The Utter Disaster Of Healthcare.gov, Ctd

Readers continue to contribute to our ongoing ACA coverage:

I recently made like the Dish and went independent, moving to my own business instead of working for an employer. This was done largely out of necessity. I am married with two kids and am at the moment the sole earner, as my kids are small. Health insurance is our single biggest expense. We’ve had help with our premiums from my parents, thank goodness, because they haven’t been affordable. I will almost certainly qualify for a subsidy.

I heard the reports of the glitchy site, and since coverage doesn’t start until January 1 anyway, I have not had a sense of urgency. Yesterday I dove in, and spent a couple of hours on healthcare.gov. Well, it still sucks. I had to re-do whole sections of the application, It took me a long time just to register for a username, and after I finished the application, I was not able to see the results. I still haven’t been able to. I have no idea where things stand, because it just gives me a blank page.

I am not to worried, as I’m sure I’ll be able to get it figured out by Jan 1. If nothing else, I am highly motivated and will give it the necessary time. But my experience certainly reflects the consensus that it is still a buggy pain in the ass.

On the other hand, a reader sends the above video, which was uploaded October 8 and has close to a million views:

This video of a guy signing up for Obamacare does put the website problems in perspective, since he demonstrates how maddening it is to register for health insurance under the status quo. Not sure why others aren’t doing the same thing.  Not to rationalize the online kinks and trouble with the ACA roll-out, but here’s another perspective.

Another reemphasizes an important point:

Yes, the ACA website has been a mess, but for all the hyperventilating over the “disaster” I’ve not seen anyone make the point that its going fairly well in states that set up their own exchanges.

The disaster is primarily an issue in states that oppose Obamacare and refused to set up state exchanges, therefore subjecting their citizens to the federal government bureaucracy and its website. So much for states rights, local control, and conservatism! (Not to mention the millions in states that now have coverage due to expanded Medicaid, which those same “conservative” state governors rejected.) The ACA is mostly working for those who want it to work – for those it’s not, that’s partly Obama administration incompetence, but more so the result of those who don’t want it to.

Another gets technical:

First, to get it out of the way – I am a long-time reader of yours, and since this is my first time writing an e-mail to the Dish, I’d just like to congratulate you on the success of your subscriber model. The lack of ads makes for a great user experience and the quality of your insight is superb as ever. Keep it up!

I’m writing to you today to try to provide a simple explanation of an 834 – I read the article from WaPo you posted earlier and I wanted to try to simplify this. I am a database/application developer and I work for an insurance company. I have actually overseen the development and implementation of 834 processing applications and I think it’s important to clear some things up.

The 834 is not a form. It’s a standard file format that is used to communicate member information from a sender (the government, for example) to a receiver (Aetna, United, BC/BS, etc). Think of it as a complex-looking version of Google translate that is meant for computers to understand. Basically, healthcare.gov should be doing the following:

1) Collect the data – a user enters data in forms on the website (name, address, SSN, etc)
2) Organize and save the data – the user submits (clicks OK) and the website saves the data by writing to a database
3) Translate the data – a separate, completely unrelated application reads that data, formats it and spits out a file (which is in “834 format”)
4) Send the data to someone else – deliver the 834 to a receiver (the insurance company you want to sign up with)

Most of the work is completely invisible to the user – and it should be! The errors we have seen raised by the website seem to indicate poor database design and/or applications that don’t interact well with the database. If the federal exchange system is unable to generate 834 files correctly, it’s probably one of the following:

1) The website is not properly writing to the database (some data is not being captured, in other words)
2) The translator that is trying to create an 834 is not reading the data correctly in the database
3) Some combination of A and B

These are very fixable, but the actual corrections are incredibly time-consuming. Debugging code is tricky even when you are the developer who wrote the program; this whole idea of a “tech surge” is a bit silly, they will have to spend weeks trying to learn what the database structure is and how the applications work/interact with it. The best chance you have of fixing these issues quickly is to leverage the team that did the application and database design.

For the record, I am a supporter of the ACA and I would love to see it work, but as an IT professional I am more than a bit irritated about the coverage of the rollout. These kinds of scenarios where the technical side of a business is trying to alert everyone else about what can go wrong, trying to raise red flags – they are extremely common in the private sector too. Think of all the times Microsoft has had to hastily patch a batch Windows update release!

Thank you for taking the time to read my e-mail, I hope I was able to shine some light on the 834 and what the likely problems are.  Of course, only people who can see under the hood, as it were, can know for sure – but these types of errors during implementation are common, they just usually don’t get aired publicly.