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Questionable design blamed for health website woes

Posted October 8, 2013

— A decision to require that consumers create online accounts before they can browse available health plans under President Barack Obama's overhaul appears to have led to many of the program's technical problems, independent experts say.

Most e-commerce websites – as well as medicare.gov – are not designed to require those merely browsing to set up accounts. But it's one of the first steps on healthcare.gov.

Consumers trying to create their accounts multiplied the volume of online transactions that overwhelmed the website last week, causing long waits and frustration. Many people were stopped by a balky security questions page.

The administration threw in additional computing hardware to handle the volume and deployed software experts to patch the mechanism for creating accounts, but reports of delays persisted Tuesday.

"I really honestly have no idea what's available to me, and I have yet to make it all the way through to review any plans," said Amy Williamson, who has been trying to shop for insurance on North Carolina's exchange for the past week.

Williamson, the controller for a small Web design company, wants to compare insurance options after Blue Cross Blue Shield notified her that the monthly premiums on her police would increase from $192 to $314 in January.

She has been able to create an account on the exchange but hasn't gotten past that point.

"When I put my user name and password, I get various errors, and it changes every day," she said. "I'm trying to review my application details, and then i get, 'Sorry, we can't find that page on healthcare.gov.'"

Williamson said the website isn't convenient, but she will continue trying a couple of times a day to get through so she can see her insurance options.

"I have to work, and have two kids and stuff at night, and getting here trying to figure out what's available all day is not convenient at all," she said. "It's extremely frustrating, and being a mom with two kids, I'm very concerned with what my expenses will be in 2014."

Healthcare.gov website troubles Frustration over health insurance website grows

Federal officials said they are working to improve the website amid continued high traffic, adding server capacity and making hardware and software adjustments. Wait times have been cut in half in recent days, they said.

“The work done to increase access to healthcare.gov in light of the overwhelming demand is beginning to show results. Call center wait times are seconds, not minutes, and people have been enrolling over the phone 24/7," Fabien Levy, a spokesman for the U.S. Department of Health and Human Services, said in an email to WRAL News. "Our work to expand the site’s capacity has led to more people successfully applying for and enrolling in affordable health coverage online, with wait times being shortened by approximately 50 percent since Friday.”

For Obama, glitches involving his signature legislation are an unwelcome twist. A devoted smartphone user, his political campaigns were models of high-tech efficiency. Yet, the problems that have surfaced so far with healthcare.gov don't even involve the site's more complicated functions.

Allowing consumers to browse anonymously was one of the recommendations of Enroll UX 2014, a $3 million, 14-month project to design an optimal user experience for the insurance marketplaces. The well-known San Francisco design firm IDEO led the project and undertook extensive consumer interviews to create an easy-to-use site.

"The first thing people said to us is, 'I need to be able to understand what my options are,'" said Sam Karp, vice president of programs at the California HealthCare Foundation. The nonprofit helped organize and finance Enroll UX 2014, which also involved the federal government and 11 states.

Karp said he was concerned when he tried the federal website last week and found that anonymous shopping wasn't part of it. He considers the omission a "major design flaw."

"That was a design recommendation, and they didn't do it," Karp said.

While several states that built their own online marketplaces do allow for window shopping, the federal site serving 36 states does not. Technology-wise, requiring accounts greatly magnified the amount of work the federal website would have to do, increasing chances of bottlenecks and other problems.

"There is an awful lot of stuff going back and forth in this system," said Bill Curtis, chief scientist at CAST, a software quality analysis firm, and director of the Consortium for IT Software Quality, which develops standards. "There is a lot of inefficient (software) code in there, and then when you throw a huge load on it, it really exacerbates the problems."

Added Karp, "If they had had anonymous shopping, many people would have taken that route and it would have potentially relieved the traffic on the identity verification part of the site."

The health care law was designed to provide insurance for people who don't have access to coverage on the job. Middle-class uninsured people can buy a government-subsidized private plan, while the poor and near-poor will be steered to Medicaid in states that agreed to expand the safety-net program. The online insurance markets were envisioned as the 21st century portal to an overhauled system.

Health and Human Services spokeswoman Joanne Peters said Tuesday the government omitted a window-shopping function because officials first wanted consumers to know the amount of the subsidy they might be eligible for. Those income-based tax credits can dramatically reduce premiums for people with modest incomes, and personal financial information is needed to calculate the subsidies.

"Our process allows us to show consumers plans with prices that reflect what they will pay with the tax credit they may be eligible for," Peters said. "Window shopping would not allow for this."

The result seemed strange to Maureen Bardusk of Galena, Ill., who's hesitant about giving her personal information before she can shop.

"I'm reluctant to give information so it can be tracked when I'm simply looking for information," said Bardusk, who's looking to replace expensive temporary coverage she's had since her husband was laid off in June.

"I don't want to be part of a marketing scheme," she added. "I assume they set it up that way so they could see who's coming in, how many times they come in and what they buy after they get there...but that isn't really customer-oriented."

Colorado, one of the states that designed its own market, made a deliberate decision to allow window-shopping, the opposite of what the feds decided.

