The Crucial Fix the Healthcare.gov Progress Report Ignores

The Obama Administration touts an improved customer experience. But there's reason to fear that it's illusory.
Reuters

On Sunday morning, the Obama Administration took credit for making key improvements to Healthcare.gov, the consumer marketplace for insurance plans. "While we strive to innovate and improve our outreach and systems for reaching consumers," an official progress report states, "we believe we have met the goal of having a system that will work smoothly for the vast majority of users." Its launch "was marked by an unacceptable user experience," but a tech team has now implemented "hundreds of software fixes and numerous hardware upgrades," it noted, adding that "the new management system and instrumentation have helped improve site stability, lower the error rating below 1%, increase capacity to allow 50,000 concurrent users to simultaneously use the site."

This is good news grounded in real fixes.

Put simply, the typical visitor to the site is less likely to encounter a crashed page or an error message, and is more likely to feel that they've successfully bought insurance. 

But will their good feelings be grounded in reality?

What the report elides by focusing on the consumer experience is the fact that back-end fixes are also needed before masses of Americans can actually buy insurance. It isn't enough to improve the front end, where consumers create an account and choose a plan. To sign up, their inputs must reach the insurance companies. 

How is progress on that front going?

The latest New York Times deep dive on efforts to fix the site includes ample reason for concern. "Large parts of the vital 'back end' that processes enrollment data and transactions with insurers remain unbuilt," the story reports. And later on it says of the fixes:

At the outset, the team had made what officials call a very intentional decision to focus their repair effort on making HealthCare.gov work better for consumers. That has meant putting off some “back-end” fixes for insurers, who use the site to receive applications and bill the government for subsidy payments.        

The article makes clear that White House political advisers are closely monitoring the process, but did not address whether the focus on fixing the front end was politics driven, policy driven, or both. There is, however, this chilling section:

... it remains unclear whether the enrollment data being transmitted to insurers is completely accurate. In a worst-case scenario, insurance executives fear that some people may not actually get enrolled in the plans they think they have chosen, or that some people may receive wrong information about the subsidies for which they are eligible.         

Their concern is understandable. If the front end of the site seems to function smoothly, even as parts of the back end aren't built, won't lots of people get the wrong idea about how likely it is that their application will result in their receiving health insurance? When the Obama Administration states that the site "will work smoothly for the vast majority of users," do they mean that it will successfully transmit their applications to insurers, resulting in their actually being covered?

Or do they just mean that consumers can successfully submit their application, regardless of what happens next? A progress report with more clarity on that point is needed. Does a broken back end render the front-end fix useless to some consumers? The progress report's narrow focus on the front end leaves me pessimistic. 

Let's hope I'm wrong.

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Conor Friedersdorf is a staff writer at The Atlantic, where he focuses on politics and national affairs. He lives in Venice, California, and is the founding editor of The Best of Journalism, a newsletter devoted to exceptional nonfiction.

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