HealthCare.gov: It almost worked | Hacker News Reader

HealthCare.gov: It almost worked

re-cycledair.com

36 pointsvital10121 comments

He writes:

"I create things all the time on the web. Its my chosen profession, so I know how hard it can be to make a good website when you need to integrate with a lot of different 3rd parties."

But I have read in several places that the Kentucky site works great. And I suspect that Kentucky's site works well because Kentucky had a limited budget and therefore kept things simple.

The New York Times quoted one official as saying that "changing requirements" caused the Federal site to be in flux up until the last moment. In my experience, I am most likely to run into "changing requirements" when my client has too much money to burn. Lack of money often leads to a reasonable restraint regarding feature requests.

In my opinion, the correct question here is why the Federal site can not be as good as the Kentucky site.

Based on my experience the bigger issue than money (though the two are related) could be too many shot-calling stakeholders. I'm sure HealthCare.gov had a much bigger budget than the Kentucky site but it also probably had far more people interested in putting their little "stamp" on it (absolutely regardless of how invisible that stamp is to people in the wider outside world who are just using the site) because the site was clearly going to be a "big deal". These little pet "stamps" often manifest themselves in conflicting requirements, power struggles that result in important technical decisions being altered haphazardly through the life of the project and dozens of other unfortunate ways.

The situation where you have a bunch of people trying to make a name for themselves within a project perceived to be very important without one strong decision maker keeping everyone in line is my number 1 "project smell" for detecting likely failure of a big project, and I'd be surprised if this wasn't a factor in the failure of the HealthCare.gov site.

It's been reliably reported you are correct, shots were being called from the White House, on down through HHS to CMS, which was officially the general contractor/system integrator before they got "fired" in the 3rd week of October.

Whereas it's been reported that Kentuky's prime contractor, Deloitte, was absolutely ruthless about that sort of thing to achieve the goal of having something of value working by the deadline.

Oregon is also an even worse example of Healthcare.gov style mismanagement, with two dueling state government organizations, one of which did the usual trick of telling the contractor's employees to stop talking to the other unit....

I think the answer is simple - the Governor of Kentucky took an active role in the project and assigned someone that you can actually pinpoint to be in charge of it. Contrast this to the federal site, where it's difficult to tell who was really managing the project.

Talking Points Memo did a good write-up of the Kentucky site [1] back in October [2], and in the last half of the article, two things stand out:

"Testing was undertaken throughout every step of the process, said Carrie Banahan, kynect's executive director, and it was crucial because it allowed state officials to identify problems early in the process. She laid out the timeline like this: From January 2013 to March, they developed the system; from April to June, they built it; from July to September, they tested it."

... and ...

"From a design standpoint, Kentucky made the conscious choice to stick to the basics, rather than seeking to blow users away with a state-of-the-art consumer interface. A big part of that was knowing their demographics: A simpler site would make it easer to access for people without broadband Internet access, and the content was written at a sixth-grade reading level so it would be as easy to understand as possible."

[1] https://kyenroll.ky.gov/

[2] http://talkingpointsmemo.com/dc/how-kentucky-built-the-count...

It took a bit more than that. The person in charge and Deloitte agreed on the ruthless simplicity you've outlined, and which we can also judge by the short timelines, 6 months to design and build, 3 months for system testing and fixes. Implicitly, your summation also tells us requirements were frozen early enough in the project.

Even if HHS/CMS had assigned a single person to be full time in charge of Healthcare.gov, it's vanishingly unlikely they would have had the authority to take such measures and make them stick, refuse requirements changes from above past a certain point, etc. etc., even if they'd known to do so, or were smart enough to listen to the contractors.

Oh, yeah, Deloitte was the general/prime/whatever contractor, CMS took on that role until "fired" in the 3rd week in August. CMS simply didn't have the skills to do that (in the Federal government we're told only the Pentagon does, and only for "medium sized" weapons projects).

I had to use ehealthinsurance to get a plan to cover a gap period this August. It's not beautiful, but it worked perfectly fine. I think it's proof positive that a central marketplace for healthcare could work.

The problems with Healthcare.gov are that it's a badly designed morass of barely functional independent systems that need to get data from other government departments (which probably don't even have real APIs) and requirements full of 'bureaucrat enhanced' logic.

I'm fairly confident that at some point it will be at least as dead annoying as Treasury Direct, though at least be functional.

Ultimately I don't view the idea as wrong, so much as I view major reforms of how the government uses and builds software as necessary.

Third party systems integrations don't explain basic independent functionality not working.

A few things:

The author could have simply contacted any insurance company directly and under the new laws, applications are very short and easy to do (no preconditions allowed, so they don't ask). A rep told me that it takes 5 to 10 days to get coverage this way.

So, take advantage of the new laws, but don't necessarily use healthcare.gov site.

A bit anecdotal: I did use healthcare.gov a couple of months ago, and things worked for me, eventually.

Give the new system a year, and people will wonder how we ever did without healthcare.gov and the new laws.

I don't think you get the discounts if you sign up directly as opposed to through the exchange, but I may be entirely wrong. Just something I think I heard.

You're correct. You only get a subsidy if done through official channels.

Which pretty much eliminates this avenue for anyone who actually needs it.

Not to mention the fact that you have to use the Federal or a state exchange if your situation changes, e.g. you lose your job, and you're now due a subsidy. Depending on who I believe (this is all incredibly complicated), if you got your plan outside of an exchange you may be SOL, or in difficultly to jump through the hoops to get a Special Enrollment Period as I think they're called.

The whole point of the website was to be easy enough to use that young people who dislike interacting with call centers would be more likely to actually sign up. If "just call" is actually the easiest way to use the program (and anecdotally, I agree that it is), then the website was largely a waste of time and money.

The california version is covered california (https://www.coveredca.com/). After investing a total of 8 hours over the course of 3 days on this site I still don't have health coverage. Timeouts abound, and even when things say they have successfully gone through they haven't. I have money to pay, I know what plan I want, I just want to sign up. As far as I can tell it's impossible.

I applied, took a few days. They sent me a letter about 'bulk payment' I received. (They must have accessed my tax records of 2 years ago). True.

What I got out of the article was a comment to use http://lucyphone.com , and I will.

Ah, thanks for posting this! I have been one of the unfortunate ones who could never even log into the site (tried numerous times over several months), but I tried today and FINALLY was able to login and view health insurance plans.

Curious: author makes it sound as though he's leaving a company where he had health insurance. Why not apply for Cobra? Off-topic, perhaps, but worth pointing out for others in a similar position.

And there is more. UX is woefully absent. Getting married sometime this year? How do you add your spouse to your policy? Having a baby? Same.

Yup, I read an article yesterday pointing out that in addition to those changes, it doesn't support easy edits for change in income, etc. Right now Healthcare.gov essentially assumes every enrollee will have the same exact plan from now until...infinity?

An alternative for researching healthcare plans: http://www.healthsherpa.com/

Well, as long as your insurance carrier is willing to play ball, you can get those changed with them, and reconcile with the government when it gets its act together. Just be careful of grab backs if you're due a lower subsidy (in the other direction the system doesn't yet implement payments to insurers, as I understand it that'll work on the honor method with the insurers submitting invoices for subsidies with reconciliation to follow).

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