Medicare chief Marilyn Tavenner testifies before the Senate Health, Education, Labor and Pensions Committee Tuesday. (J. Scott Applewhite/AP)

An administration official overseeing the federal online health insurance marketplace encouraged Americans to log on to the Web site despite its well-publicized technical problems and try to shop for coverage.

Testifying Tuesday on Capitol Hill, Marilyn Tavenner said her agency, the Centers for Medicare and Medicaid Services (CMS), plans to release information next week about who enrolled through the state and federal exchanges. She said the target for the end of November is 800,000 enrollments.

Tavenner described fixes that have been made to and repeated the administration’s promise that the site will be working smoothly for the majority of people by the end of the month.

“I would encourage folks who have not been on the Web site in the last few days to please go on the Web site,” Tavenner told members of a Senate panel. “It has improved.”

Sen. Barbara Mikulski (D-Md.), who supports President Obama’s health-care law, said trust in the program is dwindling.

“I believe that there’s been a crisis of confidence created in the dysfunctional nature of the Web site, the canceling of policies, and sticker shock from some people,” she said. “What I worry about is that there’s such a crisis of confidence, people won’t enroll.”

Other Democrats expressed confidence that once the Web site is fixed, the benefits of the law will become more apparent.

Republicans renewed their attacks on the Web site’s security, citing a recent report that a North Carolina man who recently logged on to received a letter about eligibility for subsidies — only the letter was addressed to another person. He received it in error.

Tavenner said the problem has been fixed.

Meanwhile, voluminous documents released Tuesday on Capitol Hill provided a fresh inside look at the scramble to remedy flaws just as the exchange was opening a month ago, making clear that some Department of Health and Human Services staff members and technical contractors were aware of wider problems than the White House acknowledged at the time.
Meeting notes from the morning of Oct. 1, the Web site’s launch date, show that HHS employees and the contractors were discussing flaws that included the system that verifies insurance-seekers’ identity, “glitches with eligibility questions,” and a problem with letting people know whether they qualify for Medicaid. The 175 pages of notes were from meetings in the “war room” of the CMS agency that oversees the exchange, the Center for Consumer Information and Insurance Oversight. The documents were handed over to the House Oversight and Government Reform Committee, which made them public.

The meeting notes, taken by the Logistics Management Institute, one of the contractors, from that first morning say that the Web site was erroneously denying 90 percent of the people who thought they were eligible for Medicaid and the federal Children’s Health Insurance Program — because the site couldn’t correctly handle information about where they lived, even though contractors had tried to fix the glitch.

At another meeting that day, participants discussed that some health plans were missing from the exchange, and they knew that daily reports to insurance companies, listing their new customers, would be problematic. Topics at an Oct. 2 meeting included the fact that a feature in which consumers should be able to sign up for coverage directly through insurers “is not working for any issuers.” And early on, insurers were complaining that they could not even reach a help desk.
The meeting notes reflect confusion at times over how to proceed. When a Utah health plan was inexplicably missing, the notes say, “We don’t know enough to know what to do, because we don't know if it is an across-the-board problem.” By the end of the first week, the meeting participants were worrying about how much to say about what was going wrong. “[S]tates might want to know how much to worry about the severity of the problem,” the notes say. “Could we have a communications strategy with the states about what the issues are instead? Sensitivity around errors discussion.”