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U.S. President Barack Obama delivers remarks alongside Human Services Secretary Kathleen Sebelius (R) and other Americans the White House says will benefit from the opening of health insurance marketplaces under the Affordable Care Act, in the Rose Garden
The administration met its self-imposed November 30 deadline for fixes to have the HealthCare.gov web site working for the large majority of users, but there are still significant kinks.
"The bottom line: HealthCare.gov on Dec. 1 is night and day from where it was on Oct. 1," Jeff Zients, the management expert steering the repair mission, told reporters Sunday morning.

The site is now functioning more than 90 percent of the time—up dramatically from an average of just 43 percent of the time in October, Zients said. If the site is slow, consumers will be logged into a "queue" that did not exist on Oct. 1, a sort of cyber waiting room. They’ll be notified when they can try again.

The Centers for Medicare & Medicaid Services said in its progress report that it had repaired more than 400 items on its "punch list" of bugs and needed fixes, including enlarged capacity and greater stability. The agency said it had reduced response times from eight seconds in late October to less than one second and that error rates are less than 1 percent—but those specific improvements it had reported earlier.

The front end seems to be working much more smoothly for would-be customers, but the backend operation that transmits the information to insurers is still problematic, and insurers report a raft of errors and problems from not having applications transmitted to them at all to getting duplicates. For insurers and for consumers the major issue is whether enrollments happening at the front end get transmitted to insurers, and right now that's not happening consistently.

That has to be fixed in a month's time, before people start going to doctors and filing claims with insurance companies that don't know they're supposed to be covering them.

Originally posted to Joan McCarter on Mon Dec 02, 2013 at 08:10 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (27+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon Dec 02, 2013 at 08:10:28 AM PST

  •  Worked for me... (37+ / 0-)

    I applied for Obamacare for my son.  The website was fast and smooth.  One week later BlueCross sent a bill for the first month.  My son texted me the letter, which also contained a website link to make an online payment.  I paid the first month and am waiting now for his id card.

    The whole process was picture perfect for me.

    Insurance companies are used to handling a LARGE amount of data manually, so they will muddle through any problems.  They are just groaning now to set expectations, so they won't be blamed later for the inevitable screwup here and there.

    •  Blue Cross (13+ / 0-)

      They must have their act together. Mine is all set also.

    •  The problem is…. (9+ / 0-)

      Certain "back office" functions are not working properly - for example, the government needs to tell the insurance company how much of a discount the insured should receive.  Not working properly.

      Certain subsystems have not yet been built…including the back end systems that pay the subsidy to the insurance company, or it sounds like, even perform the basic accounting functions between the government and the insurance companies.

      The government has admitted that 30-40% of the system still needs to be constructed.  

      All the governments energy has been directed to fixing the customer facing problems, not fixing the guts of the system.  

      •  Question (3+ / 0-)
        Recommended by:
        TheGreatLeapForward, TofG, askew

        Balto, how can you be sure that no energy has been directed at the back end?

        I would be astonished if there hasn’t been a concerted development effort in other areas as well – even though the urgent focus has been on the front end.

        “The meaning of life is to find it.”

        by ArcticStones on Mon Dec 02, 2013 at 09:09:48 AM PST

        [ Parent ]

        •  Tons of effort has been put into this. (4+ / 0-)
          Recommended by:
          TofG, ArcticStones, askew, FiredUpInCA

          I'm an IT guy, in healthcare and although I'm not a interfaces specialist (we've got lots of interfaces these day) I know the standards for these interfaces were developed  some time ago.

          This is not new stuff, we've been doing this for years. The insurance companies are good at this too.

          They'll have this stuff running well in short order, if its not already.

          I'll stop calling him Boner when he stops saying I belong to the Democrat Party.

          by al23 on Mon Dec 02, 2013 at 10:26:06 AM PST

          [ Parent ]

        •  From Forbes….. (0+ / 0-)
          Apparently, the accounting systems and payment systems that protect taxpayers against waste, fraud, and abuse—systems that also ensure that insurers get paid, and that premium subsidies are accurately doled out—have not yet been built.

          It’s worth noting that, technically, you haven’t enrolled in a health insurance policy until the insurer has collected the first premium from the beneficiary. If the payment systems have not yet been built, it’s not clear how many people, then, have actually enrolled on the exchanges.

          Admittedly a few weeks stale.  Full link below:

          http://www.forbes.com/...

      •  that's not the right metaphor (1+ / 0-)
        Recommended by:
        FiredUpInCA

        The "guts of the system" supports the customer facing piece. They've gotten the guts working. That's how the fixes make the web site work.

        The insurance facing piece isn't the guts; it's just another customer.

      •  they have started working on the back end (2+ / 0-)
        Recommended by:
        TofG, FiredUpInCA

        You are correct that Zients and the team decided to focus on the front end first and throughout November, but the Sunday December 1 Operational Progress Report stated that, "This includes more than 50 bug fixes that were installed just last night, many of which made improvements in the back end of the system."

        So they have started working on the back end, and my prediction is that they will focus strongly on that going forward.  

        http://www.hhs.gov/...

    •  Not for me. (4+ / 0-)
      Recommended by:
      TJ, JVolvo, ruellia, schnecke21

      I tried to log in this morning, to see whether a problem I've been struggling with for about two weeks had been resolved.  Can't log in; too busy.

