PPACA Implementation Failures: Didn’t Know or Didn’t Disclose?

Hearing Description:
The United States House of Representatives Energy & Commerce Committee met to examine the failures of the Healthcare.gov website and the contractors role in those failures. The witnesses made it clear they only built parts of the application and the full system integration was up to CMS.

Hearing Date: October 23rd, 2013

Hearing Summary: Prepared for AAPS by the Market Institute

The Energy & Commerce Committee convened to examine the problematic start-up of the Obamacare Federal Health exchange website, Healthcare.gov. Members of the committee questioned contractors that were tasked with the design of the exchange site. Rep. Fred Upton (R-Michigan) said in his opening statement he would like to know whether the contractors testifying today did not know the website would not work or did not disclose the website would not work. The contractors were present at a hearing on September 10, 2013 and assured the committee the exchange would run smoothly. There is concern if this is the last of the Obamacare “glitches.”

Rep. Henry Waxman (D-Calif.) said in his opening statement that the rollout of Obamacare was flawless with the exception of the website, Healthcare.gov. He believes Republicans should care about fixing the issues, but are only concerned with the attempted sabotage of the law. The website crashed because of the sheer number of people that want to sign up. This is validation that the law will work. In the meantime, consumers can sign up over the phone and through written applications.

Rep. Tim Murphy (R-PA) said in his opening statement he would like to know why contractors were not ready for the October 1st launch, why the website did not have proper back-end testing, and who in the administration knew of the concerns with the website. Rep. Joe Barton (R-TX) said in his opening statement he will ask contractors about the total lack of privacy that is buried in the Affordable Care Act. Rep. Frank Pallone (D-NJ). said in his opening statement Republicans were simply using this hearing as a way to try and defund Obamacare.

The first witness, Cheryl Campbell, Senior VP at CGI Federal testified in her opening statement that CGI is committed to partnering with Centers For Medicare and Medicaid Services to create a user friendly experience on Healthcare.gov. In 2007, through open and full competition, CGI was awarded an Indefinite/Delivery Indefinite/Quantity contract for Enterprise Systems Development along with 16 other competitors. Of those contractors, CMS awarded the Healthcare.gov contract in 2011. Healthcare.gov is not only a website, but a complex series of analytics and transactions. It is designed to work in real-time with other contractors, insurance companies, and the federal data hub. The first issues began with the Enterprise Identity Management (EIDM), which was designed by another contractor, and this lead to a bottleneck of users that ultimately prevented users from accessing the marketplace. Other issues have arisen, but CGI Federal is working closely with the government to optimize the performance of the site.

The second witness, Andrew Slavitt, Group Executive VP at Optium/QSSI testified in his opening statement his company was contracted to design the Data Services Hub. The hub is a pipeline that shepherds the flow of information from the marketplaces to government databases to verify information. The hub has performed well, processing 178,000 transactions on October 1st with millions more since. QSSI was also contracted to design the EIDM tool, with performance testing occurring in February and March 2013. CMS authorized the tool to operate on March 22nd, 2013. The late decision to requiring consumers to register for an account before being able to view health insurance plans is what lead to the overflow of data on the registration system. QSSI’s EIDM tool had initial problems upon launch, but it is now working well and able to keep up with demand.

The third witness, Lynn Spellecy, Corporate Counsel at Equifax Workforce Solutions testified in her opening statement that her company has experienced no problems with their income verification tool on the federally facilitated marketplaces. Equifax only receives consumer data after a person completes an application on Healthcare.gov. The majority of data has originated from the federal marketplace, but Equifax does verify data for some state exchanges.

The last witness, John Lau, Program Director at Serco testified in his opening statement that his company is contracted to provide support for paper applications. The company has no role in the design of the website. Right now, the number of applications increasing and certainly trending upwards. Thus far, there have been 18,000 applications received, with half of those being completed and the other half missing important data.

In response to questioning, Cheryl Campbell said:

CGI’s portion of the system worked, but it was CMS’s decision to go live
The website will be fixed in time for consumers to obtain health insurance by deadline
CGI was aware of the source code excerpt that essentially said a consumer “had no reasonable expectation of their data being protected” when they submit an application on Healthcare.gov
No pilot program was initiated prior to the 10/1 rollout
It would have been better if more integrated testing was done
There was an end-to-end test a few days before launch and the site failed during that test
CMS was the systems integrator and it was their responsibility to make all the pieces fit together
The website suffered as a result of the changes in code that CGI is now making, specifications on the contract there were not specific enough, and the lack of system wide integrated testing
There have been back-end isolated issues involving forms being sent to insurers laden with errors
HHS CTO Henry Chao and his team gave the go-ahead to turn off the browsing function that would have allowed consumers to view prices without having to register

In response to questioning, Andrew Slavitt said:

QSSI had a limited view of the entire project
Concerns were expressed about the lack of sufficient testing to CMS
No personal data is stored on QSSI servers
They did not see full end-to-end integrated system testing until a few days prior to launch
QSSI did not find out about the disabling of the anonymous browsing feature until within 10 days of launch
CMS was fully aware of the results of the tests that QSSI ran on the system ahead of launch

In response to questioning, Lynn Spellecy said: