A congressional hearing examining the litany of problems with the U.S. government’s online health insurance exchanges turned into a round of finger-pointing filled with claims of “Not me” or “It wasn’t my job.”
The panel of four witnesses, who appeared before the House Committee on Energy and Commerce on Oct. 24, 2013, represented the four private-sector companies that had contracted with the Department of Health and Human Services to develop and launch HealthCare.gov, the federal online health insurance marketplace. The witnesses provided more than four hours of testimony that painted a picture of a highly siloed process, in which contractors focused solely on their portion of the work with little or no idea of how the final product would function.
Each witness told the committee that the individual components of the project performed as designed when his or her organization tested them. However, they testified that project oversight by the Centers for Medicare & Medicaid Services (CMS) had been disjointed and that the agency had failed to sufficiently test the entire system before the health care exchange launched, on Oct. 1.
“The system simply didn’t receive adequate end-to-end testing,” said Andrew Slavitt, group executive vice president of Optum, which developed the CMS data service hub.
Slavitt told the committee that a website as large and complex as the federal health exchange needed several months of testing before going live. According to the witnesses, CMS began tests on the entire system only two weeks before the website launched. Slavitt said he had expressed his concerns about the testing schedule and the risks of system crashes to CMS officials.
Cheryl Campbell, senior vice president of CGI Federal Inc., said that Slavitt’s concerns proved true when an initial end-to-end test caused the system to crash less than two weeks before the Oct. 1 launch. CGI was responsible for much of the design and coding of HealthCare.gov, and, according to Campbell, the value of CGI’s contract to create the website would eventually top $200 million.
Lack of Coordination
Campbell told the committee that CMS officials made the final decision to proceed with the website’s rollout and that she had no authority to delay the system launch. Slavitt and Campbell contended that the primary reasons for the problems were a lack of coordination by CMS officials and a nearly last-minute decision to redesign the website. According to the contractors, CMS officials decided just two weeks before the launch to require users to create personal online accounts, rather than letting them browse anonymously for health insurance prices. Slavitt and Campbell said the sudden change caused several major system hiccups.
“We don’t know why CMS wanted to make the change, but once the decision was made, our job was to make it work as best we could,” Campbell said.
She acknowledged the system launch wasn’t a “pretty sight” but added that improvements were being made every day and that the system had stabilized significantly since Oct. 1.
“The system is working, and more people are enrolling,” Campbell said. “More users will be able to enroll at a faster pace as we continue to address the problems with the website.”
Energy and Commerce Committee Chairman Fred Upton, R-Mich., called the HealthCare.gov launch “nothing short of a disaster,” noting that the contractors at the hearing had previously “looked us in the eye and assured us repeatedly that everything was on track and ready to go—except that it wasn't.”
Upton and other Republicans repeatedly asked the witnesses if they had lied or willfully misled the committee during a Sept. 10 hearing to discuss progress on the website’s development. Witnesses at that hearing had testified that the system appeared to be on track for a successful launch.
Again, the witnesses replied that their components of the project had worked and looked good and that they had no insight into the entire project’s progress or state of readiness.
Democrats on the committee attempted to blunt the Republicans’ criticism and harsh line of questioning by pointing to the successful and relatively smooth rollout of state health care exchanges, compared with the federal website.
“States like my home state of California, New York and Kentucky chose to create their own exchanges,” said Rep. Henry Waxman, D-Calif., the ranking member of the committee. “These state exchanges are now working well and have enrolled thousands into health care plans—many of whom now have health insurance for the first time in their lives.”
Waxman and other Democrats maintained that the success of the state exchanges is an example of what happens when members of both political parties cooperate and try to build up a system, instead of trying to obstruct or tear it down.
“When the Republican-led Congress passed the Medicaid Part D back in 2004, I remember that Democrats held town hall meetings and workshops with our constituents to help ensure a smooth rollout,” said Rep. Jan Schakowsky, D-Ill. “What we have had with the rollout of the Affordable Care Act has been constant repeal votes and obstructionism to make sure it fails. So it’s no wonder we have had such dysfunction and problems with the launch of Obamacare.”
Bill Leonard is a senior writer for SHRM.
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