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Health Exchange Tech Problems Point To A Thornier Issue

Oct 8, 2013
Originally published on October 8, 2013 7:24 pm

One week after its rocky rollout, the federal site to help you sign up for health insurance exchanges went down again overnight for additional software fixes. The Obama administration says the technology powering the marketplaces buckled under unexpectedly high traffic. But the ongoing software hiccups for healthcare.gov point to a much thornier problem: procurement processes.

Procurement, the process by which governments decide which contractors to hire for various products and services — like software — is not a sexy topic. But it's linked to the software problems that continue to plague the behemoth system built to help millions of Americans enroll in a health insurance marketplace under the Affordable Care Act.

The shorter-term tech problem is too many people taxing a complex software system that was rushed to launch. President Obama's Chief Technology Adviser Todd Park told USA Today that contractors built a system that could handle 50,000 people using the site at once. But when coverage signup opened Oct. 1, the traffic was five times larger than what officials planned for.

"We are doing several things at once, including adding server capacity and making software changes to make the system more efficient to handle higher volume," White House press secretary Jay Carney said on Monday.

(High volume may not mean high enrollment, but we don't know until the administration releases enrollment numbers in another month.)

It's an unprecedented system, too. In order for the exchange marketplace software to check on which coverage and subsidies you're eligible for, it has to ping requests to the Internal Revenue Service database, Social Security records and Homeland Security data within seconds.

"It's called an integration catastrophe really where you've got lots of different software talking to lots of different things, and an unprecedented amount of scale," says Clay Johnson, a programmer who worked inside government as a White House Innovation Fellow. The fellows looked for ways that the federal government could improve its tech services and save money. He says that while healthcare.gov is glitchy, the real "cancer" is how the government selects the contractors hired to build these IT behemoths.

"One might look at this and go: Why can't we get the smartest people from Facebook and Google and from Twitter to come and work out these problems?" Johnson says. "The problem is that the way that federal contracting works is so burdensome that the only people who get contracts like this are experts at lobbying and experts at regulations that require you to get these sorts of contracts. And they're not experts at doing the job of building these websites."

The primary contractor behind the federal health exchange software is a global firm called CGI Federal, which didn't want to comment for this story. Johnson says it's not that CGI or other contractors behind healthcare.gov are bad. They're probably just not the best, because the best people at these tech solutions don't bother applying.

"In order to fix these problems in the long term, what we've gotta do is encourage the federal government to open its doors to smaller, more agile vendors who are better at solving these larger problems," Johnson says.

He calls for a cultural shift, simplifying the bidding process so more firms compete against incumbents, making everyone up his game. Johnson proposes starting small, with tiny contracts, because changing a deeply entrenched contracting environment is a systemic and long-term challenge.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

MELISSA BLOCK, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

ROBERT SIEGEL, HOST:

And I'm Robert Siegel. It's been one week since the healthcare.gov website went live. The rollout of the federal site where people can sign up for health insurance has been bumpy to say the least. And then overnight, healthcare.gov went down again for additional software fixes. The Obama administration says the technology powering the marketplace is buckled under unexpectedly high traffic.

But as NPR's Elise Hu reports, healthcare.gov's glitches point to a much thornier problem.

ELISE HU, BYLINE: Like many others, Philadelphia-based jazz musician Suzanne Cloud(ph) tried to sign up online for health insurance, but she hit a technical snag, a few snags.

SUZANNE CLOUD: It kind of like - and something went wrong and it just went to a page with all kinds of html stuff.

HU: The Obama administration says contractors built a system that could handle 50,000 people using the site at once. But when coverage signup opened last Tuesday, the traffic was five times larger than what they planned for.

JAY CARNEY: That is the principal reason that there's a problem.

HU: White House press secretary Jay Carney.

CARNEY: We are doing several things at once, including adding server capacity and making software changes to make the system more efficient to handle higher volume.

HU: We don't know whether high volume translates to high enrollment because the administration won't release enrollment numbers for another month. On one of her later attempts to sign up, Suzanne Cloud hit the part of the process that gets complicated for the computer.

CLOUD: The site is supposed to assess the information that you've given them and then give you what you're eligible for. I've never gotten beyond that point.

HU: In order for the software to check on which coverage and subsidies you're eligible for, it has to ping requests to the IRS database, Social Security records and Homeland Security data within seconds.

CLAY JOHNSON: It's, you know, called an integration catastrophe really where you've got lots of different software talking to lots of different things, and an unprecedented amount of scale.

HU: Clay Johnson was a programmer inside government as a White House Innovation Fellow. He looked for ways that the federal government could improve its tech services and save money.

JOHNSON: I think that there's something more to it here.

HU: He points to a bigger picture problem that's not limited to healthcare.gov. It's how the government selects the contractors hired to build these IT behemoths.

JOHNSON: You know, one might look at this and go, hey, why can't we get, you know, the smartest people from Google and from Facebook and from Twitter to come and help work out these problems? The problem is is that the way that federal contracting works is so burdensome that the only people that get contracts like this are experts in lobbying or experts at the regulations that require you to sort of get those contracts. And they're not experts at doing the job of building these websites.

CLOUD: The main contractor behind the federal health exchange software is a global firm called CGI Federal, which didn't want to speak to us for this story. Johnson says it's not that CGI or other contractors behind healthcare.gov are bad, they're probably just not the best, because the best people at these tech solutions don't bother applying.

JOHNSON: In order to fix these problems in the long term, what we've got to do is encourage the federal government to open its doors to smaller, more agile vendors who are better at solving these larger problems.

HU: Johnson calls for simplifying the bidding process so more firms compete against incumbents, making everyone up their game. He proposes starting small, with tiny contracts, because changing a deeply entrenched contracting environment is a systemic, complicated and long-term challenge. For the shorter term issues with health exchange signup, the White House message is this.

CARNEY: Well, we're not satisfied with the performance. We can do better.

HU: Despite her many failed attempts to sign up, Suzanne Cloud is staying hopeful.

CLOUD: Just calm down, be patient.

HU: It's a reminder she gives herself every day. She still hasn't completed her healthcare enrollment. Elise Hu, NPR News, Washington. Transcript provided by NPR, Copyright NPR.