      I am become Man, the destroyer of worlds

      by tle on Mon Dec 02, 2013 at 08:48:54 AM PST

      [ Parent ]

      •  P.S.; night and day? (1+ / 0-)
        Recommended by:
        Subterranean
        "The bottom line: HealthCare.gov on Dec. 1 is night and day from where it was on Oct. 1,"
        I couldn't register on Oct 1, because it was too busy.

        I can't log in on Dec (2, vs 1), because it's too busy.

        More like, midnight and 1 AM.

        Imagine if, instead of doubling down on this privatization racket,  Medicare buy-in had been implemented. (Imagine corporatist heads exploding).

        Today is the day I track down a navigator and see whether we can finally get me enrolled.

        I am become Man, the destroyer of worlds

        by tle on Mon Dec 02, 2013 at 09:01:59 AM PST

        [ Parent ]

        •  Great if you report back about the Navigator! (0+ / 0-)

          “The meaning of life is to find it.”

          by ArcticStones on Mon Dec 02, 2013 at 09:06:27 AM PST

          [ Parent ]

          •  I have an appt this Wednesday. (2+ / 0-)
            Recommended by:
            ArcticStones, shades at midnite

            In NE Florida, navigators are apparently as common as unicorns.  The first two locations (from the localhelp list) were utterly useless, and the third has one person who'll be in the office Wednesday and Friday.

            As for Healthcare.gov, the numeric error code isn't there any more.  However, the enrollment process still skips through some questions, and in the process drops my wife out of the application.  No doubt they'll call me back any moment now; it's only been a few weeks since they said they'd forward the issue to the "Advanced desk", or something like that.

            I am become Man, the destroyer of worlds

            by tle on Mon Dec 02, 2013 at 10:43:29 AM PST

            [ Parent ]

    •  Worked for us...sort of (0+ / 0-)

      We were stuck around Nov.20 with not being able to ungroup our family group on the web site so that we could choose Blue Cross here in SC.  Blue Cross does not offer family group plans.  We called Blue Cross about the problem since they sure would have an interest in selling individual plans, but they were not showing up as an option for us on the website because of the grouping problem.  A day later someone from Blue Cross called to help (the healthcare.gov call center folks were useless).  They could see our application and subsidies and so were able to enroll each of us in the silver cost sharing plan that we wanted.  We should have our member kit and first invoice in a few days.

  •  I heard about this this morning.... and *they* (24+ / 0-)

    made it sound as if it is the problem with healthcare.gov and not their own systems when it very well be either and/or both ends having issues with interfaces and communications.  You wouldn't believe how many times I had to call BCBS of Iowa to get our downloads from them because something happened on their end......  This is what happens when the 'industry' has no record standards and each company has a proprietary record layout and demands on data.  It's difficult to code for each one of them.

    •  The 834 files (0+ / 0-)

      are all government.

      •  So?? The story is that the insurance companies (3+ / 0-)
        Recommended by:
        eps62, reginahny, FiredUpInCA

        are having difficulty receiving them.  That doesn't mean it's the gov't side fault.  It could be that the insurance companies have something in their ftp receive that's messed up, along with any number of formatting issues in the interface between gov't servers and insurance servers and their own load capacities.

        It's not one sided, all gov't problems.  Insurance companies are not fail proof in their IT either.

      •  834 is a EDI spec (2+ / 0-)
        Recommended by:
        nchristine, Mr Robert

        The X12 EDI specs all have the "Designed by Committee" problem. Each committee member puts in their own pet data representation. The net effect is that you have the "Standard" and the real world implementations that all look different in the details.  

        I've done EDI translations for a long time from a supplier perspective and I have yet to see the implementation for any two purchase order or invoice transactions be even close to identical. I did a quick Google for x12 834 and looked at a couple different "Implementation Guides", which are the individual companies interpretation of the standards. Not surprisingly, the first two I found have differences in what data is sent.

        Does anyone know if the Feds told the Insurance companies "Here's our 834 implementation guide. You want to play in the exchange, you deal deal with mapping this to your systems" (known in the business as "The 800 lb Gorilla" model) or are they trying to send 834's in each insurance companies format?  If they're doing the latter, then each and every translation is likely to be uniquely developed.

  •  Who didn't see this coming, (8+ / 0-)

    now that the front-end is working:

    the backend operation that transmits the information to insurers is still problematic, and insurers report a raft of errors and problems from not having applications transmitted to them at all to getting duplicates

    This all started with "what the Republicans did to language".

    by lunachickie on Mon Dec 02, 2013 at 08:33:12 AM PST

  •  Yeah... (3+ / 0-)
    Recommended by:
    JVolvo, rsmpdx, eps62

    I called Independence Blue Cross last week (Philly area) with a few questions before I finalized my choice of plan. I am already enrolled withe the Marketplace (in October), received my eligibility letter right away, but then took some time to choose my plan. The person at IBX told me to wait until later this week to enroll...because they weren't finalized with healthcare.gov. There is now about a 3-day window for signing up without a hitch, waiting 10 days for their letter, and then getting payment to them in time to start in January.

    curious portal - to a world of paintings, lyric-poems, art writing, and graphic and web design

    by asterkitty on Mon Dec 02, 2013 at 08:42:14 AM PST

    •  Please signup - I'm in the Phlly area (2+ / 0-)
      Recommended by:
      asterkitty, TofG

      Hi - I purchased Independence Blue Cross Silver Premier policy for my son (I think it's called Premier). We got the bill last week.

