HealthCare.gov is a health insurance exchange site operated under the United States federal government under the provisions of the Patient Protection and Affordable Care Act (PPACA, often referred to simply as 'ACA' or 'Obamacare'), which currently serving residents of US states who have chosen not to create their own state exchanges. The exchange facilitates the sale of private health insurance plans to US residents and offers subsidies to those who earn less than four times the federal poverty line. The website also helps qualified people to sign up for Medicaid, and has a separate market for small businesses.
The launch of HealthCare.gov on October 1, 2013 went according to plan, despite partial severance of partial government. However, the launch was undermined by serious technological problems, making it difficult for people to sign up for health insurance. The deadline for signing up for coverage beginning January 2014 is December 23, 2013, at which time most issues have been fixed. The open enrollment period for coverage 2016 runs from 1 November 2015 to 31 January 2016. Country exchanges also have the same deadline; their performance varies.
The website design is overseen by the Medicare and Medicaid Service Centers and is built by a number of federal contractors, the most prominent of the CGI Group of Canada. The original budget for CGI was $ 93.7 million, but this grew to $ 292 million prior to the website launch. While estimating that the overall cost to build the website has reached more than $ 500 million before launch, the Office of the Inspector General released a report that found that the total cost of the HealthCare.gov site has reached $ 1.7 billion. On July 30, 2014, the Government Accountability Office released a non-partisan research which concluded that the administration does not provide "effective planning or supervisory practice" in developing HealthCare.gov website.
Video HealthCare.gov
Background and function
The site serves as a clearing house to allow Americans to compare prices on their country's health insurance plan, to begin enrollment in selected plans, and to simultaneously find out if they are eligible for government health subsidies. Visitors sign up and create their own customized user accounts first, listing some personal information, before receiving detailed information about what's available in their area. Designed to help millions of Americans who do not have insurance, comparative shopping features involve visual formats that are somewhat analogous to websites like Amazon.com and Etsy.
HealthCare.gov also details Medicaid options for individuals. This is related to the expansion of long-term programs undertaken as a joint effort under PPACA. The Congressional Budget Office (CBO) projected that the exchange would be used by some seven million Americans to gain coverage during the first year after its launch; current estimates suggest that the combined figure is slightly above eight million.
Maps HealthCare.gov
Development and history
President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010 in the East Room before a selected audience of nearly 300. He stated that the health reform effort, designed after a heated and fierce debate faced fierce opposition in the US Congress to expand health insurance coverage, based on "the core principle that everyone should have basic security when it comes to their health care". The main goal of PPACA is to increase coverage to the American people either through public or private insurance and control of health care costs. The Congressional Budget Office (CBO) estimates that PPACA will reduce the uninsured amount with an increasing 32 million coverage for elderly people from 83 to 94 per cent. Insurers are not allowed to deny insurance for applicants with pre-existing conditions. The Sunlight Foundation has stated that at least forty-seven private contractor companies have been involved with PPACA in some capacity in the fall of 2013, with the size that led to various policy changes. Reporters writing for The New York Times have called the PPACA the "most extensive social law in force in decades".
A report by Reuters described HealthCare.gov itself as a "key" to the reform move. The development of the website interface as well as the supportive back-end services, to ensure that the website can serve to help people compare health insurance plans, both are outsourced to private companies. The front of the website was developed by Seed Development startup. Back-end jobs are contracted out to CGI Federal Inc., a subsidiary of the multinational IT CGI Group of Canada, which subcontracts the work to other companies as is customary on large government contracts. The CGI is also responsible for building some state-level health care exchanges, with varying degrees of success (some not open on schedule).
According to author and journalist John J. Xenakis, the Federal CGI effort in Massachusetts is characterized as a total failure. In Xenakis's view, although the Massachusetts connector is the kind of website that small teams of five to ten can make in a few months on a $ 10 million budget, a team of about 300 with a $ 200 million budget fails. Xenakis claims CGI Federal may have hired many incompetent programmers because Massachusetts is transferring development contracts to other companies, Optum Inc. The software created by CGI is poor quality and can not be used by Optum, which should start from scratch. The CGI is also accused of cheating and reporting to those responsible for oversight. Similar problems occur in many other countries.
