Could States Have Prevented ACA Glitches?

Despite the shutdown of the federal government impacting services across the board, health insurance exchanges launched on Tuesday, Oct. 1 as scheduled. The Twitterverse made note of the irony: 

Policymakers at all levels pointed constituents to their state's exchanges, and states that opted not to run their own exchanges directed residents instead to the federal portal, HealthCare.gov.

But it was difficult to follow news reports without being bombarded by news of exchange websites crashing, succumbing to glitches undoubtedly brought on by traffic surges that overwhelmed state and federal servers. Insurance seekers may not have ended the day with new health-care coverage, but they undoubtedly got a lesson in patience.

Unhealthy Glitches

During day 1 of open enrollment, exchange platforms experienced multiple crashes and many individuals encountered delays in completing the enrollment process.

Morning news reports indicated that error messages appeared on HealthCare.gov, stating, “We have a lot of visitors on our site right now and we’re working to make your experience here better. Please wait here until we send you to the login page. Thanks for your patience!”

In Little Rock, Ark., uninsured residents gathered at the University of Arkansas School of Public Service help center for assistance in enrolling in the state’s marketplace. However, center personnel said individuals could not complete enrollment during the first few hours the center was available due to glitches with the federal platform.

Local media reported that one Florida resident tried enrolling on the new platform at 12 a.m. – the time of the official launch, but was unsuccessful since the website wouldn’t allow him to get past the security questions. Six hours later, he still couldn’t complete the enrollment due to the malfunctioning website.

New York's portal, reporting 2 million hits in the first two hours, quickly posted its own "have patience" message in a move replicated many times throughout the country.

But despite a less-than-perfect start, President Obama said like most software launches, glitches are expected. And in time, the necessary fixes will be made.

“Consider that just a couple of weeks ago, Apple rolled out a new mobile operating system and within days they found a glitch, so they fixed it,” Obama said, in a statement. “I don’t remember anybody suggesting Apple should stop selling iPhones or iPads or threatening to shut down the company if they didn’t."

Should IT Leaders Have Been Better Prepared?

With an IT deployment of this magnitude, though, should citizens expect a certain number of bumps in the road? While the Affordable Care Act (ACA) legislation passed in March 2010, states had a significant amount of work to do: First, they needed to decide whether to stand up their own system, rely on the federal government's exchange, or arrive at some kind of hybrid solution. And then, of course, they had to do the work within a highly charged political environment that could (and sometimes did) turn on a dime.

Former Oregon CIO and Center for Digital Government Senior Fellow Dugan Petty sympathized with state IT officials, classifying today's launch as successful, under the circumstances.

"There is a monumental effort that these states that are doing this on their own have signed up for and the business rules are being developed on the fly and it has been a constantly moving target," he said.
 
In Petty's view, states that took a measured approach by offering limited services via the exchanges on Oct. 1 made a smart decision. Given the abbreviated development cycle for state exchanges, they had no time for a soft launch period to work out the kinks in advance.

"If you were doing a similar kind of launch of a system, you would probably put it out in beta for a while and you would work through those bugs until you shifted over to it," he added.

Oregon, for example, is relying on community partners to help enrollees complete the insurance enrollment process in person during the first few weeks. Coloradans will have to wait until 2014 to get insurance through the state's exchange. Officials are taking full advantage of the extra three months to ensure a smoother process for enrollees.

Former San Diego County CIO Harold Tuck, also a Center for Digital Government Senior Fellow, isn't surprised by the headline-grabbing first-day glitches. That said, he blames state officials for improper planning, which he says should have included reasonable estimates as to how much traffic health exchange sites would receive.

Cloud-based software-as-a-service and platform-as-a-service technology solutions should scale adequately to handle surges like the ones observed throughout the country on Tuesday, Tuck explained, but the time and political pressure government officials were operating under could have forced them into short-term fixes.

"Maybe state government didn't look toward the technology that is truly available and instead bolted new applications on top of what they had," he said.

Despite these pressures, Tuck would have established clear expectations for a fully functional system on day one.

"I would have demanded proof that the system could handle the surge," Tuck said. "These are fundamental things that you should never get on a launch: system unavailability; there's a problem, we're working on it. To me, those are unacceptable."