The Real Root of Obamacare’s IT Problems

All of the legal and legislative challenges to Obamacare leading up to the opening of the health insurance marketplaces would have wreaked havoc on any IT project.
November 2013

Online health insurance marketplaces—a cornerstone of President Obama’s Affordable Care Act—made their long-awaited debut last month. The opening, as you probably heard, was marred by technical glitches and overloaded servers.

The federal government’s own exchange, healthcare.gov, which handles ACA insurance purchasing for 34 states, drew more than 8 million visitors in its first week of operation, according to the White House. The 16 state-run sites also saw a high volume of visitors. A few of them were temporarily shut down on opening day, and most experienced intermittent errors.

While health-care reform opponents pounced on the problems as evidence that the new law is unworkable, ACA supporters noted that people were creating accounts and enrolling in health plans despite the delays. They pointed to higher than expected website traffic as an indicator of the law’s popularity.

Regardless of where you stand on Obamacare, however, you have to sympathize with the IT staffs charged with putting the health insurance exchange sites together. Not only are states and the feds rolling out the largest new social program in nearly 50 years under a tight timeline, but much of that deployment period has been fraught with uncertainty: First came a U.S. Supreme Court challenge to the health-care law. Then there was the 2012 presidential election, where Republican challenger Mitt Romney vowed to repeal the ACA if elected. And then came complaints that the feds were slow to create a crucial data hub that all sites would use to check eligibility. These events left states short on the details they needed to design their own exchanges.

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Former Oregon CIO Dugan Petty called the Oct. 1 launch a success in light of the circumstances. “The business rules are being developed on the fly and it has been a constantly moving target,” he said in an interview with Government Technology, Governing’s sister publication.

That sort of ambiguity wreaks havoc on any IT project, but especially on one as large and complex as the national rollout of health insurance exchanges. And from the start, state CIOs warned that the three-year deployment timeframe was alarmingly short for developing these sites and linking them to a federal data hub.

Still, as the ACA entered its second week of operation, there were signs that wobbly health insurance sites were finding their legs. Kentucky reported that more than 14,000 people had completed applications on its site, and almost 7,000 had enrolled in health plans. Maryland officials said they had added capacity and made other adjustments to the state’s health benefits exchange, where nearly 14,000 people had created accounts during the first week of operation.

Even the federal government’s healthcare.gov site appeared to be showing some improvement. Obama administration officials told The New York Times they had tracked down faulty software that made it difficult for people to establish user accounts, especially during high-traffic periods.

Given the circumstances, the launch of the health insurance exchanges probably went as well as one could expect from an IT perspective, particularly for the state-run sites. Yes, the experience may have taxed users’ patience, but millions of people visited the sites and thousands of them began the process of purchasing health coverage. The exchanges will get better as IT crews continue to work out the kinks, putting the focus less on opening-day website glitches and more on the ACA’s long-term viability. For CIOs, however, the process will undoubtedly offer insights for future big IT deployments.

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