According to John J. Xenakis, the Obama administration is giving too much money to create a federal and individual state website, leading to a large, uncontrolled team that contains many incompetent programmers. It also encourages fraud and overspending by programmers.
In particular, the HealthCare.gov aspect relating to digital identity authentication is assigned to Experian. Quality Software Services, Inc. (QSSI) also play a role. The total number of companies listed in the website creation, and their names, has not been disclosed by the Department of Health and Human Services. All efforts are officially coordinated by the Medicare and Medicaid Service Center (CMS), a body of commentators such as journalist David Perera and Sean Gallagher speculating is incompatible with the task. Social activist and technologist Clay Johnson later said that the federal government has an emerging problem given that "relying on the writing-all-requirements-then-build-to-requirement-writing methodology" is not suitable for current IT especially when government contractors focus on maximize profits.
"The companies that usually get the contracts are good companies in getting a contract, usually not good at executing them," Alex Howard, a fellow at Harvard Ash Center for Democratic Governance and Innovation, told The Verge. as he evaluates the back of the project. In contrast, web-magazine journalist, Adrianne Jeffries praised the successful use of "innovative" startup business for the front-end. However, he found the overall launch of "bone-headed".
The Obama administration repeatedly modified its rules and policies until the summer of 2013, meaning contractors had to deal with changing requirements. However, changing the terms does not mean unusual in a large and expensive custom software project; they are a well-known factor in the failure of historical projects, and methodologies such as agile software development have been developed to address them. Unfortunately, regulations relating to large government contracts in many countries, including the United States, are not suitable for agile software development.
Statistics
Analysis by the Reuters news agency in mid-October suggested that the total cost of development-based Development contract HealthCare.gov tripled from an initial estimate of $ 93.7 million to about $ 292 million. In August 2014, the Office of the Inspector General released a report that found that the cost of the HealthCare.gov site had reached $ 1.7 billion. As indicated later by commentators such as Mark Steyn, the CGI company has been involved in a mid-2000 controversy before contract payments. When designing the Canadian Weapon Registry, the estimated cost of $ 2 million ballooned to about $ 2 billion.
On December 16, 2014, CNBC reported, according to Health and Human Services, registration reached nearly 2.5 million.
Concerns about the website
Issue at launch
The HealthCare.gov site was launched on a date scheduled for October 1, 2013. Although government closure started on the same day, HealthCare.gov is one of the federal government websites that remains open through the event. Although it seems to be normal, visitors quickly encounter many types of technical problems, and, with some estimates, only 1% of people interested can sign up for the site in the first week of operation. Even for those who successfully sign up, the insurer then reports some examples of applications submitted through the site with missing required information.
In journalist Bloomberg Businessweek Paul Ford summed up the issue by commenting, "Regardless of your opinion about health care legislation, this is the wrong way to create software." He also wrote, "In the meantime, it's clear that tens of millions of dollars have been spent to launch something that is broken." The ConsumerReports.org article repeats previous suggestions, with the group recommending that people stay "away from HealthCare.gov for at least another month". The group also stated, "Hopefully it will be long enough for software vendors to clean up the mess they make."
In its third week of operation, technical problems continue. The CNN.com article highlights "very long waiting time" as a problem. Other problems include a broken pull-down menu that only works intermittently, for example.
Todd Park, chief technology officer of the US, initially said on Oct. 6 that the disturbance was caused by unexpected high volumes when the site attracted 250,000 concurrent users rather than the expected 50,000-60,000. He claims that the site will work with fewer simultaneous users. More than 8.1 million people visit this site from 1 to 4 October. White House officials later acknowledged that it was not just a volume issue, but it involved software and system design issues. For example, consumers are required to create an account before they can compare plans, and the registration process may have created barriers that caused long waiting times. In addition, the stress tests performed by contractors 1 day before the launch date indicate that the site becomes too slow with only 1,100 simultaneous users, even close to 50,000-60,000 expected.
