Policy

The Key Test For HealthCare.gov Is The Part You Can't See

The consumer-facing part of HealthCare.gov is working more smoothly, but how well the invisible back-end is working is unclear. i i

The consumer-facing part of HealthCare.gov is working more smoothly, but how well the invisible back-end is working is unclear. NPR hide caption

itoggle caption NPR
The consumer-facing part of HealthCare.gov is working more smoothly, but how well the invisible back-end is working is unclear.

The consumer-facing part of HealthCare.gov is working more smoothly, but how well the invisible back-end is working is unclear.

NPR

Calling the improvements "night and day" from October, the Obama administration says it has met its goal of getting the troubled HealthCare.gov site working for a "vast majority" of users. But that's only part of a complex technology system that is designed to end with insurance companies providing coverage for millions of consumers.

We've detailed the eight-page HealthCare.gov progress report in a post on our news blog, The Two-Way. In short, it shows dramatic improvements in capacity, processing and speed. In October, only 30 percent of consumers could get all the way through the online application process for the federal insurance exchange. Now, after nine weeks of furious fixes, about 80 percent of users are able to make it through the process.

"It says my application was reviewed and processed, and I can view my results. Before, it always got stuck right here," says Kendalyn Thuma, a Kalamazoo, Mich.-based consumer who had been trying unsuccessfully to enroll throughout October.

Thuma and other consumers we checked in with report a smoother overall experience — but not a perfect one.

"Everything is relative. This is a site that has been plagued with problems from the outset," says John Engates, the chief technology officer at the server and software company Rackspace. He's one of the few outside engineers who's seen the HealthCare.gov command center from the inside.

"I think what they focused on, to a large extent, was the consumer view from the outside looking into this website," Engates says. "I don't necessarily think they've gotten all of the behind-the-scenes connections to the health insurance providers and the work that's necessary behind the scenes to really take this to the finish line. I don't know if that's all done yet."

We don't know how complete the enrollment data getting to insurance providers is, either. The metrics on how well the back-end is delivering data wasn't part of this weekend's progress report.

"We are working with issuers on a regular basis, getting daily feedback from them, and will continue that conversation," says the Center for Medicare and Medicaid Services' Julie Battaile, who says the system will need to see more user volume before engineers will know how well the back-end is working.

Those conversations will need to happen quickly, as a December deadline draws near for those who want coverage to start in January. December is also when HealthCare.gov's chief "fixer,"Jeffrey Zients, is expected to leave his presidentially-appointed role.

While outside tech experts like Engates say the site's front-end — the part that consumers can see — is dramatically improved, that's actually the easy part.

"The easy part is to put your data into the system," he says. "The hard part is to go and process that to make sure you have health care coverage. The government really has to deliver on that or else the whole thing is for naught. I mean, we really have to have a system that works from end to end or it really isn't a system."

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