By Victoria Colliver
While the federal government’s poorly performing health care website was described in Capitol Hill hearings last week as a disaster and a train wreck, California’s online enrollment process has behaved, in comparison, like an overachiever.
But it hasn’t operated without glitches. Since its debut Oct. 1, Covered California, the state’s online marketplace developed independently of the federal government’s site, experienced slowness in the early days, endured trouble with its online directory of doctors and hospitals, and had to be taken offline several times.
But the state marketplace’s woes are far less troubling than the problems that have plagued HealthCare.gov, which was so dysfunctional that most Americans have been unable to complete their applications through the site. President Obama publicly acknowledged the technical kinks last week and promised to bring in industry experts to solve the problems.
Health and Human Services Secretary Kathleen Sebelius promised Friday to review the performance of contractors who helped build the online exchange. Officials have indicated that the federal website may not be fixed until the end of next month.
The federal government’s online site “being as bad as it is, is a train wreck,” said Clark Kelso, California’s chief information officer from 2002 to 2007, who teaches law at University of the Pacific McGeorge School of Law in Sacramento.
“California did a much better job of realizing what the challenges (were) going to be in getting people to sign up,” he said. “In doing the website, our project was put together in a much better way.”
The federal website was created for 34 states that do not have their own exchanges.
California and many of the other 15 states — as well as the District of Columbia — built their own health care marketplaces, and all those sites appear to be running more smoothly.
Experts say that part of that has to do with scale. The federal government’s exchange must handle multiple insurers in all 34 states.
“You have to coordinate with the companies and their (information technology) systems,” Kelso said. “Insurance historically has been a state-level marketplace. This is the first time the feds have tried to come in and try to be a player in the federal insurance marketplace, and they have a lot bigger job to undertake.”
California, in contrast, has to deal with about a dozen insurers. The site is designed to help the estimated 5.3 million Californians who are uninsured or don’t have job-based coverage, although the state estimates that before the enrollment period ends March 31, only between 500,000 and 700,000 people will use it to buy insurance.
After the Affordable Care Act was signed into law in 2010, California became the first state to commit to building its own website to handle the task. It selected the global technology company Accenture in June 2012 to put its exchange together.
The five-year, $595 million contract included $199 million for design, implementation and maintenance of costs through June 2017. Accenture officials, who declined to comment for this story, contracted with other companies to help with the work, primarily with Silicon Valley’s Oracle and Getinsured, a comparison-shopping portal for health care services and insurance based in Palo Alto.
When it opened Oct. 1, California’s site received 987,000 visitors looking to buy health insurance in the first five days, a volume that caused pages to load slowly. From Oct. 1 to Oct. 5, Covered California officials said 28,700 individual applications were completed.
Since then, Covered California has declined to release enrollment figures, and agency officials say they won’t do so again until mid-November.
“A full month of data gives us a more complete and accurate reflection of our marketplace,” said Larry Hicks, a spokesman for Covered California.
Aside from the initial sluggishness, Covered California ran into a problem when the state’s list of doctors and hospitals wasn’t ready for launch. The information is important because most consumers need to know whether their doctors or nearby hospital is in their insurer’s network before choosing a policy.
Exchange officials took the provider directory offline between Oct. 9 and Oct. 22 to retool speed, navigation and search functions, Hicks said. He said inconsistencies in the data they received from the insurers also contributed to the problem.
The directory now provides searches for physicians, but the ability to search by hospitals or clinics won’t be available until late November, he said.
But Californians still have been able to enroll online.
San Francisco resident Bill Hancock, 56, was able to sign up for coverage shortly after the launch. As an attorney with a solo practice, Hancock does not have access to coverage through an employer and could not get coverage on his own because of a pre-existing health condition.
After experiencing a few initial glitches, Hancock signed up for a Blue Shield policy for his family that costs $1,760 a month with a $4,000 deductible.
“It was a pretty easy experience,” he said. “It took me about a half-hour.
“I can afford $4,000 as a deductible. What I can’t afford is if I have to go to the ICU.”
— Reach Victoria Colliver at firstname.lastname@example.org