Despite later comments, concerns about the readiness of the exchange have been raised in March 2013, by Henry Chao, deputy chief information officer at the Medicare and Medicaid Service Center (CMS), who said that "let's make sure it's not a third-world experience". A co-worker, Gary Cohen, also commented, "Everyone knows that that day will not be perfect." Even in 2011, when CMS provided private sector contracts, most of the PPACA regulations and implementation steps are still changing.
The New York Times and The Washington Post reported in November 2013 that the Obama administration brought in a consulting firm McKinsey & Company to rate website. Their report, presented in March 2013, warned that efforts to build HealthCare.gov sites were left behind and risked failure unless immediate steps were taken to correct the problem.
On October 21, 2013, President Barack Obama discussed technical issues and other issues at a thirty minute press conference at the White House Rose Garden, saying there was "no excuse" for them. He commented, "There's no icing: the website is too slow, people have been stuck during the application process and I think it's fair to say that there's nothing more frustrating with it than mine." He also stated that "technology wave" is being done to fix the problem. The President also pointed out that people can register through the call center or directly.
White House press secretary Jay Carney says more time is needed to make the website work properly. Carney also hinted that if the problem remains unresolved for a long time thus preventing people from fulfilling their legal obligation to get insurance in time for a February deadline, the legal penalty for not getting insurance will not apply because Obamacare law states that if affordable care is not available, penalty will not be paid.
So, shortly after the launch of HealthCare.gov, the problem still did not affect the legal requirements for Americans to have health insurance on December 15, which remains on the books as stated. However, on October 23, an effective legal deadline for applying for health insurance through HealthCare.gov without getting a penalty through an individual mandate was extended until March 31, 2014, possibly because of problems with HealthCare.gov and some state health services exchange (but without explanation de jure as given).
The Obama administration appoints contractors, Quality Software Services, Inc. (QSSI), to coordinate the work of fixing website problems. The company has worked on the back-end website before the website goes live. As stated earlier, before the launch, the Medicare and Medicaid Service Centers (CMS) have played the coordinating role, but critics allege that they are not suitable for such systems integration roles. The administration appointed Jeffrey Zients to act as their advisor on this issue.
On October 25, Zients promised, in a conference call to the media, that the site would work properly "for most users" by the end of November. He also claims that 90% of visitors can now complete the account creation process and actually use HealthCare.gov to compare plans. Perhaps the biggest problem he faces, as recognized in the call, is the fraudulent reports given to insurance companies, often messing up basic details like a person's gender.
As stated earlier, the HealthCare.gov issue has been going on even weeks after launch. For example, a network failure error at the associated data service center kills the website function again October 28. This came just days after the head of Health and Human Services Kathleen Sebelius has highlighted the design of the data center as a government success. However, state-based exchanges mostly work well in enrolling individuals over this time period, with CNN.com describing it as "largely error free".
A large number of technical improvements were made during October and November, with the NPR.org report later commenting that the website appears to "work more smoothly." However, on Nov. 13, the Obama administration revealed that fewer than 27,000 people have registered to private health insurance through the site. As of Nov. 30, more than 137,000 people have obtained health insurance through the federal website. That figure represents a strong increase, but the enrollment rate is still far below US government estimates.
Accenture was chosen to replace CGI Group as the prime contractor for the website in January 2014.
The big problem with future registration is related to the accuracy of HealthCare.gov information sent to insurance companies. As stated in the NPR.org article citing "sustainable issues" with HealthCare.gov, about one in ten registration notifications contains significant errors.
A hacker broke into the part of the HealthCare.gov insurance registration site in July and uploaded malicious software, according to federal officials.
Open enrollment period 2015
Registration for 2015 through the federal government website, serving 37 countries without a registration website, begins at midnight November 15, 2014, and ends on February 15, 2015.
The US Department of Health and Human Services reports a relatively smooth experience for users. However, scattered problem reports, such as blocking login access and long waiting times, were found. In one case, a call center worker told a reporter that solving their problem might take five to seven business days.
In January USA Today reported that more health plans were offered in approximately 75% of the districts for 2015, and while the average insurance premiums rose less than the 10% average annual jump for plans before the Affordable Care Act, there are some huge improvements.
