President Obama laid out the big-picture pitch for being critical and optimistic about Healthcare.gov at the same time in his remarks Monday morning. Later that afternoon, senior administration officials provided a more granular look at White House views on the behemoth website, its unacceptable performance so far, and where they think this is all going in the five months and one week of open enrollment left.
The meeting took place in the West Wing's basement Ward Room, notorious within the White House for its impenetrability to cell phone and wireless signals, and decorated with naval imagery and a bristly fall floral arrangement. This is the view from inside that bunker:
- At the outset, the White House anticipates Medicaid enrollment may go faster than private-insurance enrollment through the exchanges because it involves only the extension of an existing system, and can sometimes—as in Oregon—be done in one big batch for tens of thousands of people who've already been identified by a state. This is also what happened in Massachusetts in 2007, when Commonwealth Care was launched; a free Medicaid-like program that was part of the state's implementation of its universal health-coverage law drew far more people than private plans during the earliest months of enrollment.
- The administration thinks October will see the smallest number of people purchasing insurance. The real shopping in the individual market will begin in mid-to-late November and December. The White House has not released a figure for how many have gained coverage so far, though it's made public that nearly 500,000 have applications in process or completed for a mix of private insurance and Medicaid coverage through the state- and federally run exchanges.
- Officials expect the number of people seeking to enroll will spike right before the December 15 deadline for getting coverage by January 1, drop in January, level off in February, and spike again in March in advance of the end of open enrollment for 2014 on the 31st of that month.
- Existing demand on the federal website for state exchanges has been huge, with 20 million unique visitors—not "hits" or pageviews—to Healthcare.gov in the first three weeks. In the first three days, there were 8.6 million unique visitors to the site, which created a well-documented traffic jam.
- While this has been a challenge for the website, to say the least, the White House believes this level of intensity bodes well for finding and reaching new people to buy insurance. Of course, this also means the website issues will need to be largely resolved by mid-to-late November, so that when the anticipated surge of purchasing takes place, people can complete their transactions.
- The strategy for enrolling people has put the website at the center, but there are redundancies built into the system and the other means of enrolling people—by phone, on paper (paper!)—are being strengthened to take some of the stress off Healthcare.gov as fixes are made to the site. Matt Yglesias is right to observe that this clearly was not anyone's plan A.
- The number of people staffing the call center is being increased by 50 percent.
- When Massachusetts rolled out Commonwealth Care in 2007, people used a variety of media to get information, and they took their time doing due diligence on products before making decisions. Based on that precedent, it won't be a surprise if people go the federal or state websites five or six times for information (this is assuming functional sites), and also call the call center, before making a decision about which plan to purchase.
- Cabinet secretaries will be deployed around the country to help encourage enrollment in the months ahead, especially in the key urban areas identified as having high concentrations of the uninsured.
- All the state exchanges are also using a key part of the federal data architecture. The data hub piece of the system, used to verify citizenship, Social Security numbers, and other personal information, is solid.
- As for what is less solid, the Centers for Medicare and Medicaid Services (CMS) has brought in a tripartite "tech surge"—outside eyes, some full-time internal staff, and more contractors—to diagnose problems and debug the code on the federal site. The White House wouldn't say who the contractors and outside eyes were, referring that question to CMS. Update: On Tuesday, HHS released one name—Jeff Zients—and elaborated on the categories of people involved in the fix-it project.
- Officials say CMS isn't lacking any resources to get fixes done.
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