America's Bitter Pill

by Steven Brill

As for actual traffic online, the CMS people had access only to the same data point that any website operator has—how many visitors had come. They had never installed a dashboard that would give them up-to-the-minute traffic numbers for individual pages, let alone the number of people who had actually enrolled. All that would have to be tabulated at the end of each day. But they did know that visits to the home page were high. Amazingly high: over a million visits by 7 A.M.

  There were smiles all around. “Chiquita [Brooks-LaSure] had tears in her eyes,” Bataille would later recall. “We were finally doing this. We were all just so proud.”

  At about 8:15, Bataille began hearing from some of the CMS people who had offices in the HHS building and had not been furloughed that they were seeing Twitter chatter about the website not working. Soon, the Twitter messages were multiplying, almost by the second.

  The operations centers still said they had nothing to report, no real signs of trouble. One reported in at about 8:30 that the only problem was traffic on the phone lines, which had become jammed.

  The traffic was now so high, one senior person reported to one of the CMS press people, that he was beginning to think they had been “hacked by some right wingers. But so far so good.”

  “HAVE A GREAT DAY”

  By now Bataille was picking up reports from call center supervisors that people were complaining about something having to do with the identity verification process for registering an account. Either it was broken or the instructions about how to use it were unclear.

  I already knew that. At 8 A.M. I had gone online pretending to be from Indiana (one of the thirty-six states on the federal exchange) and was told, first, that, unlike in Kentucky, I had to establish an account before I could browse around. To establish an account I had to provide my name and Social Security number. Then I had to answer some “security” questions in order to prove I was who I said I was.

  The process is used by many security-conscious websites. A big data company—in this case Experian, the giant credit rating and background checking service—would assemble questions that presumably only I, and Experian, would know how to answer. What brand was the first car I owned? Where was the first house I had ever bought using a mortgage? If I answered the questions correctly, I was me.

  The instructions about how to proceed to the quiz were, indeed, unclear. And when I figured them out, it did seem that something was broken. None of the questions appeared, yet I was told I had failed.

  It looked like one of the risks of having multiple contractors with no one in charge of the whole package was playing out. Experian routinely connected this software into hundreds of website deployments. Either lead contractor CGI or Experian, or both, seemed to have failed to complete the link for HealthCare.gov.

  I tried again. This time I got three questions, but before I could check the multiple-choice boxes, the screen went blank. On the third try, I got no questions. Instead, I was taken back to the home page Bryan Sivak had built, and to “Sonya,” the smiling young woman whose face dominating the screen was about to become the ubiquitous image accompanying every news story about the website. By now Sonya seemed like she was laughing at me.

  I tried one more time. Same result, except that this time I couldn’t even get back to Sonya. Instead, I got a message that would become the staple of the news coverage of the launch: “We have a lot of visitors to our site right now and we’re working to make the experience here better. Please wait here until we send you to the login page.”

  While I kept that screen opened hoping to get back to the log-in page, I tried the handy option allowing me to do a live chat with one of the customer service people whose scripts Mandy Cohen and Julie Bataille had slaved over. This service had been put up live in the weeks prior to the launch, and when I had tested it then with various questions, the answers I got were so quick and so smart that I had begun to think maybe they really were going to pull this off.

  Now, I typed in my question about the identity verification glitch. This answer repeated itself eight times over fifteen minutes:

  “Please be patient while we’re helping other people.”

  Then I got a ninth message: “Your chat session is over. Thanks for contacting us, and we hope we’ve answered your questions. Have a great day.”

  I emailed a press spokesman—the first one who had talked to me about his colleagues’ post-traumatic stress disorder ten days before—to ask about the glitch, and about the fact that by now I had been waiting nearly forty-five minutes to get back to the log-in page.

  Here’s what I got back:

  This is what we’re telling reporters right now:

  “We have built a dynamic system and are prepared to make adjustments as needed and improve the consumer experience. This new system will allow millions of Americans to access quality, affordable health care coverage.… Consumers who need help can also contact the call center, use the live chat function, or go to localhelp.​healthcare.​gov to find an in-person assistor in their community.”

  It was a parodylike attempt to glide over reality with the kind of happy talk—“dynamic”!—that Washington reporters roll their eyes at.

  My own reaction to that statement and to the “Have a great day” live chat sign-off was more jaundiced. I remembered all the speeches Barack Obama had made about the arrogance, lack of accountability, and overall incompetence and consumer unfriendliness of insurance companies.

  Then again, the press statement was the product of honest ignorance. No one at HHS and CMS, including the press office, had any idea of what the problems really were. Even if the staff at any of the command centers had been inclined to level with their bosses or the press flacks, they, themselves, didn’t know much, either. They had no idea of how many people were getting through and enrolling. By now, 8:45, they had heard something from Bataille about the identity verification problem, but throughout the day they would not know what the rates of error were for the identity check, or even what the wait times were for the home page.