State and federal health care exchanges have registered more than 9.5 million people, but the numbers vary. Florida accounts for nearly a seventh of all people who have chosen the plan on the exchange. Texas, however, has the lion's share of uninsured adults when registration is lagging behind.
Open enrollment period 2016
The open registration period for 2016 starts on November 1, 2015 and ends on January 31, 2016.
Fake website
Before HealthCare.gov online, there are concerns about misleading or fake websites at the state or local level. It was later reported that over 700 fake or misleading websites had been set up. In early December 2013, the third fake health insurance site closed in Kentucky. California Democrats politicians slammed a California Republican website that resembled the official Web site of Obamacare, but gave political criticism of the law, not insurance.
Personally operated exchange
In part in response to outages of Healthcare.gov, a number of privately operated services have been launched to provide a tool for consumers to calculate the feasibility of subsidies, as well as research, compare, and register for examples of plans including HealthSherpa and Stride Health. In November 2013, HealthSherpa was launched by a coders team in San Francisco and received media attention for its ease of comparative use. Critics point out that by focusing solely on providing information, the HealthSherpa site does solve some of the most difficult issues, including allowing consumers to actually enroll in a plan. Stride Health is launched in 2014, and focuses on simplifying the registration of health care by recommending plans to users based on their data and offering a full service team on the phone that can help users enroll in plans. The company saw its initial success through partnerships with a number of large companies. As of March 2014, HealthSherpa has become a full-service broker that allows users to register directly on the HealthSherpa site.
Security
In July 2014, a hacker broke into a test server for healthcare.gov and uploaded malicious software. By the end of 2014, healthcare.gov appears to have rewritten most sites and moved important "server-side" functions, instead of being executed on the client side in the user's web browser.
Data privacy
The initial launch of health.gov was hit by security concerns and led to information security experts openly testifying before the Congressional Committees on Science, Space and Technology and others talking to the government about security vulnerabilities at healthcare.gov. David Kennedy can find 70,000 health records that should be private, but available to the public via google dork.
There is a concern that personal information entered into websites may not be secure in the manner expected by users: on January 24, 2015 Kevin Counihan, C.E.O. from Healthcare.gov, addresses concerns about privacy on the federal website. He said they launched a review of their privacy policy, contracts for third-party tools and URL construction. He says that Healthcare.gov has encrypted a URL that contains data about the user's age and income, and whether they are pregnant.
On January 20, 2015, the Associated Press reported in an article entitled: "Government health care sites secretly share personal data" that HealthCare.gov provides access to personal data of registrants to private companies specializing in advertising. Data may include age, income, zip code, whether a person smokes, and whether a person is pregnant. It may also include a computer's Internet address, which can identify a person's name or address when combined with other information collected by data brokers and online advertising companies.
There is no evidence that this data has been misused, but connections to dozens of third-party technology companies are documented. Some of these companies also collect very specific information.
Copyright infringement
In October 2013, The Weekly Standard reported that the site infringes the copyright of SpryMedia, a UK-based technology company, by utilizing their software with a copyright notice removed. The software is DataTable, a free and open-source plugin for jQuery designed to enhance data presentation, and is licensed under GNU GPL version 2 and a modified BSD 3-clause license. HealthCare.gov further corrects the license violation by providing appropriate attribution, license and copyright notices.
Reception and possible consequences
Technical issues were heavily criticized, and Republican representatives sent a list of questions to President Obama, demanding an explanation for what went wrong. Some Republicans are calling for the Secretary of Health and Human Services, Kathleen Sebelius, to be fired, as she oversees planning for the launch of the site. Former White House Press Secretary Robert Gibbs described the technical problem as "unbelievably embarrassing", and he said that some people should be fired. Scott Amey from Project on Government Oversight showed an increase in construction costs from $ 93.7 million to $ 292 million, and he asked: "Where is contract supervision?" According to John J. Xenaxis, this website has about 500 million lines of code, which will make it difficult to maintain and difficult and expensive to repair or update.
American conservative commentators such as National Review writers Jonah Goldberg and Mark Steyn argue that website launches are catastrophic that cause greater problems throughout the law, with Goldberg asserting that "Republicans who insist that this monstrosity should postponed that looks a little more reasonable with every leap that passes. "In a statement, the Republican National Committee (RNC) responded to President Obama's comments that" technology wave "is a code for" spending waves "and will spend millions of dollars. The statement also reads, "The federal bureaucracy has proved itself too slow, too bloated, too incompetent, and too outdated to manage American health care."
