IT and ACA

~ Laura

The Affordable Care Act has IT problems. Megan thinks that the IT problems will spell the doom of ACA. I doubt it, but the problems are still there.

I logged into Healthcare.gov five minutes ago. I tried twelve times last week and couldn’t get through. This time, it worked. But I hit a problem when it asked for the answers to security questions. It said that I gave the same answer to the three security questions (I didn’t.), so it booted me out and told me to start all over again. I tried three times and couldn’t make it happen.

Years ago, I worked on an implementation study of a reform of a New York City department. IT was a big issue, because the city couldn’t afford competent programmers. A competent programmer would cost more than the department executives. I assume we’ve got the same problem here.

Will it doom ACA? Probably not. Is it a major pain in the ass? Yes.

Published by Laura

34 thoughts on “IT and ACA”

  1. The intersection of IT and government is pretty scary, for people who know how these projects should function. In Chicago the sign-up process for park district programs is absolutely frightening due to IT issues. And the recent conversion to a new public transit card has been bungled big time.

    The cynical amongst us would argue that until the city stops giving IT contracts to aldermen’s nephews, things won’t improve. But I’m not sure it’s corruption as much as it is ignorance. Let’s face it, even great companies are sometimes unable to properly supervise technical staff/contractors. It takes a very specific skill set. Also – the government’s NSA wiretapping habits aren’t exactly helping when it comes to hiring good coders.

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  2. Forgot to add – IT issues don’t necessarily doom ACA, but they may lead it further down the path of privatization. That’s where these things go when the public sector proves incompetent.

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  3. I’m sure it is frustrating to deal with if you want to sign up, but I have to admit I’m mostly amused that the ACA’s IT launch can be this bad and attract this little news because the attempt to stop the ACA was so ham-fisted and counterproductive that it drove everything else from the news for weeks.

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  4. Very few government entities have the funding to hire the kind of professional who have the experience to oversee such a complex IT project. Underfunded (and perhaps not very technically sophisticated) government is at the mercy of the huge IT contractors that snow them, always has been, and will be for the foreseeable future. This is the most visible government/IT disaster but, oh my god, this is so business-as-usual in my world.

    I don’t think any level of messed up website is going to make people change their minds about insurance companies covering people with pre-existing conditions. Or covering children under the age of 26. Or the easier shopping experience (you can comparison shop most exchanges without logging in – and if you like a product from Blue Cross, nothing stops you from buying the same product at the same price directly from BCBS). I do feel bad for people who need the subsidies that require them to deal with the website.

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  5. So I’ve just been in the midst of several IT rollouts as a consumer (Smugmug, the photo site where I host my photos), the new iPhone software, and some other things I”m spacing on right now).

    My conclusion is that there is a frightening tolerance for releasing incomplete software (the Smugmug rollout was distinctly terrible, with people discovering significant bugs consistently and a significant loss of services). Combined with the difficulty people have with interacting with online software with which they are not already familiar (which includes changes) I haven’t seen a rollout that wasn’t accompanied by chaos for anyone who needed to use the system. I was really frustrated to hear the head of our exchange effort (we do not use the federal system) be casually dismissive of the failures of the rollout of the exchange, as business as usual (and, in my opinion, not for government, but for the tech industry).

    The brick & stones rollout appears to have been much smoother in our state (with community health care sing up events held at communty centers).

    I personally blame the tech industry and the attitude of close is good enough and we’ll let the customers figure out the bugs.

    I know some of you are involved in the industry and would love to hear examples of good major rollouts and how they were accomplished: I’ll admit that when Citibank changed their online site, I did not experience the degree of frustration I experienced with Smugmug. I was frustrated, and the fonts are still to small, and I had to learn how to do everything differently, but I was still able to pay my bills.

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  6. Here is a tweet from my IT son: “Failures of the US Healthcare Exchange are not ‘glitches’. They are failures of engineering and eng. management. I weep for my profession.”

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  7. What athletes call “practice,” what musicians and actors call “rehearsal,” the software industry calls “beta.” That does not mean that it is any closer to finished, however, but the industry thinks the term gives it a license to make an unfinished product available to the general public.

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  8. “The law’s supporters are engaged in some high-speed blamestorming: It’s the Republicans’ fault for not giving the law more money, or it’s the fault of Republican governors who didn’t build their exchanges, or maybe it’s one of the vendors — CGI, the firm with the largest contract, is the most favored target, but at various times, the administration has clearly been teeing up to blame Experian or Oracle. Or perhaps the fault lies in federal procurement rules, which prevented the government from getting the right kind of staff and service. A lot of that shows up in the article; there’s a long prelude about the political barriers that the administration faced. But ultimately, the litany of mistakes that the administration made overwhelms these complaints.”