  AT LAST: “KATHY IN ILLINOIS”

  However, by 10 A.M. there were cheers in Tavenner’s conference room, including a “woo-hoo” from Tavenner herself. They had just gotten word—through a Twitter message—that a woman in Illinois had successfully enrolled her family. “It was such a great moment,” Chiquita Brooks-LaSure later told me.

  The CMS spokesman called me with the good news—though on background, not to be attributed to him, because at CMS everything was always on background, never to be attributed to anyone (even the people whose job it was to talk to the press). “This means the system works, even the identity part,” he said excitedly. “We did it! Now, it’s only about capacity, and we can fix that in a few hours or maybe by tomorrow.”

  It soon turned out that they could not confirm that the Illinois woman had actually enrolled, because the system couldn’t provide the information. It was only several hours later—during which Tavenner and Bataille repeatedly had to delay a press conference so that they could give reporters the information—that the first enrollment was verified.

  For the rest of the first week in October, CMS’s Web page apologizing for delays would tell visitors, “We appreciate your patience and look forward to helping you get quality, affordable coverage just like Kathy did”—which was followed by a link to a newspaper article describing the triumphant experience of Kathy in Illinois.

  “THE SAME WAY YOU’D SHOP ON AMAZON”

  By midmorning, everyone in the outside world who cared was aware of the identity verification problem. It was all over social media. Twitter had become the dashboard for real-time monitoring of the government’s most expensive, ambitious website ever.

  As word about the identity problem came in to the command center run by Chao and hosted at CGI, the CGI people were already grousing that they had warned that the system needed to be tested end to end and that Experian had done a lousy job.

  At CCIIO’s command post, the toldya-so’s were all about
CGI and Chao.

  At the White House, there was also frenzied activity amid charges and countercharges. But it was all about the government shutdown, not the Obamacare website. What functions and people had to be suspended? How should the president’s schedule be changed? What was the exact deadline, based on available Treasury funds, for getting the debt ceiling raised before the government would be in default? And what would be today’s plan of attack to force the House Republicans to relent?

  As for Obamacare, they knew there were some problems, but Sebelius had assured chief of staff Denis McDonough that it was all about the traffic, which was so huge that it had busted one of the pipes—the identity verification process—that would soon be fixed. The system worked. We know this because we spoke to the lady in Illinois (who was soon besieged by all the reporters Tavenner’s people had sent her way, with her permission).

  True, the site was now not even allowing people onto the home page to encounter the identity verification hurdle. But that, too, was all about traffic, the White House team was told. Despite the worried internal emails at CMS just days before about insufficient capacity, the White House staff were all told that they could fix that quickly, too.

  In a noon Rose Garden statement, with a dozen citizens whom the White House press office said were about to benefit from buying insurance on the new exchanges standing behind him, President Obama lashed out at the Republicans: “One faction of one party in one house of Congress in one branch of government shut down major parts of the government. All because they didn’t like one law. This Republican shutdown did not have to happen.”

  Obama then turned to the program the Republicans were holding hostage, explaining how the rollout of the exchanges that morning would help the people standing behind him.

  “Sky-high premiums once forced Nancy Beigel to choose between paying her rent or paying for health insurance,” Obama said. “She’s been uninsured ever since. So she pays all of her medical bills out of pocket, puts some on her credit card, making them even harder to pay.… Well, starting today, Nancy can get covered just like everybody else.*19

  “So if these stories of hardworking Americans sound familiar to you,” the president continued, “well, starting today, you and your friends and your family and your coworkers can get covered, too. Just visit HealthCare.gov, and there you can compare insurance plans, side by side, the same way you’d shop for a plane ticket on Kayak or a TV on Amazon.”

  However, Obama warned, the website wasn’t going to be like Amazon on day one. “Now, like every new law, every new product rollout, there are going to be some glitches in the sign-up process along the way that we will fix,” he said. “I’ve been saying this from the start. For example, we found out that there have been times this morning where the site has been running more slowly than it normally will. The reason is because more than one million people visited HealthCare.gov before seven o’clock in the morning. To put that in context, there were five times more users in the marketplace this morning than have ever been on Medicare.​gov at one time.”

  Obama didn’t point out that it was CMS—whose experience with websites only extended to the little-used Medicare site he had just mentioned—that was running HealthCare.gov.

  “A HIGH-CLASS PROBLEM”

  Presidential press secretary Jay Carney’s 2 P.M. press briefing illustrated how the Obamacare launch and its attendant problems had been eclipsed by the shutdown. Only four questions were about Obamacare. The first was with whether the president was willing to make any changes to the law, including postponing the mandate, as part of a deal to end the shutdown and debt ceiling standoff. The second was about how confident the administration was that the young invincibles really would enroll.

  Only the third question, from Major Garrett of CBS News, asked about “the consumer experience on the websites—some have had glitches, some have been slow.… Is that entirely a product of over-expected use, or are there some internal mechanistic things you have to fix because they’re not quite ready?”

