Health

Did Politics Help Cause HealthCare.gov Failures?

Clinical applications counselor Rachael Richardson, left, works with Louis Peters at the Henry J. Austin Health Center, in Trenton, N.J., as he and others fill out papers to sign up for new plans through the health insurance exchange.

Clinical applications counselor Rachael Richardson, left, works with Louis Peters at the Henry J. Austin Health Center, in Trenton, N.J., as he and others fill out papers to sign up for new plans through the health insurance exchange. // Mel Evans/AP File Photo

Two stories dominated U.S. headlines during the first half of October.

There was the government shutdown, which drew to a close late Wednesday and was largely seen as a case of partisan politics hijacking the work of nonpartisan career employees. Then there was the troubled launch of the online health insurance marketplace, HealthCare.gov, which was largely seen as a failure of bureaucracy. 

Politics may have had as much to do with the HealthCare.gov failure as they had to do with the government shutdown, though, according to Lawrence Kocot, a visiting fellow at the Brookings Institution and formerly senior advisor to the administrator of the Centers for Medicare and Medicaid Services.

Kocot helped launch an online Drug Plan Finder application for Medicare Part D, the Medicare prescription drug benefit, in 2004 and 2005. When a new government program is the subject of intense political debate, that can make building the technology systems that support the program especially difficult, he said.  

“Politics has probably played more of a role in this than in any other rollout I’ve seen,” Kocot said of the online health insurance marketplace.

“That probably made [agencies and contractors responsible for designing the system] more guarded about information they were willing to share,” he said. “It probably resulted in a level of scrutiny of some decisions by career staff that otherwise may not have been as intense. It probably made them more aware of oversight. It probably hampered communication with other parties.”

Increased scrutiny can be a good thing, he said, helping to catch errors early in the process and to ensure a host of federal agencies, state agencies, regulators, contractors and private-sector interests are all on the same page.

Heightened scrutiny may also cause trouble, though, especially if it delays early decisions that later decisions are dependent on.

“If something should be approved and it has a long line of other things that need to be approved behind it and it’s held up because somebody in a political position decided they needed to get very involved in the details and technical specifications -- of something for which they may not arguably have had the right skill set, but they felt like they had to do it because of the political implications -- that obviously slows down the process,” he said. “And if one process is slowed down, others may be slowed down and that leaves to chance whether or not things are going to go as originally planned.”

Political scrutiny was likely only one ingredient in Healthcare.gov’s poor showing, Kocot said. Others include a contracting system that may be ill-prepared to handle fast-paced technological innovation and a poor job setting expectations by some government officials, he said. 

Software failures have plagued HealthCare.gov since its launch, drastically reducing the number of people who were able to enroll in insurance programs through the federal site and frustrating some state exchanges that rely on federal data. The federal site also suffered from insufficient server capacity during its first days, according to U.S. Chief Technology Officer Todd Park.

Less than 1 percent of visitors to Healthcare.gov have successfully enrolled in insurance programs using the site so far, according to figures from the market research firm Millward Brown Digital.

The largest share of people left Healthcare.gov because their attempts to register with the site -- one of the first phases in the enrollment process -- failed, Millward Brown found. IT experts have warned there may be more software troubles that haven’t yet been uncovered because people have been halted at the registration phase.

The deal struck Wednesday night to end the government shutdown added new requirements for the Health and Human Services Department to verify the eligibility of people claiming certain tax credits on the health care exchanges. An HHS spokeswoman said Thursday that the agency already verifies eligibility in the online exchange and is reviewing the new law to see if additional steps are necessary. 

While frustration with HealthCare.gov is running high, the true test of the site will be whether, once all the software is repaired, people choose to return to the site and sign up for coverage rather than pay a penalty the health care law imposes on those who do not buy insurance or receive it through an employer, Kocot said.

He noted that the Medicare Part D Drug Plan Finder suffered from glitches in its early days, including missing data and insufficient server capacity, but those problems were largely forgotten once the program itself proved successful. 

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