    I think the Dems were damn fools not to take the 1-year delay the Reeps offered them. They have also, as Em Aitch points out, been exceedingly lucky that the Reeps have given them so much cover in the fog covering the shutdown. Quite a lot of blame should go to Pelosi (“You have to pass it to find out what’s in it”) and to Obama himself, who seemed to think that some kind of magic salve would make things better over time after passage and has watched it basically consume his Presidency. ACA may well fail, at very high cost. If the Dems are trying to salvage it, at the very least Sebelius should fall on her sword, to deflect attention from the others.

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    1. Listen Davey, if you could stop with the Em Aitch, I’d really appreciate it. It implies a degree of mutual chumminess that I really don’t feel.

      And the “You’ve got to pass to find out what is in it” is getting really old. It was passed, people had plenty of time to study it, and then we had a presidential election in which anybody who wanted to repeal the ACA knew that voting against Obama was the only reliable way to stop it.

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  9. The comment about practice and rehearsal is probably supposed to refer to (lack of) testing. To be clear, there’s a huge difference between Google labeling everything “beta” so they can speed up their release cycle and the healthcare.gov site crashing because it’s not sized properly. One is a purposeful decision that values speed to market over absence of bugs (AKA greed). The other is almost always the result of early architectural shortcuts whose impacts weren’t fully understood (AKA incompetence).

    BJ, I would offer up the purchase of Ofoto/Kodak by Shutterfly – handled very well, including the transition of terabytes of images. Or how about the experience of filing one’s taxes with a site such as the former TaxEngine (now owned by H&R Block)? This company applied modern usability principles to tax filing and emerged with a system that’s actually easy to use.

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  10. Hmh. I ignored the Ofoto/Kodak Shutterfly transition, and let my Kodak pictures die. So I can’t judge that one personally.

    I suspect that there was a lot of behind the scenes work that worked properly at Smugmug, too. But, there were major failures as well (including people who logged on to their sites thinking all their pictures had disappeared). Smugmug didn’t think that was a big deal, because the pictures hadn’t actually disappeared and they fixed access within a week or so. It was still a failure, though (and, I suspect an architecture failure, in this case, rather than a volume failure).

    What I see as a user is a culture that doesn’t test their product thoroughly and I do believe that was the issue with our state site — I think they released it, using early users as beta testers (not for greed, but valuing time to market over thoroughness), and counted on their early testers to identify the bugs, and then they took the site down to fix the issues.

    i think the issues at healthcare.gov were different (and I think the WA site head said so — but he said so in the form of saying, yes, we had bugs, yes we’ll fix them, like smugmug). Looks like the fed site might have some more structural issues.

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  11. I’ve been working thru the ACA application today, as we are losing our health insurance at the end of the month. We have other alternatives, but I just want to find out what our premiums would be through ACA. It worked remarkably smoothly for most of the app… until the page where it says I need to review my application details by clicking on a link… and when I do so, I get an error message. In the midst of a really stressful time, it is freaking infuriating and stressful to deal w/ the wonky site.

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    1. And to add insult to injury — neither the live chat nor the very friendly phone rep could help in the least. Gah.

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  12. MM quotes this passage, which as she says, is amazing:

    “Deadline after deadline was missed. The biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring, according to people familiar with the process. As late as the last week of September, officials were still changing features of the Web site, HealthCare.gov, and debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.”

    Wow.

    Interestingly, CGI, the IT contractor, was fired from a Canadian gig last year:

    “CGI Federal’s parent company, Montreal-based CGI Group, was officially terminated in September 2012 by an Ontario government health agency after the firm missed three years of deadlines and failed to deliver the province’s flagship online medical registry. The online registry was supposed to be up and running by June 2011.”

    “CGI Federal also is the prime contractor for state health exchange websites in Colorado, Vermont, Hawaii and Massachusetts. Three of those states also reported significant website glitches. In Hawaii, health exchange officials formally apologized for the inconvenience in delays and said they did not know when the site would be available. Only Massachusetts, which has had a state health program in operation for seven years, reported no website problems.”

    http://washingtonexaminer.com/canadian-officials-fired-it-firm-behind-troubled-obamacare-website/article/2537101

    Even more interestingly, CGI apparently won the ACA contract on a no-bid basis.

