Notes reveal chaotic birth of health plan marketplace

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WASHINGTON -- More than 100 pages of "war room notes" released by congressional investigators Tuesday offer a window into the chaos that overwhelmed the Obama administration when the federal health insurance marketplace started up last month, as officials realized that its problems could not be fixed quickly.

The documents were made public just as Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which oversaw creation of the troubled website, wrapped up her testimony at a Senate hearing in which she faced tough questioning from Democrats and Republicans alike.

Sen. Barbara A. Mikulski, D-Md., told Ms. Tavenner that the problems with the federal insurance website, HealthCare.gov, could deter people from enrolling and threaten the success of President Barack Obama's health care overhaul. "There's been a crisis of confidence created in the dysfunctional nature of the website, the canceling of policies and sticker shock from some people," said Ms. Mikulski, a strong supporter of the 2010 health care law.

The documents -- notes of meetings between federal officials and government contractors working to fix the insurance exchange -- were released by House Oversight and Government Reform Committee chairman Darrell Issa, R-Calif. Mr. Issa has been a fierce critic of the health care law, which was passed without any Republican votes.

The notes indicate that by Oct. 8, one week after the exchange opened, administration officials had begun to realize that its problems were widespread and could not be easily fixed. No sooner was one problem solved than others popped up. The documents show that officials were focused on addressing individual bugs, rather than the larger issue: The website was not working properly from Day One.

Users were blocked at the first step, creating accounts, because their identities could not be verified.

The "fix is taking longer than expected, and the website is shut down to carry it out," the notes for Oct. 8 say. Technicians "are not promising a time on the website anymore."

A day later, about 30 percent of applicants could not enter crucial information about their income, address and citizenship. The application process on the website simply skipped over these items, the notes say.

The documents show that officials debated whether to allow consumers to shop for insurance without creating personal, password-protected accounts.

The Obama administration eventually allowed such "anonymous shopping," but, according to the notes, officials realized that the premium estimates shown on the website were not entirely accurate because they did not reflect different prices charged to people of different ages.

On Oct. 11, it was noted that the website was inaccurately calculating premium subsidies for low- and middle-income people.

On Oct. 15, it was noted that some consumers had been pushed into subsidized private health insurance plans "when they should be in Medicaid."

Ms. Tavenner said many of these problems had been addressed, that the website was improving by the day, and that it would "work smoothly for the vast majority of users" by the end of November.

Senate Health Committee chairman Tom Harkin, D-Iowa, joined Republicans in voicing concern about the security of personal information that consumers provide to the government when applying for insurance through the federal marketplace, or exchange. "This is a paramount concern," he said.

Lawmakers heard about a bizarre case in which a North Carolina man using the federal website received a government letter addressed to a stranger in South Carolina who had applied for insurance on the exchange. The North Carolina man was able to download and view information intended for the South Carolina man, even though the two had no connection to each other.

After learning of the privacy breach, Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said: "We identified a piece of software code that needed to be fixed, and that fix is now in place. We take the security of the marketplace seriously."



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