Health and Human Services Secretary Kathleen Sebelius visits navigators helping enroll people on HealthCare.gov.
Besides movie theaters and Wal-Mart, one place that will stay open this Thanksgiving is the new HealthCare.gov "exchange operations center." Staffers on the "tech surge" to fix the error-riddled site have just days to meet the Obama administration's self-imposed deadline for a functioning site.
The pledge came from the president, the vice president, the Health and Human Services secretary, and the numerous spokespeople that represent them, like White House spokesman Jay Carney. "By November 30th, HealthCare.gov will be working smoothly for the vast majority of users," Carney has said, time and time again.
But the definition of working smoothly varies, and the metrics are far from transparent. So judging whether the administration meets his deadline will depend on the experiences of people who share their stories, and the administration's own selectively released numbers.
In the non-descript building at the headquarters of lead contractor QSSI in Maryland, about 30 to 40 members of the post-rollout "tech surge" will be working through the Thanksgiving holiday. After the site failed to work in October — engineers, database architects and contractors from different companies were pulled together to work in one room.
"Imagine a room full of desks, that look like ... those curved desks [at] a NASA control center," says John Engates, chief technology officer for the server and software company Rackspace. He was one of half-dozen technologists invited by the White House to go inside the command center this week, get a briefing on how the tech surge is operating and talk out ways to improve government IT in the future.
"On the walls you have these giant flat-panel monitors [showing] metrics of how the site's doing. Uptime metrics, performance metrics, graphs that show how different aspects of the website are performing in real time," Engates says.
For the month of October, only about 27,000 enrollments — one-fourth of the total nationwide enrollments in the health exchanges — happened in the 36 states reliant on HealthCare.gov.
The administration isn't scheduled to release another batch of insurance enrollment numbers until mid-December. But the site metrics the administration is sharing show the tech system is getting stronger.
On Oct. 1, when the exchange opened, it took more than 8 seconds to load a Web page on the site. That's now down to a fraction of a second. Overall system errors have dropped. And the site can now handle 50,000 users at once — which was the original objective. Two weeks ago, improvements to the software got concurrent users to half that level, so with time has come progress.
"The definition of working well is relative to how badly it was working earlier on," says Himanshu Sareen. He is CEO of Icreon Tech, which develops enterprise software. "It is working better, for sure. But it's relative, right, because we started out with a system that just did not work at all."
By one important metric — public confidence in HealthCare.gov — has already taken the kind of hit that may be hard to overcome.
Private insurance companies are capitalizing on HealthCare.gov's troubles as a way to sell their own out-of-exchange policies.
"Things don't always work like they're supposed to," begins a commercial for the health insurer Wellmark Blue Cross and Blue Shield. "Good thing the government exchange isn't the only place to buy health insurance," says the voice-over.
Increases in enrollment at state-run exchanges suggest it's possible for the federal exchange to make up ground, but only if it has a functional site. Engates — who visited the control center — says he's more hopeful now that he's seen it from the inside.
"You sort of assume the worst and until you know anything better, that's kind of your impression, but I do have a lot better sense that things are on the right track now," he says.
The administration has said again and again that its late November deadline is not a "magic date." HealthCare.gov will remain a work in progress.
"The system will not work perfectly on Dec. 1, but it will operate much better than it did in October," said Julie Bataille, the communications director at the Centers for Medicare and Medicaid Services.
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Transcript
LINDA WERTHEIMER, HOST:
It's MORNING EDITION, from NPR News. Good morning. I'm Linda Wertheimer.
DAVID GREENE, HOST:
And I'm David Greene.
We are almost at the end of November. And that is when the Obama administration faces a self-imposed deadline.
JAY CARNEY: By November 30th, HealthCare.gov will be working smoothly for the vast majority of users.
GREENE: That's White House press secretary Jay Carney, talking about efforts to fix the error-riddled online health insurance exchanges being run by the federal government.
This week, the administration announced small businesses will have to wait another year before they're able to use HealthCare.gov to find plans for their employees. But for individuals looking to buy a plan, the question looms: Is the website fixed?
Here's NPR's Elise Hu.
ELISE HU, BYLINE: In a nondescript building in Columbia, Maryland, you'll find the new operations center for HealthCare.gov. After the site failed to work in October, engineers, database architects and contractors from different companies got pulled together to work in one room.
JOHN ENGATES: Imagine a room full of desks that look like, you know, the consoles in a control center, like a NASA control center.
HU: John Engates didn't engineer HealthCare.gov, but as chief technology officer for the server and software company Rackspace, he was one of half a dozen outside technologists invited by the White House to go inside the command center this week.
ENGATES: On the walls, you have these giant, you know, flat-panel monitors that have metrics about how the site's doing. You know, uptime metrics, performance metrics, graphs that show, you know, how different aspects of the website are performing in real time.
HU: The administration isn't releasing another batch of insurance enrollment numbers until mid-December. But the site metrics show the HealthCare.gov tech system is getting stronger. On day one, page loads topped eight seconds. That's now down to a fraction of a second. Overall, system errors have dropped. And the site is now on track to handle 50,000 users at once. That's the original objective for opening day.
HIMANSHU SAREEN: So the definition of working well is relative to how badly it was working earlier on.
HU: Himanshu Sareen is CEO of Icreon Tech, which develops enterprise software.
SAREEN: It is working better, for sure. But I think it's relative, right, because we started out with a system that just did not work at all.
HU: By one key metric, public confidence, HealthCare.gov's already taken the kind of hits that will be hard to rehabilitate.
(SOUNDBITE OF ADVERTISEMENT)
UNIDENTIFIED WOMAN: Things don't always work like they're supposed to.
HU: Private insurance companies are capitalizing on HealthCare.gov's troubles as a way to sell their own out-of-exchange policies.
(SOUNDBITE OF ADVERTISEMENT)
UNIDENTIFIED WOMAN: Good thing the government exchange isn't the only place to buy health insurance.
HU: Engates, who visited the control center, says he's more hopeful now that he's seen it from the inside.
ENGATES: You sort of assume the worst, and until you know anything better, that's kind of your impression. But I do have a lot better sense that things are on the right track now.
HU: But just because the consumer experience is smoother on the front-end doesn't mean the whole system is running as intended.
ROBERT ZIRKELBACH: The back-end challenges are still not resolved.
HU: Robert Zirkelbach is spokesman for America's Health Insurance Plans, the trade association for insurers. He says the invisible part of the system that sends enrollment data to insurance companies is still far from perfect.
ZIRKELBACH: Health plans are still receiving enrollments that have information that is inaccurate or missing. Some of the enrollments are duplicates, and other enrollments aren't even making it to the health plan.
HU: The administration has said again and again: We may be reaching this late November deadline, but it's not a quote, "magical date," as the Center for Medicare and Medicaid Services' Julie Bataille emphasized on Wednesday.
JULIE BATAILLE: There are things that are high priority fixes that remain on our punch list that we are actively working through over the next few days.
HU: Keeping the exchange operations center a busy place through the weekend.
Elise Hu, NPR News, Washington. Transcript provided by NPR, Copyright NPR.
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