Exchanges: Mistakes Made Prior to Launch, Sebelius Asked To Resign

The Obama administration made a series of missteps as it prepared for the Oct. 1 launch of open enrollment in the Affordable Care Act's health insurance exchanges, which resulted in technical glitches that have hindered many consumers' attempts to enroll in coverage, the New York Times reports.

An investigation by the Times -- including interviews with dozens of contractors, consumer advocates insurance executives, current and former Obama administration officials and a review of confidential administration documents -- shows many stakeholders believed the exchanges were not ready for launch because of several financial, technical and managerial issues.

From the beginning, some observers expressed serious doubts about CMS' ability to oversee the entire project, including questioning the agency's capacity with software engineering, integration and testing, while also supervising 55 contractors. Individuals close to the project believed CMS should have appointed a lead contractor to oversee the project. An internal government progress report in September 2011 noted CMS had too few workers "to manage the multiple activities and contractors happening concurrently," calling it a "major risk" to the whole project.

In addition, the Obama administration struggled with funding after the Republican-controlled House blocked money for the project. The administration further hurt the project's prospects by delaying several major rules until after the November presidential elections, giving insurers and contractors little time to prepare. For example, the biggest contractor -- CGI Federal -- was awarded its $94 million contract in December 2011 but it was unable to start writing code until this spring because the federal government delayed rules, according to those familiar with the process.

In February, an insurance executive working on information technology predicted that the launch would be "a train wreck," saying, "We don't have the IT specifications. The level of angst in health plans is growing by leaps and bounds." He added, "The political people in the administration do not understand how far behind they are."

Despite assertions from top federal officials that the exchange would launch on time as planned, confidential progress reports from HHS show that senior officials repeatedly expressed doubts that the computer systems would be ready on time, noting that delayed regulations, a lack of resources and other factors were impeding progress (Pear et al., New York Times, 10/12).

Federal health officials could have to rebuild part of HealthCare.gov after a new tool that allows users to get a price quote for coverage experienced several problems, The Hill's "Healthwatch" reports.

The new tool does not require consumers to create an account to receive an estimated cost of coverage, unlike the enrollment system. However, users encountered error messages and were unable to confirm their email addresses through the tools (Viebeck [1], "Healthwatch," The Hill, 10/11).

Further, the Washington Post reports that some electronic enrollment files are missing time stamps, a key element that would let a health plan track how far along a consumer is in the enrollment process (Goldstein/Cha, Washington Post, 10/11).

According to report from the Wall Street Journal, HHS was expected to make adjustments to the registration system over the weekend (Weaver/Radnofsky, Wall Street Journal, 10/10).

In related news, some Republicans are calling for HHS Secretary Kathleen Sebelius to resign or be fired over the mishandling of the health insurance exchanges, The Hill's "Healthwatch" reports (Viebeck [2], "Healthwatch," The Hill, 10/11).

Sen. Pat Roberts (R-Kan.) on Friday said that Sebelius should step down "for gross incompetence" in preparing for the exchange launch. He said, "In the absence of a full repeal of Obamacare, which is my preference, we need new leadership from top to bottom. I am calling on the secretary to resign." He added, "Today, we know, the problems with the exchanges are systematic, profound and indisputable. And yet the secretary won't shoot straight with the American people" (Howell, Washington Times, 10/11).