      You should signup - I did it during dinner time

      •  I am going back into the site (0+ / 0-)

        tomorrow evening. Of course I am going to sign up. I have no choice, for various reasons.

        I think the issue is that I have to go through healthcare.gov because of the subsidy. I both qualify for and desperately need the subsidy. I can't go directly to Blue Cross because of this, and BC told me they were not ready with healthcare.gov.

        curious portal - to a world of paintings, lyric-poems, art writing, and graphic and web design

        by asterkitty on Mon Dec 02, 2013 at 11:05:16 AM PST

        [ Parent ]

      •  Pa. site is much better (no thanks to Corbett). (0+ / 0-)

        Work on "back end" improvement should also be better. Without it, only individual fix would be pointless.

  •  "cyber waiting room." (9+ / 0-)

    Well hopefully the "cyber waiting room" doesn't have magazines from 3 years ago in them.

    I want 1 less Tiny Coffin, Why Don't You? Support The President's Gun Violence Plan.

    by JML9999 on Mon Dec 02, 2013 at 08:43:28 AM PST

  •  in other words (9+ / 0-)

    while the federal government responded to the issues with the website quickly and efficiently, the private sector twiddled its thumbs.

  •  Private insurance companies were screwing people (3+ / 0-)
    Recommended by:
    TKO333, eps62, TofG

    left, right, and center, every day of every year for decades now.  And people were angry and helpless and deeply vulnerable.  

    Now we have all that with a little bit less vulnerability, and the opportunity to blame all the bad parts on the government instead of on the insurers who will keep not doing what they have always not done.

    "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

    by lgmcp on Mon Dec 02, 2013 at 08:45:37 AM PST

  •  At TPM there's an artic re Red Erik ranting about (7+ / 0-)

    how the rightists should forget about attacking the web site for Obamacare and go after the law....the usual clap trap but what struck me is the accompanying photo of his Redness. His face looks exactly like that of a squished doll head I once saw mounted in the grill work of a NYC sanitation truck!

  •  FYI: The unofficial enrollment figure is now up to (4+ / 0-)
    Recommended by:
    ArcticStones, assyrian64, eps62, askew

    ...at least 330,000 as of this morning, based on the Bloomberg report claiming about 100,000 November enrollments via Healthcare.gov.

  •  Worked for me (2+ / 0-)
    Recommended by:
    LI Mike, auapplemac

    I was finally able to complete an application and get an eligibility notice yesterday. It worked great. Very disappointed in the plans available to me though. Very expensive and I am not eligible for any tax credits. I would have to pay way more for less coverage than what I have now. I will not be buying insurance through the marketplace for sure. I was hoping for a better outcome.

    •  How do you know it worked? (0+ / 0-)

      It could have been easy as pie to "sign up" for coverage, but your actual information was not properly transmitted to the insurer.

      •  keep hoping for failure, anything is possible!/eom (5+ / 0-)
      •  How do I know it worked? (2+ / 0-)
        Recommended by:
        auapplemac, Cardinal Fang

        Because I was able to complete an application on healthcare.gov. I had not been able to do that up until yesterday. The website worked great.

        I did not sign up for coverage through the marketplace after I saw the plans available to me and after receiving my eligibility notice, which states I am not eligible for any tax credits.

        People need to understand that the ACA is not going to be a wonderful cost saving panacea for everyone. There are going to be a lot of middle income earners like me who already buy their own insurance who will see their rates go up (a lot). I would see a 55 percent increase in my monthly premium over the plan I have now. And that's just a Bronze plan. The cheapest plan I could get.

        Sorry to be a buzz kill but that's the truth.

        •  That's not "working." (0+ / 0-)

          When you actually have insurance coverage, that's "it worked."

          •  I already have insurance coverage (1+ / 0-)
            Recommended by:
            TofG
            •  Nobody said it was 100% better for everyone (4+ / 0-)
              Recommended by:
              limpidglass, GRLionsFan, TofG, eglantine

              You haven't provided any details about your current coverage or the plans available to you.  Since with the ACA there are so many advantages to you there are only a few possibilties:

              1) Your current coverage is a junk policy that is either being canceled by your insurance company now, or it will be soon when they go to change something (such as the premium) and it falls out of compliance with the minimum coverage standards.

              If this is the case, then yes, you will almost certainly start paying more for real, actual health insurance. We knew this was going to happen to people in that situation years ago. The benefit is now the money they pay for insurance is actually going to be used for their benefit rather than being thrown away. There are numerous examples of people with junk insurance having their policies canceled once they start needing it, ridiculously low maximum benefit caps, huge out of pocket maximums, etc.

              2) Your current coverage is a mistake - we've heard of at least one example of this where a couple had really great coverage at a really cheap price and they could not find a comparable replacement policy on the exchange. When their insurance company was contacted about this, the insurance company said that the current policy these people had was completely out of line and they could not figure out how these people were paying so little money for such great coverage. That policy would be canceled within a year now that the insurance company was made aware.

