HealthCare.gov tech team scrambling to create workaround for site before deadline


Online enrollment under the Small Business Health Options Program (SHOP), which already had been delayed from its Oct. 1 start date, will now be postponed until November 2014. (Jon Elswick/Associated Press)

Days before the Obama administration’s self-imposed Nov. 30 deadline for fixing HealthCare.gov, its technology team is scrambling to build a new part of the Web site as a workaround that would enable more people to buy health insurance without relying directly on the site.

The new mechanism, EZ App, 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 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.

The workaround, aimed at diverting consumers from the Web site, is the latest indication that significant uncertainty remains about how the government will handle the large number of people who are likely to want to sign up for health plans soon.

Meanwhile, the Obama administration announced Wednesday that it will delay a significant piece of the health-care law: the online small business insurance marketplace.

The federal health-care exchange is falling short of expectations

The Small Business Health Options Program, known as the SHOP exchange, will not offer online enrollment until November 2014, a one-year delay from a launch that was initially planned for last month.

Small businesses will still have the option to purchase SHOP plans through a broker or agent, who will help the employer file a paper application. The federal government expects to process those filings for eligibility within three to five days, according to a document circulated to business groups.

Administration officials described the decision as necessary while they made fixes to the individual health exchange, which the White House has promised will “work smoothly for the vast majority of users” by Saturday.

But the administration will not be able to meet another internal target by then, said a person involved in the project who spoke on the condition of anonymity because of the matter’s sensitive nature. The goal was for tens of thousands of users to be able to register for an account and then log in on an hourly basis.

In a conference call with reporters Wednesday, Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services, said that between now and Saturday, technical workers will be trying to fix the site’s hardware so that 50,000 people can use it simultaneously, as the White House has promised.

“We are still on track to make sure by the end of the month the vast majority of users will be able to go through the site smoothly,” she said, cautioning that more changes will be needed to ensure that the system is able to accommodate 50,000 users at once. “We have a lot of work left to do in the next few days, both some software fixes and some hardware upgrades.”

Even as the administration prepared for a new wave of customers to log onto the Web site next week, it cautioned its allies and reporters that there could be hiccups.

An administration official, who spoke on the condition of anonymity to discuss the matter freely, wrote in an e-mail Wednesday that on Monday, the White House asked allies — including Enroll America, the Service Employees International Union and Planned Parenthood — not to encourage large numbers of people to use HealthCare.gov in the first week of December so the administration can see how many people are visiting on their own.

Bataille told reporters that the administration plans to install a new function “in the next few days” to address times when demand exceeds the site’s capacity, such as the peak time of 2 p.m. Under this system, visitors will receive an e-mail telling them when to return to the site.

“We aren’t sure what traffic will be on Dec 1, 2 — but think high volume is quite possible and don’t want users to be frustrated by more waits,” the administration official wrote, adding that consumers will have an easier time accessing the site during mornings, evenings and weekends.

Meanwhile, at a CMS command center in Columbia, Md., and at IT contractors’ offices in Northern Virginia, work to improve the site is sometimes producing results. In one hopeful sign, the number of consumers who were able to enroll in a health plan reached a record Tuesday of about 10,000, said an official familiar with the project, who spoke on the condition of anonymity about information that is not public.

The official said that IT workers have been striving to reach a different capacity goal that won’t to be attained before the deadline. This private, second goal, focusing on the early stages of using the Web site, calls for 80,000 people per hour to be able to create an account, and for 320,000 per hour to be able to log in. Technical workers attempted to upgrade the site to meet this goal, but the fix did not work, and the next attempt is scheduled for late this weekend at the earliest, administration officials said.

EZ App aims to address a key problem that has hindered the ability of call centers, health-care companies and insurance brokers to enroll consumers.

Their role is important because administration officials have made clear that the Web site alone is not going to be able to handle all the people who are likely to want insurance before the new year, when the 2010 federal health-care law requires most Americans to have coverage or risk a fine.

The idea behind the subsidy tool is to bypass the technical problems that make it difficult for the call centers and industry representatives to find out the size of the federal subsidy that, in most instances, will help people pay for their health plans.

Work on EZ App began about three weeks ago.When it is built, it will contain 35 “scenarios,” each of which will consider consumers’ income, age and the number of people in their family. For each scenario, the system will have defined an estimated subsidy, and whoever is helping a given consumer enroll will choose the one that most closely matches the person’s circumstances, said the official familiar with the project.

Insurance industry leaders are worried that customers may owe more than the estimate and don’t want to have to collect more money from them.

“The health plans want to make sure whatever estimate of subsidy is used, they want to make sure it’s final,” said an insurance industry official, who spoke on background to discuss private conversations that industry representatives have had with administration officials. If health plans were at risk of losing money, the official said, they “wouldn’t go along with it.”

An administration official who spoke on the condition of anonymity to discuss ongoing operations did not confirm the existence of the subsidy tool. This official said that this weekend, the government will begin deploying two new features of the system. In the part of the site where consumers can browse plans but not buy them, they will see 35 scenarios giving them a better sense of the plans’ prices. And some call centers will use a tool that will make it easier for consumers to enroll by asking them a few screening questions.

Sarah Kliff contributed to this report.

Amy Goldstein is a national reporter for The Washington Post, focus on health-care policy.
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