Federal Exchange Website’s Software Inefficiencies Blamed for Delays

On Tuesday, health policy and technology experts said that the new health plan enrollment website for the three dozen federally run health insurance exchanges has "a lot of inefficient (software) code" and lacks an essential component allowing consumers to the browse the website before signing up for coverage, the AP/UT San Diego reports.

Unlike most e-commerce websites, the federal exchange portal -- at healthcare.gov -- requires consumers to create an account before they can look at coverage and cost information for the health insurance plans available in their state, according to AP/U-T San Diego (Johnson/Alonso-Zaldivar, AP/UT San Diego, 10/8).

On Monday, U.S. Chief Technology Officer Todd Park cited the account-creation requirement as the cause for the portal's problems last week, which blocked millions of new visitors from viewing their enrollment and coverage options or accessing information detailing their eligibility for federal subsidies. In addition, some users who already had established accounts could not access them. Others were asked to verify their email addresses to gain access to their accounts, but the verification link did not work as intended (California Healthline, 10/8).

San Francisco-based design firm IDEO -- which launched Enroll UX 2014, a $3 million project to design a best-practice user experience for the online insurance exchanges -- recommended that the federal website allow consumers to shop for plans anonymously. Some of the state-run exchanges adopted IDEO's recommendation, but the federal government did not.

Sam Karp -- vice president of programs at the California HealthCare Foundation, which helped IDEO organize and finance Enroll UX 2014 -- called the omission of the anonymous browsing feature a "major design flaw." He added, "That was a design recommendation, and they didn't do it." CHCF publishes California Healthline.

HHS spokesperson Joanne Peters said the department did not implement the so-called window shopping function because it wants consumers to see whether they are eligible for subsidies, which requires them to enter their personal financial information.  "Window shopping would not allow for this," she said (AP/UT San Diego, 10/8)

Many consumers remained locked out of the federal exchange website as of 10 a.m. on Tuesday, hours after the administration took the portal offline for another round of maintenance and repairs, the Washington Post reports. Despite the problems, HHS officials later in the day said "an extraordinary number of people are coming to check out" the website (Eilperin et al., Washington Post, 10/8).

Meanwhile, many health insurance executives and representative have remained silent on the glitches and have declined to lay blame on the administration, CQ HealthBeat reports.

One insurance executive who asked to remain anonymous said, "We are committed as an industry to not [be] throwing rocks at HHS. There were informal commitments to the White House to not throw rocks." The executive noted that calls for various fixes, such as delaying the start date of coverage or extending the open enrollment period beyond six months, are "premature" and "[n]one of that is even being talked about" (Reichard, CQ HealthBeat, 10/8).

On Tuesday, House Permanent Select Committee on Intelligence Chair Mike Rogers (R-Mich.) said that the reported system problems with the federal exchange website have made the portal's information hub vulnerable to hackers, The Hill's "Hillicon Valley" reports (Sasso, "Hillicon Valley," The Hill, 10/8).

The hub is meant to verify exchange applicants' income information with the IRS and then transmit verifications back to the marketplace. It also aims to relay information between the exchanges and other federal agencies, such as Citizenship and Immigration Services and the Department of Homeland Security (California Healthline, 8/13).

Rogers said hackers that break into the hub could gain access to consumers' credit history, health records and Social Security numbers, among other personal data. He said, "There is no way in God's green Earth they can secure that system today," adding, "We better fix this before we continue to move forward on the system or we will all regret it."

According to "Hillicon Valley," CMS has said that there are "several layers of protection" in place, and it is constantly being monitored ("Hillicon Valley," The Hill, 10/8).