              3) A very small minority of people who are healthy, make a good income and have an insurance policy that isn't "junk" but it does not comply with the new minimum requirements of the ACA. There is either a maximum benefit amount, or an extremely high deductible or co-pay, or there are other restrictions that make the policy fall out of compliance with the minimum benefit requirements.

              The benefit to these people are the protections afforded by the ACA minimums, particularly the removal of maximum benefit caps. The trouble is, the increased benefits means that the monthly premium might be increased as well.

              So, which one is it for you?

              [Terrorists] are a dime a dozen, they are all over the world and for every one we lock up there will be three to take his place. --Digby

              by rabel on Mon Dec 02, 2013 at 09:54:07 AM PST

              [ Parent ]

              •  Closest to #3 (1+ / 0-)
                Recommended by:
                rabel

                My current insurer has offered me a policy for $5.00 more a month that complies with the ACA. If I go through the marketplace the cheapest Bronze plan (from the same insurer btw) would increase my monthly premium 55 percent. Ridiculous! Guess which one I'm going to buy.

                •  Ridiculous! (0+ / 0-)

                  It is ridiculous, that your insurer is offering one plan to you and not to everyone else. This is very good for you and does not reflect poorly on the exchange at all.  It reflects very poorly on your insurer as a dumb business decision.

                  I'm going to guess that in one year your plan will either be phased out, the price increased, or your plan at your cost will be offered on the exchange.  If I'm wrong, I'll owe you a beer!

                  [Terrorists] are a dime a dozen, they are all over the world and for every one we lock up there will be three to take his place. --Digby

                  by rabel on Mon Dec 02, 2013 at 04:56:34 PM PST

                  [ Parent ]

        •  you have purchased a piece of paper, (1+ / 0-)
          Recommended by:
          auapplemac

          which may or may not mean you will get actual health care when you need it. You won't know until you actually get sick.

          It has "worked" only in the sense that it allowed you to purchase that piece of paper.

          Caveat emptor is the principle here. The insurance companies will devise an endless array of tricks to squeeze you. That's how they make their money. The policy that looks so straightforward and clear, probably isn't. If it were, they wouldn't turn a profit.

          As for the ACA being more expensive for some people--if it costs them more without benefiting them, then why should they support it? Some people are getting kicked off their insurance for various reasons, others may see premium rises, and no doubt other things will happen. Why should any of them support the law?

          "In America, the law is king." --Thomas Paine

          by limpidglass on Mon Dec 02, 2013 at 09:29:43 AM PST

          [ Parent ]

  •  Further improvements for HealthCare.gov! (9+ / 0-)

    It’s wonderful to hear how the right-wing pundits have fallen silent this morning. The GOP chorus shouting lies and disinformation now has one less thing to shout about. The fact that the front end of HealthCare.gov is working, and with far better capacity, is an important milestone.

    Jeff Zients & co now need to press forward with undiminshed speed.
    There is plenty of more work to do, including:

    -- Fix the back-end reports to insurance companies
    -- Get the payment functionality up and running
    -- Launch the Spanish version of HealthCare.gov
    -- Get the small-business site up and running
    -- Continue to optimize HealthCare.gov
    -- Further expand the capacity as deadline approaches
    -- Better integrate the efforts of Navigators
    Also, I have a suggestion: HHS should now start releasing weekly reports. The enrollment surge is here – and that is the best way to create a positive ACA narrative, as well as to drive more people to enroll.
    .

    “The meaning of life is to find it.”

    by ArcticStones on Mon Dec 02, 2013 at 08:49:36 AM PST

    •  My thought too. (4+ / 0-)
      Also, I have a suggestion: HHS should now start releasing weekly reports. The enrollment surge is here – and that is the best way to create a positive ACA narrative, as well as to drive more people to enroll.
    •  Overcoding leading to additional problems? (0+ / 0-)

      Read an interesting article by a Techie over the weekend.  He had learned that the ACA website contained 500 million lines of code, in comparison he stated that Facebook contains about 20 million lines of code.

      He drew two conclusions - the process was deliberately overbuilt to bilk the federal government out of money because so much coding couldn't be justified; and because the site was overly complex anytime that there was a change to the regulations that required updates to the website it would be a nightmare.  

      Because one change would impact so many other areas of code.  Meaning, that (1) as use of the site ramped up many other problems would be found; and (2) fixing those problems would be very difficult to properly test.

      It's great the site is better than it was, but if this guy is correct the website may be a continuing source of concern.

  •  For those saying it is working (0+ / 0-)

    are you referring specifically to healthcare.gov or for your state's marketplace site?

  •  I'm one of the 10% who can't (5+ / 0-)

    get through the process.  We finally got our application processed and received our subsidy confirmation but still can't get through the "set" process.  Been trying since Nov 12, called multiple times and been told multiple times someone would call us back to fix the problem (the healthcare.gov personnel get the same error message I get when they tried to access my account).  I've picked out our policy and am desperate to get this fixed as I lose my employer insurance Dec 31.   For medical reasons  I've been told to cut back my hours to no more than 25 a week but i wasn't too worried about it seeing that we could get affordable insurance through the ACA.  That was several weeks ago.  Now I'm starting to sweat.  

