surface” in December and beyond that and will need to be fixed. Even if the site works well, he said, “that doesn’t mean that the site will be sufficient for 100 percent of users or consumers to use for enrollment.”

The Washington Post reported last week that the federal exchange is unlikely to be working fully by the end of the month. The uncertainty over the site’s future performance stems from the fact that it currently is malfunctioning when more than 20,000 to 30,000 people — about half the intended capacity — try to use it at the same time.

According to a government official familiar with the new target, the 20 percent who are unlikely to be able to enroll online are expected to fall into three groups: people whose family circumstances are so complicated that the Web site cannot determine their eligibility for subsidies to help pay for health plans; people uncomfortable buying insurance on a computer; and people who encounter technical problems on the Web site.

No benchmarks schedule

Until last month, no concrete performance measures had been developed for HealthCare.gov, the first-ever government computer system for consumers to buy private insurance, several officials confirmed.

“Many asked about benchmarks,” said a senior administration official who spoke on the condition of anonymity because of the topic’s sensitivity. But there was “no schedule of them.”

When HHS in 2011 invited contractors to bid on the chance to build HealthCare.gov, the department’s “statement of work” did not include requirements typical of many IT contracts in which interested companies must spell out how the system would perform, according to an industry representative close to the project, who was granted anonymity in order to speak frankly. The agreement that CGI Federal, the company chosen as the main contractor, signed on Sept. 30, 2011, also did not contain specific performance criteria, success measures or response times.

The meaning of success was defined for the first time during the panicky days of October, when White House officials belatedly recognized that the federal exchange had serious software and hardware defects.

At a meeting late in the month at CGI Federal’s offices in Herndon, White House presidential innovation fellows assigned to help repair the exchange presented estimates of how quickly people would need to get from one Web page to the next in order to reach the 80 percent goal, according to a government official familiar with the discussion. They calculated that the system would need an error rate of less than 1 percent and a typical wait time of no more than 500 milliseconds — half a second — no matter what part of the Web site visitors were on.

The metrics were written on a wall, according to an industry official familiar with the meeting. Officials from the Medicare and Medicaid center “later came into the room, heads nodded, and the CMS team rallied around the measures,” said the official, who spoke on condition of anonymity to describe a private meeting.

Site accuracy in question

The new performance measures address how easily consumers should be able to progress through the Web site. But there are still no concrete goals for the site’s accuracy, including whether users are correctly informed whether they are eligible for federal help in paying for health plans or whether insurance companies are given correct information about their new customers.

Bataille, the CMS communications director, said that focusing on improving the system’s performance “will make a difference for consumer experience and accuracy of transactions.”

Administration officials have talked publicly in recent days about one of the measures: a reduction in errors that freeze Web pages or otherwise hinder the ability to sign up for insurance. They have said the error rate has dropped from up to 6 percent a week ago to less than 1 percent now.

“That is something we need to continue to drive lower,” Bataille said. “We need to have lower error rates. We need to have a fast site.”

On the other measure — which assesses how quickly people can move through any part of HealthCare.gov — one official said that the Web site has performed close to the half-second on most days.

But the current load on the system is light because many people are staying away following the rollout problems. Even then, the official said, “swings from good performance to bad performance have been frequent.”

Scott Wilson contributed to this report.

Amy Goldstein is a national reporter for The Washington Post focused on health-care policy.
Juliet Eilperin is a White House correspondent for The Washington Post, covering domestic and foreign policy as well as the culture of 1600 Pennsylvania Avenue. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.
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