  “Well, I’m not an expert on Web design,” Carney replied, “so, I can’t guarantee that there aren’t glitches that are just technical in nature. And I’m sure there are, as we said there would be, as with any large-scale rollout of a policy like this. It was true of Social Security.… But what is unquestionably the case is that there has been an enormous amount of interest, as we’ve seen by the number of people who have visited the website.

  “And it’s kind of like people trying to get tickets to the first Pirates home play-off game,” Carney added, warming to the theme. “I mean, you know when you go on the site and it’s hard to load the page that it’s because a lot of people like you want to find out if tickets are available, and the great news about this is it’s not one game, it’s not one night; the seats are unlimited and the availability will be there for every American family that wants affordable health insurance. So we take this, as Bill Clinton used to say, as a high-class problem.”

  Through the afternoon, the Twitter noise continued. Brooks-LaSure and Julie Bataille, who was in charge of press communications, called the operations people supervising the outsourced customer callin phone banks. Yes, there was that woman in Illinois, but they were hearing about all kinds of problems, she was told. Bataille and her colleagues were now trying to log on themselves, and failing continually. They tried calling the customer service hotline and got a strange-sounding busy signal.

  Still, all of that seemed to be consistent with Bill Clinton’s “high-class problem.” It was all a matter of that rush of first day traffic built around a successful launch.

  THE TIGER TEAMS IN ACTION

  At 8 A.M., there had been a gathering of the people from CCIIO who would be participating twice a day in meetings of the CCIIO “war room”—which should not be confused with the CCIIO “command center,” which was where designated CCIIO operations people would spend the day.

  This first war room meeting at 8 A.M. had been convened to spell out how the subsequent meetings would work. It seemed like they had their act together, according to minutes of the meeting compiled by a staff person. A “CIRT Team” would “report cross-cutting issues to raise to Michelle [Snyder, the CMS chief of operations] and Marilyn [Tavenner].” Not mentioned was Henry Chao, who was supposed to be in charge of the website’s technology.

  “CIRT is a Tiger Team; it stands for Critical Incident Response Team,” the minutes explained.

  By the time of the war room’s second meeting, on the afternoon of October 1, 2013, there had been a lot of “critical incidents,” and things seemed considerably less buttoned up.

  Everything seemed to be going wrong, not just the identity proofing.

  Some of the problems that had surfaced were near comic: A majority of people who managed to get far into the application process were answering “yes” to a routine question about whether they were currently in prison and, therefore, ineligible for federal help in paying their premiums. Apparently, the website had worded the question with some kind of double negative and “most people would answer it in a way that mistakenly indicates they are incarcerated when they are not,” the minutes of the meeting reported. Testing would have caught that.

  A report that an offering of a dental insurer in South Carolina had been “suppressed” was discussed in the same conversation in which someone else reported, “We heard that the capacity was 100,000 people, and there are 150,000 people on.” Capacity, of course, was nowhere near 100,000, or even 10,000.

  The connection to the IRS’s data for income verification—which everyone had feared would be the toughest link to build—was working. But it didn’t matter. No one could get that far because “identity proofing” was “an ongoing issue.”

  Insurance brokers, who under the law could help people sign up and get a commission from the insurance company, had been given a special connection to log on. That was not working, either.

  Worse, the CMS caseworkers who had been assigned to handle insura
nce company questions or complaints had all been furloughed because of the shutdown, as had the two people who were supposed to run a conference call for insurance company technical people.

  As for the headline news, one member of the Tiger Team reported to the others in the war room that there were “5,800 applications in the world right now—unsure if they are completed at this point.”

  SIX ENROLLMENTS, FLICKERING LIGHTS

  By the next morning, the war room would be told that as of 8 A.M. October 2, 2013, “6 enrollments have occurred so far.” No one knew where that 5,800 number had come from.

  In the Henry Chao/CGI command center, there was just a rolling all-day meeting that first day, where no one took notes. “It was chaos,” recalled someone who was there. “No one seemed to be in charge. The only decision made was to order more servers” to increase capacity. But that was complicated by government procurement rules and by the fact that they had not reserved any servers to provide backup.

  At the Department of Health and Human Services building, where CMS’s top officials and press and congressional liaison staffs were housed, the people who had not been furloughed—a minority—stayed until nearly midnight, talking to congressional staffers and the press about the woman in Illinois, about how capacity was being added, and about all the traffic.

  The only number they provided had to do with all the visitors. One million had visited before 7 A.M., as the president had happily reported. There were 2.8 million visits through the day. “On background,” they emailed reporters, “the system is functioning, with individuals being able to start and finish enrollment on-line. We expect to continue improving the time it takes to enroll in the coming hours.”

  “At least that’s what they’re telling us,” one of the press relations people told me, referring to the information the operations staff was providing. “At this point, who knows? We’ll see in the morning.”