  •  Typical Obama administrtation. (0+ / 0-)

    Concentrate on what looks good to the voters, rather than the substantive part of a problem.

    As long as the voters can "sign up" with no visible problems, they don't give a shit if the actual information transfer to insurance companies is still a clusterfuck.

    It takes the heat off Obama.

  •  Backend should be working now. (1+ / 0-)
    Recommended by:
    auapplemac

    No time left for fixing.  End of the month is too late.

  •  Complex byzantine process will have problems (7+ / 0-)

    We just need to hang together and solve the problems.
    No sense in going all "Chuck Todd" over this. Let the MSM focus on the negatives.

    How often do you hear anybody touting control of pre-ACA abuses such as recission, pre-existing condition denial, lifetime coverage caps, medical loss ratio control?

  •  Having worked for a couple of regional insurers (10+ / 0-)

    over the past decade, on the IT side, I can attest that this is not necessarily the most tech-savvy of industries run by the most tech-savvy of executives and managers, most of whom come from a more traditional insurance, sales and marketing than a tech background, and don't always "get it" when it comes to the role that technology plays in business, and how it really does require a very different business approach both because of the things that it makes possible, and because of the things that it makes necessary.

    E.g. the data one has to work with tends to be all over the place, meaning inconsistent, redundant, incomplete, inaccurate, untimely, corrupted, etc., the insurance plans developed by marketing types in collaboration with actuaries and compliance are often not easy or simple to translate into software (because of the many rules that business needs and government regulation impose that don't always play nice with each other or reality), and there's often poor understanding and estimation of the costs, effort tradeoffs and time required to implement it into software--"just get it done" is kind of idiotic.

    Basically, unlike, say, airlines or finance, this is an industry still dominated by non-tech savvy people, yet is obviously very tech-dependent these days, like all industries, and that's caused a lost of problems in integrating technology into it. I suspect that that's been one of the reasons for the botched rollout of the ACA, both in government and in industry.

    "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

    by kovie on Mon Dec 02, 2013 at 09:04:52 AM PST

    •  Very true .... (1+ / 0-)
      Recommended by:
      FiredUpInCA

      I see a lot of this as the companies try to move from claims paying shops to quality monitoring and quality improvement operations.  The data you need does exist someplace, but the various "someplaces" don't talk to each other and often have conflicting data fields. For example, making sure that "Sally Jones" in on DB is the same "Sally Jones"(maybe with a middle initial or middle name?  Maybe at a different address? etc.) in another DB.

      •  One job I had required that I take (10+ / 0-)

        a bunch of data feeds from different sources in different formats, dump it into a database (that I created because none existed), clean it up and make it consistent, accurate and relational (by far the most time-consuming part of the job), and then spit it out to publishable PDFs to be posted online or printed and sent out as part of your annual insurance packet telling you what doctors you could choose, drugs you could get, etc.

        The data was a mess, e.g. one row had "123 1st Ave" and another "123 First Avenue", and I had to standardize it all yet distinguish between entries that looked alike but actually were unique. Lots and lots and lots of such data problems and I had to make sure to not introduce my own assumption-based errors. Plus the execs I worked with, while they knew the business or medical side of things well, were kind of clueless about technology, nor cared.

        I'm sure that my experience is hardly unique, not just in this industry but in many others. We're still very much in a long-term and painful transitional period between the pre-technology to post-techology eras. The "upside" is that for people with the technical skills (as well as people skills AND patience!), there will be good, and well-paying, jobs to be had for years, helping to bring things into the post-technology era.

        "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

        by kovie on Mon Dec 02, 2013 at 09:28:39 AM PST

        [ Parent ]

    •  This. (1+ / 0-)
      Recommended by:
      FiredUpInCA

      "Believe nothing, no matter where you read it or who has said it, even if I have said it, unless it agrees with your own reason and your own common sense."

      by grape crush on Mon Dec 02, 2013 at 09:12:18 AM PST

      [ Parent ]

      •  This is not an excuse, mind you (2+ / 0-)
        Recommended by:
        ruellia, ferg

        for the botched rollout, as Obama should have put a lot more, and better, resources on project and program managing this beast. It would have been less than perfect even then, but probably not nearly as bad, especially in terms of optics and politics. But it is, in part, an explanation.

        "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

        by kovie on Mon Dec 02, 2013 at 09:31:59 AM PST

        [ Parent ]

        •  Understood... (1+ / 0-)
          Recommended by:
          kovie

          ...however, to the aforementioned point regarding tech-savvy management, it's largely not there in government or in the upper levels of corporate America.

          I've had my own headaches caused by my company's leadership having a bright idea, laying out vague requirements, and telling their underlings to make it happen. They aren't close enough to the project to understand what it is they are really asking for, much less effectively staff and lead an undertaking of large magnitude.

          And they can't be expected to, really. At some point management has to delegate and trust people when they say they can meet a commitment.

          That is, as you say, in part an explanation. Another would be the rat's nest of backend government and private data systems that would need to be integrated together in order for everything to work, and I don't know if that will ever be perfected.