    “Federal officials considered only one firm to design the Obamacare health insurance exchange website that has performed abysmally since its Oct. 1 debut.”

    http://washingtonexaminer.com/feds-reviewed-only-one-bid-for-obamacare-website-design/article/2537194

    I can’t find a cite right now, but as I recall, the administration was initially trying to keep the identity of their IT contractor a secret.

    I think the fact that such a major IT project got handed to a Canadian contractor is a scandal in and of itself. I realize that CGI might have looked good on paper, but the scale of a US project vs. a Canadian project is so very different that it was very unwise to go with the Canadians.

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  13. I am not familiar with this particular software house, but it’s extremely unlikely that a project of this scale could succeed if its requirements were still insignificant flux this late – even if they’re using an agile methodology.

    Just a reminder to the world that 68% of software projects fail. Mostly because of bad requirements. This stuff is hard to do, it really is.

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  14. We’ve had a form of government healthcare, military tricare, for many years. I assumed from the get-go that Obamacare, since it was managed by the government, was likely to be significantly more messed up than Tricare, which is usually pretty messed up. Tricare’s website NEVER works, you always have to call, you always get put on hold, and for even the most routine issues you can easily spend 2-3 hours on the phone. Things that I have found myself repeating to upwards of ten different people to whom I have been transferred included:
    1. the circumstances of my son’s medevac to a different hospital after an incredibly traumatic birth experience. I still can’t tell the story without crying. I got to tell the story in a tearful postpartum state while it was still fresh in my mind TEN TIMES on the phone to TEN DIFFERENT PEOPLE.
    2. I think we need some marriage therapy because of war-related PTSD issues. I got to tell THAT story TEN TIMES on the phone to TEN DIFFERENT people. THat was fun . .
    3. Various Aspie kid issues, often involving medication.
    4. Issues involving birth control

    The reason I mention this is that many of us now work in open office spaces in cubicles. Try to imagine having to repeat this stuff ten times in an open public space while your coworkers glare at you and wonder why you are not working. Yes, I am sure that there are people who do not pursue anything beyond emergency care for exactly that reason.

    We also had a situation where we lived abroad but we had a military PO box that included an address near Dulles airport as part of the maildrop system. Tricare insisted on assigning us to a provider in Northern Virginia — ALTHOUGH WE LIVED IN EASTERN EUROPE — and it took many, many, many phone calls to sort this out. Some pretty serious incompetence there.

    IT is difficult to get the necessary referrals to the necessary specialists, and when you do get a referral you are given few options regarding where it will be and when. I am lucky in that my job is flexible and I have my own car. I have often wondered how people who are dependent on public transportation and who must work fixed hours even get to these appointments — assuming that they are able to get permission to have them in the first place!

    I guess that big, poorly managed government insurance is a step up from no insurance, but I am also sure that the same nameless, faceless bureaucrats who treat poor women on welfare badly when they apply for other services will likely treat them equally as badly when they attempt to procure health care for their families. (I filed a complaint against a doctor who kept referring to me as “Mommy” and addressing me like I was a little slow when I questioned the standard of care we were receiving — I can just imagine what this guy will do to women who are minorities, speak a second language, etc.)

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  15. Louisa said:

    “1. the circumstances of my son’s medevac to a different hospital after an incredibly traumatic birth experience. I still can’t tell the story without crying. I got to tell the story in a tearful postpartum state while it was still fresh in my mind TEN TIMES on the phone to TEN DIFFERENT PEOPLE.
    2. I think we need some marriage therapy because of war-related PTSD issues. I got to tell THAT story TEN TIMES on the phone to TEN DIFFERENT people. THat was fun .”

    “The reason I mention this is that many of us now work in open office spaces in cubicles. Try to imagine having to repeat this stuff ten times in an open public space while your coworkers glare at you and wonder why you are not working. Yes, I am sure that there are people who do not pursue anything beyond emergency care for exactly that reason.”

    That sounds terrible.

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  16. You can buy the insurance coverage from the group we buy insurance from using the exchange on our site and it costs a bit less than what we pay now. For a family of 4, making 40K, the same insurance costs $1700/year. We are generally very pleased with our health insurance, through pregnancies, a couple of surgeries, and routine care (medevac, aspie issues, PTSD therapy not tested, and I can imagine all of those things would be more complicated than our issues).

    Will be interesting to see if our experience changes as more people join the rolls. I think our plan just hopes it will mean more “customers” Though the plan is a co-op and has an interesting history; so no profit motives for shareholders.

