Perspective on the Obamacare Rollout
Now that the GOP hostage-taking is done, the media is ready to pay attention to the Obamacare rollout. It is been frought with problems — access to the website, errors on the website, transfers of data to the insurance companies and it just sounds like the failure of the century. Certainly something like this *should* roll out better, but I can’t think of a tech rollout that I’ve seen that has been glitchless. If you’ve used Faceboook long enough, you know that every time they change their interface, the place is glitch-city until they fix it. Facebook is not the same as Obamacare, of course, but Obamacare isn’t the only health care initiative that had a great many issues when it rolled out. So how about a reminder?
Medicare Part D.
This was a real mess when it rolled out — and this one I had first hand experience in, helping relatives get signed up. The signup was hugely confusing — lots of plans and a tough time matching up plans to your normal med needs and once you thought you were signed up, sometimes they couldn’t find you when you showed up at the pharmacy OR they charged you higher prices than you expected. Those things definitely got fixed, but once it rolled out, this looked like another serious botch too, at first:
Medicare’s new prescription drug benefit is off to a rocky start. Dozens of plans, overloaded computers and an entirely new system have left seniors nationwide scratching their heads. The problems are particularly serious for the 6.5 million low-income Americans who get both Medicare and Medicaid — and whose Medicaid drug coverage ended Dec. 31. […]
It’s a problem that’s cropping up across the country. Computers are correctly recognizing low-income seniors as being enrolled in Medicare drug plans, but they’re not flagged as low-income — and are being charged the regular prices.Stephanie Altman, staff attorney with Health and Disability Advocates in Chicago, says that effectively cuts them off from their drugs. “People are walking out of the drugstore in tears, maybe they don’t have a credit card or someone to borrow from, or the pharmacist won’t put it on credit,” she says.
It’s putting pharmacists in a difficult situation, says Tom Clark of the American Society of Consultant Pharmacists. “The pharmacy personnel are concerned that they may not get correctly reimbursed for the medication. And they may not be able to bill and get reimbursed later, after the medication is dispensed,” he says.
This article from Georgetown (comparing the ACA rollout with Medicare Part D) provides an excerpt from a Washington Post article that reported on the Medicare Part D launch:
The rollout of the new Medicare drug benefit has been anything but smooth. At a news briefing yesterday, Mark B. McClellan, head of the Centers for Medicare and Medicaid Services, provided a how-to demonstration of the much-awaited Medicare Prescription Drug Plan Finder, which he said would be available on www.medicare.gov by 3 p.m. It wasn’t. … Problem is, the Medicare folks have had some trouble getting the tool up and running. The original debut date was Oct. 13, but officials delayed it, citing the Jewish holiday Yom Kippur. Next it was promised on Oct. 17, but that day, too, came and went without personalized plan comparisons being available. Late in the month, McClellan told reporters that the feature definitely would be ready before Nov. 15, the date when seniors can begin signing up for the drug benefit. Yesterday [November 8], McClellan announced that the time had come. … But the tool itself appeared to be in need of fixing yesterday. Visitors to the site could not access it for most of the first two hours. When it finally did come up around 5 p.m., it operated awfully slowly.
And how about the rollout of Romneycare in Massachusetts?
What happened in Massachusetts is pretty much exactly what’s happening right now with Obamacare. After the law went into effect in Massachusetts, state offices were totally overwhelmed by the number of people clamoring to sign up for insurance, or what the state’s Medicaid director dubbed the “stress of success.” Lost paperwork, computer glitches, confusion over who was eligible for what, and not enough staff to handle the workload meant that in those early days, consumers could wait several months after submitting an application to finally get coverage. So many people were trying to enroll in the expanded Medicaid program that the Medicaid agency ended up with a months-long backlog of applications. In the first two months, only 18,000 of more than 200,000 potentially eligible people had successfully signed up through the connector, according to Jonathan Gruber, an MIT professor who helped design the Massachusetts system and served on the Connector board. And all of that happened in a state with only 300,000 or so eligible applicants and without a well-funded opposition trying to derail the law at every turn.
But guess what? Eventually the kinks got worked out and people got covered. Enrollment opened in October 2006, and by the deadline for getting mandatory coverage, July 1, 2007, the Boston Globe reported, 20,000 more people had signed up for insurance on the exchange than the state had expected—12,000 of them in just the two weeks before the deadline. Total enrollment went from 18,000 in December 2006 to 158,000 a year later, says Gruber. Today, Massachusetts has the lowest rate of uninsured residents in the entire country—less than 4 percent—and polls show that people are generally happy with how everything worked out. The conservative Massachusetts Taxpayers Foundation has called the state’s health care reform law “a well thought-out piece of legislation.”
Which isn’t to say that the current issues with the tech side of the Obamacare rollout aren’t serious, because they are. It is to say that the GOP jumping up and down about this implementation were not especially concerned about the difficulties in rolling our Medicare Part D or the Connector in MA. At least, they weren’t calling for either of these programs to go away, and in fact, they were mostly invested in making the kind of legislative changes that would help these programs be successful. They won’t be interested in making Obamacare successful, because making sure that poor working people have access to healthcare is against their religion.