          "Believe nothing, no matter where you read it or who has said it, even if I have said it, unless it agrees with your own reason and your own common sense."

          by grape crush on Mon Dec 02, 2013 at 11:14:11 AM PST

          [ Parent ]

          •  I don't know if it's upper management's job (2+ / 0-)
            Recommended by:
            grape crush, OrganicChemist

            to come up with new ideas, so much as to approve of those that they believe are worthwhile and feasible, and then make sure that the proper human and other resources are allocated to them to assure that they get done properly, and check in from time to time to make sure that that's the case and make adjustment when and where necessary.

            It's the job of those below them to come up with these ideas, do proper cost/benefit, ROI, feasibility and other studies, maybe conduct a small pilot proof of concept trial, and only after they've passed these tests present them to upper management, with data to make their case. And then, if approved, make it happen. At least, this seems to make most sense to me.

            But this isn't how things work in many places, I suspect in large part because upper management sees itself as being in the business of coming up with fast and impressive results, which is possible under certain circumstances and with a huge allocation of resources (e.g. WWII), or in "nimble" startups (where no one sleeps), but not in most. And when such demands are inevitably unmet, the people who get blamed are those below them, not them.

            We have a fundamental failure in our upper management culture in the US, in the private and public sectors, that's focused on rewarding only the people at the top, and coming up with instant and impressive results. It's the Mother of All Bubbles, and it's killing us. We need to get back to a more realistic and sustainable model. Enough of overpromising and underdelivering, and then patching the gaps with yet more bullshit and bubbles.

            "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

            by kovie on Mon Dec 02, 2013 at 11:35:54 AM PST

            [ Parent ]

            •  It is their job to provide leadership... (0+ / 0-)

              ...and direction, even if they don't get their hands dirty with the details. Whether that's setting production targets or marketshare goals, it's on them.

              I do agree that there's a problem in our upper management culture, but that would mean changing the way our execs are compensated and taxed, and we can't do anything to hinder the progress of these captains of industry, right?

              "Believe nothing, no matter where you read it or who has said it, even if I have said it, unless it agrees with your own reason and your own common sense."

              by grape crush on Mon Dec 02, 2013 at 12:18:17 PM PST

              [ Parent ]

              •  Whatever their job is (0+ / 0-)

                Surely part of it should involve some reality-based interaction with the real world and their subordinates, so they're not making unrealistic demands or needlessly risking their companies' brands and reputations. But so long as compensation isn't tied to performance and executive boards are rubber stamps controlled by them and their proxies, this won't happen. And it's disastrous for everyone below them, and the economy as a whole.

                If this is what Harvard, Stanford and all the other big name B-Schools have been teaching, then they're worse than useless. They're dangerous and should be shut down. Economies don't exist for the profit and benefit of a few at the expense of everyone else, nor do companies. That's not even socialism. That's sustainable capitalism and basic human decency.

                "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

                by kovie on Mon Dec 02, 2013 at 01:22:40 PM PST

                [ Parent ]

  •  How big are these problems? (7+ / 0-)
    While insurers will start covering people who pay their share of the premium, many insurers worry the government will be late on the payments they were expecting in mid-January for the first people covered.

    “We want to be paid,” said one executive, speaking frankly on the condition of anonymity. “If we want to pay claims, we need to get paid.”

    Insurers said they had received calls from consumers requesting insurance cards because they thought they had enrolled in a health plan through the federal website, but the insurers said they had not been notified.

    “Somehow people are getting lost in the process,” the insurance executive said. “If they go to a doctor or a hospital and we have no record of them, that will be very upsetting to consumers.”

    Thomas W. Rubino, a spokesman for Horizon Blue Cross Blue Shield of New Jersey, which says it has about 70 percent of the individual insurance market in the state, said the company had received “some but not a lot” of enrollments from the federal exchange.

    Federal officials are encouraging insurers to let consumers sign up directly with them. But in the middle of this online enrollment process, consumers must be transferred to the federal website if they want to obtain tax credit subsidies to pay some or all of their premiums in 2014.

    http://www.nytimes.com/...

    While it is clear the backend still needs to be fixed, I am not getting a sense from any of the news reports quoting insurers, how extensive the backend problem is.

    Exactly what percentage of people who think they have signed up for a plan in the Federal exchange, actually have not, is what I want to know.

    This NYT report saying insurers are getting calls requesting insurance cards for coverage that the insurers haven't been notified of, does not tell me how many insurers are experiencing this problem nor how many callers fall into this category.

    “If they go to a doctor or a hospital and we have no record of them, that will be very upsetting to consumers.”
    http://www.nytimes.com/...

    How many people are going to go to a doctor or hospital assuming they are insured by a company who hasn't sent them an insurance card or enrollment confirmation?

    I am not satisfied that I am getting a clear and accurate picture of the extent of the backend problem based on random, unquantified quotes from insurers.

    I would like to see what percentage of backend transactions are successful and what percentage are problematic, in clear hard data. Just like I know that for the consumer, the page load time shrunk from 8 seconds per page to 1000 milliseconds.

    I want hard data from Healthcare.gov and insurers in order to understand how big the backend problem is because according to Jeffrey D. Zients, the point person in charge of repairing Healthcare.gov:

    Software fixes installed on Saturday night should improve not only the consumer experience, but also the “the back end of the system,” which consumers rarely see.
    http://www.nytimes.com/...

    Yet the insurers still say there has been no improvement.

