With Shutdown Over, Focus Shifts to Glitches on ACA Website

With the focus off the partial federal government shutdown, lawmakers and observers now are able to pay more attention to the rocky rollout of the Affordable Care Act's insurance exchanges, Politico reports (Norman, Politico, 10/17).

According to CQ HealthBeat, industry observers believe that the government might have to shut down the federal exchange website in order to resolve persistent technological glitches that have hindered consumers' ability to purchase insurance from the marketplaces. According to David Brailer -- national coordinator for health information technology during the George W. Bush administration -- "the option's being discussed." He said federal officials' efforts to "fix little pieces of it" have had "no effect," and the system clearly has a "more fundamental problem."

However, an HHS official in an email said that the agency "is not planning to shut down the exchange ... We are taking the application function off line at night for a few hours from time to time for maintenance work though" (Reichard, CQ HealthBeat, 10/16).

Republican Lawmakers Launch Investigations Into ACA Rollout

In the meantime, Republicans -- who previously were "caught up with the shutdown" -- now are "set to have a field day" with the ACA's difficulties, according to Politico (Politico, 10/17).

Republicans on the House Energy and Commerce Committee already have asked HHS Secretary Kathleen Sebelius and top officials from two government contractors involved in the rollout -- CGI Federal and Quality Software Services -- to explain why the exchange's launch went so poorly, after earlier testimony indicated that the exchange would run smoothly. 

Specifically, the committee has asked Sebelius and the two contractors to provide information about when the testing of the exchange system was completed, the causes of the current glitches and any work being done to resolve those issues. The committee also asked for all communications between the contractors and HHS in the week preceding the Oct. 1 launch to determine if any problems were apparent prior to the rollout (Pugh, Sacramento Bee, 10/16).

According to Politico, the law's opponents will also likely investigate other problematic areas of the rollout, such as HHS' failure to anticipate high traffic flow to the site. Industry observers -- such as health care consultant Bob Laszewski -- said that the technology community's "natural peer review function" could have spotted errors early on in the system's ability to only accept about 50,000 users per hour.

In addition, Reps. Diane Black (R-Tenn.) and Patrick Meehan (R-Pa.) have asked HHS to provide various security and access information about the exchange, including a "security control assessment" of the federal data hub and information about whether the agency followed "critical best practices" for security weaknesses (Politico, 10/17).

Glitches, Delays Still Hinder Consumer Access

Meanwhile, the federal exchange still is tackling a host of lingering technological glitches that could take years to resolve and which -- according to a Millward Brown Digital report -- could deter consumers from attempting to purchase coverage, Politico reports.

For example:

• Several leaked emails, memos and reports describe hardware and software malfunctions on the exchange;
• Consumers still face a variety of error and delay messages when they try to log into the site;
• Web brokers who have contracted with the administration to offer subsidized insurance through their own websites have been unable to connect to the federal system; and
• Insurers are concerned that lingering problems might result in consumers' insurance being rejected once they try to use it (Cheney et al., Politico, 10/16).

Dan Schuyler -- a director at the health care group Leavitt Partners -- also pointed out that the two central issues were high traffic flow and a potential fundamental flaw with the system's design. He added that if the administration does not "get it fixed within two or three weeks, we may have a backlog of consumers who won't be able to enroll by Jan. 1" (Kennedy, USA Today, 10/16).

Meanwhile, consumers using the state-run exchanges have found that while they can readily get through the log-in process, they are unable to access tools that help them determine which policies provide the doctors, hospitals or drugs they need. For example, California has suspended its site's physician directory tool after consumers encountered several flaws with the system, and exchanges in Maryland, Oregon and Rhode Island still are developing similar tools (Goodnough, New York Times, 10/16).

Report: Exchange Contractor Funding Surges, Even as Exchange Flounders

In related news, a Reuters review of government documents finds that payments to one of the exchange contractors -- CGI Federal -- surged from an original maximum of $93.7 million to $292 million by April, just as several federal and state officials warned that the exchange was in trouble, Reuters reports.

CGI Federal was awarded a contract in 2007 of $55.7 million for the initial year's work on constructing the exchange, with three potential one-year options that brought the total to $93.7 million. CGI Federal neared that total by August 2012, and in 2013 the government made several additional payments that brought the total to $196 million by mid-September. According to Reuters, the contract is now valued at $292 million when potential options are included.

According to Reuters, HHS has not replied to requests for information about CGI's contract (Begley, Reuters, 10/17).

Sebelius Has No Plans To Resign

Aides to HHS Secretary Kathleen Sebelius on Wednesday said that she has no intention of resigning from her post, despite widespread complaints about the ACA's rollout, the New York Times reports (Pear, New York Times, 10/16).

Several Republican lawmakers -- including Sen. Pat Roberts (R-Kan.) and Republican National Committee Chair Reince Priebus -- have called for Sebelius to resign or be fired over her leadership on the exchange's launch. Roberts 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" (California Healthline, 10/15). 

During a press conference in Cincinnati on Wednesday, Sebelius said that while "I am the first to admit that the launch was rockier than we would have liked ... there are vast improvements" and frustrated consumers should "come back" and try again (New York Times, 10/16).