California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Obama Urges Patience With Exchange Glitches; Fixes Made

President Obama in an interview with the Associated Press on Saturday acknowledged glitches in the federally operated online exchanges, but urged consumers not to "give up" in their attempts to obtain coverage through the portal, the New York Times reports.

Obama said the high amount of traffic on the websites "shows that people really need and want affordable health care." In response to reported delays and problems with the sites, he said, "Folks are working around the clock and have been systematically reducing the wait times" (Calmes, New York Times, 10/5).

Obama said he was unsure of the total enrollment numbers so far, but he predicted that at the end of the open enrollment period in March 2014, the exchanges will "probably exceed what anybody expected in terms of the amount of interest that people had" (AP/Modern Healthcare, 10/5).

Treasury Secretary Jack Lew in an interview with "Fox News Sunday" said that the problems facing the exchange websites are normal. "It is not unique that when you have a very large, new software program come out that people work to clean it up," Lew said (Howell/Eldridge, Washington Times, 10/6).

Federal Exchange, State Medicaid Agencies Still Cannot Communicate

Meanwhile, officials said the federal exchange will not have the capability to communicate with state Medicaid agencies to determine consumers' eligibility until Nov. 1 at the earliest, Kaiser Health News' "Capsules" reports.

The federal exchanges' online portal originally was intended as a "one-stop shop," through which users could determine whether they were eligible for Medicaid or federal subsidies and purchase coverage. However, technical issues are preventing the sites from informing users whether they are eligible for Medicaid. Federal officials said the problem will not be fixed until at least Nov. 1.

Instead, consumers currently eligible for Medicaid will have to resubmit their information to their local Medicaid office. However, those who will be eligible under expanded Medicaid programs in January 2014 will not have to resubmit their data. A CMS spokesperson said the issue will not cause a delay for consumers because coverage does not begin until Jan. 1, 2014 (Galewitz, "Capsules," Kaiser Health News, 10/4).

Exchange Closed Over Weekend for Repairs

In related news, the federal exchange site was taken offline during "off-peak hours" over the weekend for repairs, the Wall Street Journal reports (Landers, Wall Street Journal, 10/4). The site was taken offline around 1 a.m. each night for a few hours, according to an HHS spokesperson.

HHS said that several upgrades would be implemented by Monday, including:

  • Website upgrades that will enable more simultaneous users to access the exchange;
  • Additional technicians working to fix problems; and
  • New pathways to get to the online coverage application faster.

In addition, HHS said that call centers were increasing staffing levels and that wait times now are less than one minute (Alonso-Zaldivar, AP/Modern Healthcare, 10/5).

GOP Criticizes Delays

Following the news that the federal exchange would be shut down for repairs over the weekend, critics of the ACA said the problems justify their calls to delay the law, The Hill's "Healthwatch" reports.

House Speaker John Boehner (R) in a press release on Friday said the "news that [the] enrollment system is already going offline confirms that the launch of the president's health care law has been an unmitigated disaster." Boehner continued, "How can this administration tax individuals for not purchasing a product from a website that doesn't even work?" (Viebeck, "Healthwatch," The Hill, 10/4).

Experts Cite Exchange Design Flaws

Although the Obama administration and proponents of the ACA recently have insisted that the problems with the federal online portal are because of a high volume of traffic, health information technology experts say coding problems and design flaws are causing the website to crash, the Journal reports.

According to the Journal, IT experts said the site's "sloppy software foundation" made it unable to withstand high online traffic last week. In addition, the experts say there are several other issues with the portal, including:

  • Problems determining the identity of users;
  • Existence of stray software code that serves no purpose;
  • Lack of basic Web efficiency techniques;
  • A security question system not properly populating; and
  • A system that finds eligibility for Medicaid and subsidies is making inaccurate determinations (Weaver et al., Wall Street Journal, 10/6).

The experts noted that bringing more servers online to deal with the high volume of visitors -- which federal officials have suggested as a solution to the delays -- will not fix the coding issues and design problems, Reuters reports. Bill Curtis -- chief scientists at CAST, a software analysis firm -- said the federal government likely will have to "reconfigure a lot" of the website (Begley, Reuters, 10/5).

Customers Can Sign Up by Phone, Paper

With consumers facing long waits in the online portals, the federal exchange website on Friday prompted users to sign up by phone, the Washington Times reports.

The site stated, "In a hurry? You might be able to apply faster at our Marketplace call center. Call 1-800-318-2596 to talk with out of our trained representatives about applying over the phone" (Howell, Washington Times, 10/4).

Meanwhile, the online issues have caused some early users to abandon the Web and instead resort to paper applications. According to Politico, the Obama administration has long been prepared for an influx of paper applications. Over the summer, the administration awarded a $1.2 billion contract to Serco to process an expected 6.2 million paper applications during the ACA's initial open enrollment period.

However, some experts are wary of paper applications. Tricia Brooks -- a senior fellow at Georgetown University's Center for Children and Families -- noted that paper applications are less effective because they are "more administratively cumbersome." Kevin Counihan -- CEO of the Connecticut health insurance exchange -- said that state is "actively discouraging paper" applications because they are "clunky" and "subject to error" (Millman, Politico, 10/7).

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