    "I am not interested in picking up crumbs of compassion thrown from the table of someone who considers himself my master. I want the full menu of rights." (From "You Said a Mouthful" by Bishop Desmond Tutu - South African bishop & activist, b.1931)

    by FiredUpInCA on Mon Dec 02, 2013 at 09:15:01 AM PST

    •  Back end issues could be disastrous for some... (1+ / 0-)
      Recommended by:
      FiredUpInCA

      We have a close friend who is an executive for one of the medium-sized insurance agencies involved with this. She said that the volume certainly has picked up, but there are still way to many issues with the data feeds.  Also, the issues are all over the place - garbled fields, blank fields, other crazy data, many duplicates, etc. When it was just a trickle, they just threw a lot of people at it to manually try to sort it all out. As the volume increases, that is no longer possible. Many people will probably eventually get their insurance, but for a very large number of people, there is going to be some heartache when they find out they aren't really enrolled after all.

      A huge issue is going to be subsidy funds paid by the government directly to the insurers. Nobody seems to have a feel on how this will be successful at all. The whole process seems fraught with problems and many insurers are worried they will be left holding the bag if there are all kinds of problems and the subsidy payments are delayed or  incorrect. If a subsidy for an enrolled customer is the vast amount of the payment, but the insurer never receives it, do they deny coverage? What a nightmare and PR disaster that will be. Hopefully they will be able to focus on these issues now that the front end is working better, but with the limited time for many people, this will  not be pretty.

  •  Obama's not on the ballot anymore (1+ / 0-)
    Recommended by:
    limpidglass

    So, folks can stop kissing his heinie. It's OK. You can root for good, progressive government and help for millions of Americans without worrying at all whether it will somehow hurt Obama's chances for reelection.

    And, umm, no. Pointing out the Obama administration's fuck ups with respect to Obamacare doesn't mean you're "rooting for it to fail." Quite the contrary.

    I'm hoping it works. Unfortunately, we are stuck with the incompetent political hacks, fixers and handlers of the Obama administration who care more about PR than fixing the nuts and bolts back end problems facing Healthcare.gov.

    Because, you see, if they fixed the fundamental database integration problems that directly connect with insurers (which should have been done first) the front end interface with the public on the website would still be buggy and inconsistent. But, that's a minor irritant, frankly.

    So, they make some cosmetic changes to the website that gives the public and media the illusion that it's working properly, but still have massive back end problems to fix.

    As I said, Typical Obama administration.

    •  Exactly. (0+ / 0-)

      Reminds me of a story I once heard about a platoon commander in World War II. He and his men were taking heavy fire from a machine gun nest, and although he had a mortar and a bazooka, they were both out of order and needed to be repaired before he could fire back.

      So what did the idiot do? Rather than remain out in the open until he could get his weapons working, he told his men to cover behind a concrete wall until they had the capacity to destroy the nest.

      Bottom line: this guy did absolutely nothing to take care of the real source of danger, but took cover instead.

      This administration's priorities are similarly messed up.

  •  Covered CA is sucking right now (1+ / 0-)
    Recommended by:
    schnecke21

    I put in an application on Nov 1 and was told 2-3 weeks until it would be processed, at which point I would be contacted.  I didn't hear, so I decided to call bright and early this morning.  After waiting on hold for 1 hour, I tried the chat option, which left me waiting a half hour before telling me that there was no one available and to try again later.

    I tried emailing early last week.  No response so far.

    I tried logging into the website and kept being told I was entering incorrect information, but there was no way for me to reset my password or get the correct info.  It would not let me form a different account.

    So I'm stuck for now and kind of pissed.  I appreciate the options given to me by the ACA, and look forward to better coverage, but for one of the "better" systems, the California website enrollment system has a lot of flaws that could frustrate someone less favorable toward the system than I am.

    •  Oh and (0+ / 0-)

      the website is slow loading and barely working right now.

      Lest you say that this is just the post-holidays rush, I have tried on two earlier occasions and gotten the same experience.

      •  Just tried Covered CA (0+ / 0-)

        Seems pretty quick now.

        I'll stop calling him Boner when he stops saying I belong to the Democrat Party.

        by al23 on Mon Dec 02, 2013 at 10:18:01 AM PST

        [ Parent ]

        •  never mind (0+ / 0-)

          It's clocking on the "individuals and families " tab.

          Sorry

          I'll stop calling him Boner when he stops saying I belong to the Democrat Party.

          by al23 on Mon Dec 02, 2013 at 10:20:07 AM PST

          [ Parent ]

          •  The initial click works (0+ / 0-)

            But after that it's stuck and refuses to load.

            I'm waiting on the chat option again.  Maybe there will actually be someone ready for me this time.

            •  Nope -- no one there again (0+ / 0-)

              And when you ask for an email response, it sends you to a page that says: "Permission Denied: You do not have permission to access this document."  WTF?

              Who has time to wait 1+ hours every day to deal with this until it's resolved?  I won't lose coverage, but if the application doesn't go through before January 1, I get hit with a much higher premium for the coverage I have.  I have no reason to believe my application won't be processed in time, but this is very frustrating.

              •  WOW, and now it won't let you even make a call (0+ / 0-)

                I tried the main phone number again, got the error music, and heard "We're sorry, all circuits are busy now."  I would be happy to call again in the evening, except that they're not friggin available then.  

