A current protestation aside, President Obama is going to have to delay the individual mandate that penalizes consumers for not carrying health insurance under Obamacare. The President can’t force people to have healthcare coverage when they can’t even purchase it on the law’s signature exchanges.
Despite the Obama Administration’s refrain that the IT woes are a sign of heavy web traffic, or are just temporary glitches, the problems are far more systemic. They are unlikely to be soon resolved.
The issues are unlikely to be mere coding errors, but stem from the way the modules are constructed to speak to different systems and networks.
This is especially true when it comes to communicating with the state Medicaid systems, which are often decades behind current IT standards. Some are still operating on the COBOL programming language.
It is likely that large chunks of this middleware will need to be re-written, or was never firmly in place form the start.
For a crude analogy, remember how hard it is to get electronic health records to speak to each other and to different health system software. The exchange challenges, in some respects, are a similar task, albeit made easier because you are not dealing with so many lines of discrete health information (although at least health information has been largely standardized. A lot of the payer-based information that the exchanges are passing back and forth, especially with the state computer systems, doesn’t exist in any standard format).
These kinds of interoperability issues are revealed by where the biggest problem exists right now: With the program that calculates the subsidies that consumers are offered, to help reduce the cost of Obamacare.
These calculations are dependent on the ability to query across the different systems at the IRS, HHS, DHS, and state agencies, among others.
The Administration started building these systems late, and rushed them online, without perfecting these networks. Working them out now, in real time, is going to take months, and maybe a year.
All along, the Obama team set a low bar for itself, seeming to take comfort in just getting this program started. They underestimated the cost of a shoddy roll out.
It didn’t have to be this way. When Medicare’s national Part D drug system was being designed, getting the software architecture in place was the first task embraced by the leadership. The enrollment portal was on line weeks before the program went live. Testing the systems with real data started months in advance.
For the Obama team, the need to design an analogous system seems to have been an afterthought. These “glitches” aren’t just the usual fare when a new IT package goes live. The basic architecture of this system simply doesn’t work.
As I noted earlier this week on the editorial page of the Wall Street Journal, in planning these systems, the Centers for Medicaid and Medicare Services dawdled for more than a year until the current CMS Administrator took over.
Health and Human Services started testing the chief pieces of these systems just a month before the program went live.
Just days before opening the exchanges, CMS was still delivering data to several big Web insurance marketplaces that would allow those markets to connect with the federally run exchange and enroll customers. The entire system didn’t go on-line until the day the exchanges launched.
We are seeing the results.
In a post this morning in the Washington Post, from two supporters of the President’s plan, the Administration is taken to task for shoddy work: “Part of the problem, according to a number of designers, is that the site is badly coded, which makes the traffic problems more acute.”
Another post describes how the coding in the web site facilitates problems when a lot of users try and to log on. The IT experts described the situation as similar to what happens when hackers conduct a distributed denial of service, or DDOS, attack on a website by getting large numbers of computers to simultaneously request information from the server that runs a website, in turn overwhelming the site and causing it to crash. “The site basically DDOS’d itself” the post recounts.
The Administration says they added more servers to smooth some of the problems. But a revealing article in InformationWeek
notes that the behavior of the Healthcare.gov site suggests that it was probably the registration software component that stalled or failed under high load, not the servers.
HHS boasts about the web traffic that the exchanges have garnered. A lot of those hits must be Washington journalists and curious politicos. Because the embarrassing truth, which is seeping out of insurers, is that enrollment rates in many states are running in the single digits.
This doesn’t mean enrollment wont pick up as the on-line portals start to work fluidly. But that could take a long while. Meanwhile, the January 1 deadline for having coverage will start approaching.
In the meantime, President Obama is going to have to suspend his individual mandate, despite his political positioning in the current budget battles. People can’t be fined for not having something that they can’t purchase.
You can follow Dr. Scott Gottlieb on Twitter @ScottGottliebMD