The contractors who came forward to testify on the disastrous rollout of the federal health-care exchange pointed the finger at the Center for Medicare and Medicaid Services. A lack of comprehensive testing, a last-minute change to the site’s design, and tight, top-down control from CMS led to the large-scale problems consumers have faced in the three weeks since the exchanges went live, they said.
End-to-end testing of the exchanges was performed only by CMS, the four contractors (CGI Federal, Optum, Equifax, and Serco) told the House Energy and Commerce Committee and, as a result, they were unaware of many of the problems afflicting the site. Testing, they said, was not conducted “until a couple of days leading up to the launch,” according to one. Cheryl Campbell of CGI Federal, the key contractor behind Healthcare.gov, told the panel that she still does not know the results of the tests conducted in the days before the site launched. “CMS has [the results],” she told lawmakers.
Some of the siloed testing conducted by the contractors was problematic. Optum is the company charged with creating the registration tool consumers use to create an account on the exchanges and its representative, Andrew Slavitt, told lawmakers, “We informed CMS that more testing was necessary.”
The contractors also pointed to a last-minute change to the site’s architecture, made at the behest of CMS, as the cause of its many ills. That change required consumers to register for an account online before they could shop for insurance plans on the exchanges, preventing them from seeing the cost of the plans without the subsidies they are eligible factored in. Some have charged this was a political decision on the part of the administration to prevent consumers from getting “sticker shock” and turning away.
Slavitt, who works for the company that created the registration tool that facilitated this process, told the panel that problems arose when Healthcare.gov ”was inundated by many more consumers than anticipated.” He pointed to ”a late decision [by CMS] requiring consumers to register for an account before they could browse for insurance products” as the root of that problem. (CGI officials told the House Oversight Committee in a briefing that the decision was made in late August or early September.) Slavitt said requiring consumer registration before allowing them to shop plans ”may have driven higher simultaneous usage of the registration system that wouldn’t have occurred if consumers could ‘window shop’ anonymously.” CGI’s Campbell echoed Slavitt’s account: The registration requirement “created a bottleneck that prevented the vast majority of users” from accessing the site.
The contrators painted a picture of chaos and disorganization in the way the order came down from CMS. Cambell said she received it just two weeks before the rollout; Slavitt, somewhat shockingly, said that he was made aware of it within ten days of the launch, telling lawmakers, “I don’t know who made the decision, I don’t know when the decision was made, and I don’t know why the decision was made.” Campbell fingered CMS deputy director Henry Chao as the government official who demanded it.
While Thursday’s witnesses said they had no indication that the White House was involved in the decision to make the change, the Oversight Committee is investigating just that. In a January 2013 briefing and in one earlier this month, according to the Oversight Committee, CGI officials told committee members that, in discussing matters related to the exchange, CMS officials repeatedly mentioned “the White House” and said things like ”this is what the White House wants.”
Going forward, lawmakers and others will want to know: Was the decision that right now appears to have caused so many of the problems plaguing Healthcare.gov a necessary one, or was it made for political purposes?