                •  Okay, signed up online (0+ / 0-)

                  Took way too long (4 hours trying, overall), but I finally got through to someone and it's done.  It sounds like they're ironing out the kinks, and more people are being trained... hopefully soon.

  •  You cite backend problems (3+ / 0-)
    Recommended by:
    reginahny, FiredUpInCA, askew

    and linked to the NYT.

    Problem is, the only mention  of these problems in that article is from spokespeople representing the insurance industry.  I would like to hear more on  this from the administration.

    I'll stop calling him Boner when he stops saying I belong to the Democrat Party.

    by al23 on Mon Dec 02, 2013 at 10:13:01 AM PST

  •  insurers at back end... (2+ / 0-)
    Recommended by:
    TofG, FiredUpInCA

    So say the "insurers" at the back end who are known for their integrity, technical saavy and deeply rooted concern for people.

    On what planet did we (the 'small d' we) not predict that if the site was fixed on schedule the Republimedia would not immediately launch some other Waterloo?

    Pre ACA there was NO opportunity for health care for millions of USians. None. Not even crap plans. None. Now there is.

    It is not perfect, neither were Food Stamps, Medicare / caid, Social Security in TWO FREAKIN months. But yeah, I'm going to base my next hair on fire freakout on what Insurance companies complain about. Not. YMMV.

  •  fix one bottleneck, unmask another (2+ / 0-)
    Recommended by:
    eps62, grape crush

    A few years ago, our hospital brought in an industrial engineer to study the way we schedule procedures, and how we bring patients through the system.  (whether for xrays, cat scans, endoscopies or major surgery) He was a Toyota alumni & an advocate of 'lean management'

    Some interventions should have been obvious:  Don't have patients come register on the 5th floor, then go down to the 4th floor for blood work.  The bloodwork could be scheduled in advance.  Others were the result of observation:  They videotaped techs going into an OR after a case was completed & assembling the equipment for the next case.  The Toyota group asked why the assembly couldn't take place outside the OR, before case A was completed, and just rolled in for case B.  This took 10 minutes off the turnaround time between cases, which multiplied by 8 added more than an hour of procedure time without building any new rooms.  Two techs were promoted to supervisory roles to organize the remaining techs. No one had to hired, fired or demoted.

    Anyway, it was something during the lectures that we heard that comes to mind.  Scheduling & room cleaning were streamlined at a mid-western endoscopy center.  The first day it was rolled out, everything came to a halt at noon: No scopes.  Lean management is a failure.  Let's go back to the old way.  A quick search revealed all the used scopes sittingb at the end of the hallway, waiting to be taken to the sterilizing center. More used scopes came down than central processing was able to clean.  You don't go back to the old way, yiou need to briing central processing up to speed.  

    So nuts to the insurers.  They have to get their act together.

  •  This diary seems excessively pesimistic in tone. (3+ / 0-)
    Recommended by:
    snapples, askew, ArcticStones

    There have been significant improvements and will be more.

  •  Sometimes I Have To Wait A Couple Of Minutes..... (2+ / 0-)
    Recommended by:
    ArcticStones, FiredUpInCA

    when I've gone on line to navigate my insurance agent or doc's or my dentist websites.  There have been times when they screw up, record the wrong info etc, etc, etc.  I've NEVER gone ape
    over their website.

    Once.....I called FOX News & was on hold for 20 minutes.  Several times, I've called John Boehner's office & been on hold for 10-15 or even 20 minutes when I've been forced to listen to that phony patriotic clap trap he plays.

    Obamacare has made significant, vastly improved progress.

    Get over it people.  It's going to be an awesome little system soon.......and for millions, the first time they have had medical insurance in their entire lives.  

  •  ACA - Healthcare.gov site (1+ / 0-)
    Recommended by:
    belinda ridgewood

    I applied twice, early on and both times my apps disappeared into the ether. Nobody I spoke with could tell me where they went. I did another one on the phone and they lost that one as well. I finally was able to get an app all the way to the ID verification process but got a message that I had already tried too many times and to call Experian. That was news to me. Called Experian was was told I needed a special code. Called Healthcare.gov back and they said they cannot provide a code (huh?). I uploaded my DL and waited. And waited. And waited some more. Called them back after two weeks of seemingly no progress. They said sorry, nothing we can do and said to wait until ID was verified. A week later nothing. They escalated my case and I was to get a call back within 3-5 business days. Ugh. Call never came so I called again. They gave me another callback date which came and went. Went back online today and thankfully was able to delete my last application and start all over again. Did another app today and got to the ID verification process. I was  stopped dead in my tracks again. Called again. Got another call back date.

    This, for me, has been a complete disaster. As an Obama voter for 2 years running, it gives me great pause. I do have faith but they really need to get their shit together instead of having apologists answering the phone. They need people who can solve issues on the spot.

  •  That was what insurance lobby reported (1+ / 0-)
    Recommended by:
    FiredUpInCA

    I am dubious.  This sounds like usual health insurance corporate bullshit.  Face it, the negative story is over.  ACA works and people will get signed up.  Bugs, smugs ... all computer has bugs.  It will get fixed.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Riane Eisler

    by noofsh on Mon Dec 02, 2013 at 04:59:20 PM PST

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