Officials didn't want to "spook" consumers, said Gary Schneider, IT program manager for Connect for Health Colorado, the state's marketplace. "We were trying to be less intrusive and create a more consumer-friendly experience." Consumers are allowed to set up their accounts after they've narrowed their options.

Window-shopping is the norm at most e-commerce sites. Consumers can shop online for books at Amazon, flights at Travelocity, hotel stays at Hotwire and staples at Staples — all without creating an account or registering. The sites ask for personal information only when customers say they are ready to check out.

The Obama administration says government technical experts are on their way to solving the accounts creation problem. Independent experts say other glitches may be lurking as the more complicated functions of the website come into play, including real-time verification of identity, legal residence, family composition and income.

"My suspicion is once they get these problems resolved, then we are going to the next layer, and that will expose new problems," said Curtis, the software quality expert.

"Since this system was developed in a rush they did not have time to thoroughly test it," he added. "The American people are now doing that for them."

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  • nuts4u Oct 10, 2013

    Nearly three years to get this right and all the backing by the federal government and still it did not work. The obama and his bunch blame it on volume. Well they knew how many were uninsured why didn't they plan for that number. obama will not take the blame for this just as he has side stepped the blame for everything else that has happened during his rein. The worse is yet to come. Over billing over paying and then throw in the IRS as chief enforcer.

  • Mon Account Oct 9, 2013

    Stymie, if you've ever tried to buy season tickets or concert seats or even book airline travel ============================================================ ====

    This is NOT buying tickets. this is something they have had YEARS to get a handle on and have not. Don't find excuses for the failures.
    stymieindurham

    --

    This is not an excuse for failures. It is a reason for it. It is expected. It is part of the lifecycle of software development, release and support.

    In an ideal world it wouldn't happen but, as pointed out with many examples, it happens all the time.

    Did Ticketmaster fail?
    Did Facebook fail?
    Did Microsoft fail?
    Did iOS7 fail?

    No - they behaved as anticipated.

    If you can come up with a single example of a computer system that was released and working 100% and stayed that way then I'd be more than floored.

    Remember: if you don't like the ACA and want to use the computer system's expected flaws as a reason it is a bad law, you're barking up the wrong tree. Woof woof!

  • Mon Account Oct 9, 2013

    "This is a non-event. PR-wise it's bad but if you work in software you'd be shocked if there were no problems at launch." ============================================================ ====

    So, that is an acceptable business practice - failure is acceptable?!!! You won't be in busienss very long if the word get's out.
    stymieindurham

    Yes, it is an acceptable business practice. It is not failure- it is going live with known flaws.

    Every corporation that produces or consumes software understands that this is expected. No one expects that the same Windows XP CD released on day one would be able to be used to install again even 6 months later without getting hit by Windows Updates.

    If software wasn't released until exactly perfect then the business would fail... because it would never be released (or installed).

  • LKG-Lover Oct 9, 2013

    It is broke. Thank you Obama. Now we have very expensive healthcare without any improvement in service. GDP is predicted to be 1.6 for 2013, but it will probably be even lower for 2014 due to the impact of people not having any money to spend on products because their healthcare costs have increased. this will slow the economic recovery if it doesn't kill it.

  • junkmail5 Oct 9, 2013

    Not true. HHS, Sebelius who works directly for Bo is a shining example of an incompetent bureaucrat dictating arbitrarily health law. Delay for businesses but not for individuals.- UNC006

    uh... what?

    delaying a requirement to OFFER INSURANCE is not, in ANY way, "dictating health law"

    It'd be like saying "The government waiting 1 year to require Geico to cover car accidents with deer is dictating the automotive industry"

    You're first not understanding the difference between INSURANCE and the SERVICE.

    Then you're being dishonest about even THAT.

    Further- the delay is over an entirely DIFFERENT item.

    One is a requirement to HAVE insurance. It's fundamental to the law working.

    The other is a requirement for business over a certain size to OFFER insurance to employees. Which isn't since they can otherwise buy it elsewhere until that happens.

    Delaying one doesn't imply delaying the other AT ALL since they're DIFFERENT requirements applying to DIFFERENT groups.

  • UNC006 Oct 9, 2013

    Again- Obamacare isn't the government "running" your healthcare.

    AT ALL.

    Not true. HHS, Sebelius who works directly for Bo is a shining example of an incompetent bureaucrat dictating arbitrarily health law. Delay for businesses but not for individuals. She actually thinks part-time employment is declining not to mention the smooth roll-out. People laughing AT the HHS is not a good thing...

  • grimreaper Oct 9, 2013

    What was the estimate for healthy males 26-30...a 230% average increase in costs or something like that...sounds fair, and affordable...really, why work and pay that when you can become a bum, get free stuff from the government...no incentive to work...none...

  • grimreaper Oct 9, 2013

    So, the government cannot even effectively run tax collection and you thought they could run something as complicated as healthcare...ok...where is Reverend Jim when you need him...

  • veyor Oct 9, 2013

    Government, you're no Apple Computer Company. I know of two families that are being forced to drop insurance coverage altogether because of the doubled cost.

  • duster 340 Oct 9, 2013

    I like to ask this question have any of you had any luck with the web site? I have not and like to ask WRAL have you tried the site?
    Thanks

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