WASHINGTON — Two weeks into the launch of the federal health insurance exchange, the website is still plagued with problems, leading critics to wonder if the problem is worse than it appears.
There are two key issues at the core of the problem, said Dan Schuyler, a director at Leavitt Partners, a health care group by former Health and Human Services secretary Mike Leavitt. One is the volume, which HHS estimates at 14.6 million unique visitors, and the second is the platform's design.
The main problem, Schuyler said, could be "core fundamental design flow," but it's impossible to know because HHS is saying so little. "Only the contractors and HHS know that," he said.
They need to figure out the problem soon, Schuyler said, if the government is to meet its goal of 7 million new health customers signing up on the exchanges by March 31. "That's 39,000 enrolled a day, and we're not seeing anywhere near that volume," Schuyler said. "If they don't get it fixed within two or three weeks, we're going to have a backlog of consumers who won't be able to enroll."
HHS didn't have enough time to test its system for "one of the most complex IT platforms undertaken by the feds or the states," Schuyler said.
HHS did not respond to a request for information, and its website states that there are too many media requests now to answer all of them. However, at the end of the first two weeks, HHS issued a statement:
"We won't stop improving HealthCare.gov until its doors are wide open, and at the end of the six-month open enrollment, millions of Americans gain affordable coverage," said HHS spokeswoman Joanne Peters.
President Obama criticized the problems in a Tuesday interview with KCCI, a Des Moines TV station. "I am the first to acknowledge that the website that was supposed to do this all in a seamless way has had way more glitches than I think are acceptable and we've got people working around the clock to do that," he told the Iowa station. "We've seen some significant progress but until it's 100% I'm not going to be satisfied."
Tuesday, Millward Brown Digital released an analysis showing that 36,000 of the 9.47 million people who visited the site the first week made it to the enrollment page at healthcare.gov, with the assumption that only a small percentage of the visitors were able to enroll. HHS has not released enrollment numbers. Millward Brown is an international market-research group.
HHS Secretary Kathleen Sebelius is scheduled to make an announcement Wednesday morning at a speech in Cincinnati about the number of insurance applications the exchanges have received since Oct. 1.
Schuyler described the system as analogous to building a house. The core is the foundation, and the ancillary pieces are the windows and deck. If the problem is core, that would be similar to deciding that the ranch house the government already built needs a basement. If it's ancillary, they're just replacing single-pane windows with double-pane windows.
"This feels like a core issue," he said, "but I think we'll have a little bit more insight over the next two weeks."
He said he's concerned that the easy pieces of code — logging in and creating an account — shouldn't be causing a problem, and it worries him that the more complex areas, such as verifying identity, will also cause problems after the "upfront" problems are fixed.
Part of the problem with the federal exchange is that HHS had to wait until the states had all decided if they were going to have their exchanges before the federal government could build and test their program, said Mark Pauly, professor of health care management at the University of Pennsylvania.
As a member of the first Bush administration, Pauly helped develop the idea of the requirement for individuals to buy health insurance, which is the reason for the creation of the health care exchanges.
However, "I think the history of Medicare Part D is that people eventually figure out their problems, or they get fired and somebody else fixes their problem," Pauly said. "I'll state the obvious: It's going to take time."
They do have time, Pauly said, adding that if he were looking for insurance, he'd probably give the government some time before heading for the website.
HHS should focus on making the exchanges more shopper friendly, said Joel Ario, managing director at Manatt Health Solutions and former director of health insurance exchanges under Obama.
Now, shoppers want to see what plans are available and how much those plans will cost, and they need to be able to do that without creating an account — especially if people haven't been able to get past that step without being booted out of the system.
"I think the concerns are more talk among the careful observers," he said. "The consumers — it's more curiosity. They want to see what's available at this point."