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    1. Does the Fed site require you to get an account? our state site doesn’t (though I think that what I got is only an estimate, and I don’t know how it would out for an actual application).

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    1. That so many people think things like that is why I expect that the Republican primary season will brutal to the extent that it might impact some seats.

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      1. Mmmm, pass the popcorn.

        I remember the last campaign of Connie Morella. People kept saying, “We like you, and you’re a good fit with the district, but the very first vote you make will put Tom DeLay into power, and *that* is not a good fit with our district.”

        There are some signs that something similar is happening at the state level in Virginia in the districts that Obama won but have Republican representatives. The election is soon; we’ll get to see if the shutdown, and teapartiness in general, plays a role, especially in Northern Virginia.

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      2. In Rhode Island, people voted out Linc Chaffee simply because he was a Republican. They liked him a lot but … Republican. Then they voted him as an independent governor, but then they didn’t like him after that so he’s not running again.

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  21. I remember Connie Morella, and yes, her position became unsustainable as people started voting on the outcome of the House Speaker election and not on a well-liked congressperson in the district.

    I think the modelling of votes to produce “safe” districts works against a house turnover because of that thinking/voting out Connie Morellas, but there are 17 districts where Obama won, but held by a Republican (yes, only 17). There’s Rigell & Reichert in VA & WA, who I think are kind of Morella (except that they’re not, really, since they are less centrist in their votes and politics). Many of the others are Republicans in districts with growing immigrant populations, I think (in northern CA, FL, etc.). Actually, one might explain the VA & WA districts that way, too, economically centrist immigrants, who don’t have a strong ideology on the size of government but want a good climate for business (which they do see as being lower taxes, less regulation, . . . ). But, I’m pretty sure that they don’t’ see it as shutting down government and that they have no ideological opposition to national health care. I just don’t see how those groups are going to support a speaker who shuts down DC.

    There’s some interesting analysis at the Princeton Election Consortium:

    http://election.princeton.edu/

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  23. Amy P, I would blame the government, not CGI. Supervision of software projects is a complex task. These are problems which are not solved by throwing money at them–although the fix will be expensive, if it’s even possible. Remember the UK health service computer system? That cost £12 billion, was abandoned, and nearly bankrupted the country.

    This wasn’t a release of a “beta version.” If it had never been fully tested in-house, it wasn’t even beta.

    From Politico, on the “tech surge:”

    Sen. John McCain on CNN Sunday said the whole Obamacare rollout has been “a fiasco.”
    “Send Air Force One out to Silicon Valley, load it up with some smart people, bring them back to Washington and fix this problem. It’s ridiculous. And everybody knows that,” he said on CNN’s “State of the Union.”
    (http://www.politico.com/story/2013/10/obamacare-website-fixes-hhs-98569.html#ixzz2iMoqy8KR)

    Such naivete. So far, we’ve seen politicians blaming tech companies for the debacle. Any programmer smart enough to fix the problem will be smart enough to avoid the project altogether. It’s Dilbert on steroids.

    For what it’s worth, my husband, who is a software guy but doesn’t work on projects of this nature, guessed last week that the whole thing probably has to be re-architected. Even then, he said the different legal requirements for confidentiality would make it a nightmare. (That was before we read it had been supervised by HHS & Medicare.) He burst out laughing when he read McCain’s comment.

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  25. “[E]xamples of good major rollouts. . . .”

    Amazon. Everything Amazon does is fabulous. Their site always works. When they make changes, the changes work right away. I pretty much shop only there, because the difficulty and frustration of other websites isn’t worth whatever modest savings there would be from shopping around.

    Admittedly, you can’t do interlibrary loan requests, or access jstor, through Amazon, but those are about the only things where I go to another website.

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    1. Amazon is REALLY good and has always been REALLY good, from the moment they opened up. Netflix’s streaming service seems to work really well too, although I wish they had more stuff available.

      Another beautiful interface I was looking at recently is the Kelly Blue Book one for locating a car in your area, which is probably very similar in complexity to health insurance selection. You start with the distance you are willing to drive and then go through a series of different selection criteria, winding up with a list of cars in order of expensiveness. It was such a beautiful, clean, effortless experience compared to my past experiences of looking at cars on Craigslist that I made my husband have a look at it.

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  27. The line I read is: “Putting nine women on the job doesn’t mean you can produce a baby in one month.”

    I confess, I know very little about IT projects. The legal work involved in large complicated transactions, about which I know quite a lot, is very modular, so adding more bodies does produce results more quickly, although the cost mounts at faster than a linear rate. But the suggestion is that IT work isn’t like that.

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