Chairman of the Board John Boehner, Representative of the Republic of Ohio, told reporters that throughout November "more Americans will lose their health care than those who will register." Ohio Governor John Kasich told NBC's Meet the Press program on October 27 that the launch had "made everyone just shake their heads". He also added that it seems very likely that most Ohio people will pay more for the HealthCare.gov plan. Kentucky Governor Steve Beshear counter-argued that while the website did not work well but soon because HealthCare.gov represented "the future of health care", and he commented as well, "You know, my advice would be to provide the news media and critics here are interesting a long breath. "
The Daily Show host Jon Stewart especially railed the HealthCare.gov controversy during an interview with Sebelius. He jokingly challenges him to race online: "I'll try and download every movie ever made, and you'll try to sign up for Obamacare, and we'll see what happens first." He also faces baking the Obama administration's opposition to the postponement of an extended individual's mandate.
Sebelius then said in response to criticism, "The majority of people who called me to resign I would say are people I do not work and who do not want this program to work in the first place". He also said, "I have had many conversations with the President and I have committed to him that my role is to run and run the program, and we will do that." His popularity in native Kansas where he previously served as governor, according to Kansas University political science professor Burdett Loomis, has spurred him to stay on.
US House Minority Leader Nancy Pelosi, a Democratic Representative from California, commented on the controversy that he feels optimistic about things being improved, saying "I have confidence in technology" as well as "while there is a distraction, there is a solution, too." Democrats in Congress has accused Republican HealthCare.gov critics of acting in bad faith. "We want the process to improve, but we are not interested to mentorpedo the process," said Representative Xavier Becerra, another Democrat from California and chairman of the House Democratic Caucus.
Republican Senator Marco Rubio has drafted legislation as a result of the controversy to postpone the individual's mandate. The proposed law has attracted widespread Democratic support. Professor and author Victor Lombardi commented to Bloomberg Businessweek that the website problem "does not sound havoc", and he added that history "can assess this project as a catalyst that revolutionized the US health care system" some will remember a few hiccups at launch. "
Although the law that established the formation of HealthCare.gov has been divisive and political speculation has taken place, voting conducted by the Gallup organization around a difficult launch time still finds that the majority of Americans support keeping at least some aspects of Obamacare. In particular, only 29% of the public likes complete retraction. However, the joint survey of The Washington Post and ABC News stated that 56% of respondents considered the issue of the website as a harbinger of other issues with health care measures.
On October 29, 2013, Rep. Lee Terry (R, NE-2) introduced the Information Exchange Disclosure Act (H.R. 3362; 113th Congress). The bill will ask the US Department of Health and Human Services to send a weekly report to Congress on how many people use HealthCare.gov and sign up for health insurance. These reports will mature every Monday to March 31, 2015 and will be publicly available. The bill will "require weekly updates on the number of unique website visitors, new accounts, and new enrollments in quality health plans, as well as coverage levels," separating data by state. The bill will also require a report on efforts to repair parts of the damaged website. Parliament is scheduled to vote on January 10, 2014.
Kathleen Sebelius resigned as Secretary of Health and Human Services on April 10, 2014. She was replaced by Sylvia Mathews Burwell on June 9th.
See also
- Medicare and Medicaid Service Centers
- eHealthInsurance
- Health care in the United States
- Health care reform in the United States
- Health care reform proposed during the Obama administration
- Health insurance in the United States
- Health insurance market
- List of failed custom software projects and overbudget
- Month of Mythical Man-Month
- Provision of Patient Protection and Affordable Care Act
- United States Department of Health and Human Services
References
Further reading
- "The Beginning of the Secret that Saves the Worst Website in America", Atlantic , July 2015
External links
- Official website
- HHS.gov/HealthCare
- HealthCare.gov Sending Personal Data to Dozens of Website Trackers, Electronic Frontier Foundation, 2015
Source of the article : Wikipedia
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