
HealthCare.gov: It almost worked - vital101
http://www.re-cycledair.com/healthcare-gov-it-almost-worked
======
lkrubner
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.

~~~
nhebb
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/](https://kyenroll.ky.gov/)

[2] [http://talkingpointsmemo.com/dc/how-kentucky-built-the-
count...](http://talkingpointsmemo.com/dc/how-kentucky-built-the-country-s-
best-obamacare-website)

~~~
hga
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).

------
Glyptodon
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.

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

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mark_l_watson
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.

~~~
cmelbye
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.

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

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

~~~
hga
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.

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pmikesell
The california version is covered california
([https://www.coveredca.com/](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.

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puppetmaster3
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](http://lucyphone.com) , and I will.

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dm2
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.

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gdubs
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.

------
Lilme
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.

~~~
hga
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).