But these problems aren’t unique to Obamacare, even though your media will work to convince you of that.
After rightfully trashing the GOP on the brinksmanship – the media is trying to make amends with wingnuts by going overboard with this story. Sad but predicable.
This is what happens when you get rid of competent government employees and try to do everything with overpriced contractors who hire the cheapest people they can get to maximize their profit.
The military does this day in and day out, but their massive overpriced contractor screwups usually aren’t news… It’s more like corporate pork.
But when DHHS does it, people notice.
It’s not just the military — the FBI’s Virtual Case File upgrade might be the biggest government software failure ever.
Which reminds me that perhaps the more interesting conversation that is happening on the periphery of Obamacare is that the government’s method of procurement of tech and tech services might be partially at fault. So that the government makes project awards to people who know how to write proposals, but who probably don’t have the right technical expertise. It tends to lock out the firms who may have more applicable or up-to-the-minute expertise.
cassandra
Right after 9/11 I did work for government contractors in the start-up of DHS. I can recall making multiple suggestions that would have run fine of any software and servers current at the time (I had, in fact, researched those suggestions pretty thoroughly before making them).
What I was finally told when none of them were accepted is that the servers that DOJ (which initially provided server capacity for DHS in the first year) were so antiquated that they could not host the software applications I was suggesting. Then I was told that the only software they were buying was custom-built by Oracle for their servers, because Oracle was the only company that could (or was interested in) manufacturing software for their archaic computers. You can guess what Oracle was charging for this.
Ironically, they were in this mess because the budget money they were using had strings that said buy all the software you want but not a dime for new hardware at a time when it would have been far cheaper to have invested in new hardware capable of running off-the-shelf software. Not sure if that applies here, but the mentality (everywhere but the NSA, obviously) seems to have been pretty prevalent. I know two ex-IRS employees who told much the same story.
This isn’t surprising, Steve. And I think that government agencies are restricted in ways that that their private sector counterparts are not — on top of the fact that most of the major government contractors have legions of people wandering DC to make sure their companies are at the top of the provider list. It is one of the biggest holes in the argument that Government Should Function Like Business. It also incentivizes not always useful behavior like Government Project Managers building in their own technology needs into the tasks that contractors will do for them. Sometimes this is the quickest and cleanest ways for these folks to even get an updated computer.
cassandra
It is not even just legions of contractors. Outside of defense there are only a handful of approved “general contractors” (Booz Allen, to cite the most prominent) and most smaller outfits are unable to work unless they effectively enlist somebody like Booz Allen as a silent partner. The company I worked with (which has to remain nameless here) had to turn over 15% of its gross profits to BA just for holding open the door.
Which, of course, drove the end price to the government for the service up by far more than 15% ….
“The military does this day in and day out, but their massive overpriced contractor screwups usually aren’t news… It’s more like corporate pork.”
You have no idea….
A porter shitter contractor issue almost shut down training on the Marine Corps’ biggest base.
Snowden worked for a private contractor. After there were stories of shortcuts taken by private firms, the private industry can always do it better crowd was silent.
This incident continues to demonstrate just how unserious the “small government” crowd is. Because smaller government means that those highrises along the DC beltway on the Virginia side get emptied out of the government contractors who live there. Small government is going to be a pretty big hit to the private sector, so you really won’t be seeing that any time soon.
My spouse finally, after three weeks, got through via the ACA 800 # and had a good experience. She’s under insured with a third tier company and needs to get more coverage.
But, as a retired marketing guy, I must say that it appears to me that HHS missed a huge part of their early challenge with a significant segment of the un-and under insured by not aiming their marketing and public education early and long at those who have no experience with insurance, don’t understand the jargon, like “co-pay” . It looks to me like they aimed it at a pretty well educated and tech savvy crowd. Let’s hope there’s enough time to overcome this characteristic of a large part of their market.
Just saw Sec. Sebelius on CNN re: the rollout/website. I’m sorry, wish I could say her answers were forthright and enlightening. They weren’t. She was obviously heavily coached by a p.r. hack and just kept repeating the mantra over and over. She did not look or sound confident, nor convincing, as much as I want this to work for them and us. We must do so much better, leadership-wise.
I just saw that online and am not so sure that it was as bad as that. I think that rhetorically they were going for reassuring people that the insurance was there and you could get it. Given some of the BS I’ve seen coming from the right, this might have been a decent tactic. There’s no getting around the fact that the website has serious issues and needs perhaps more work than we know — but then Medicare Part D was a clusterf*** when it rolled out too.
The wingnuts have their new Benghazi and the “main stream” media is more then willing to indulge them in their hysterics.
But what happens when they fix this in 5 weeks?
It would be stupid for the GOP to make too much of all of this.
Really? It just means that 3 years from now the Fox News watchers will be insisting that the website doesn’t work.