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I'll make this as short as possible—I'm a busy person, as are most of you—but some length won't be avoidable. I hope you'll forgive typos. I am not going to go through and proofread/revise, for time reasons.

Let me start by going for the jugular. The trouble with the Obamacare rollout goes deeper than "website trouble." There, I've said it. I think it's time we admit it and shift from defending the rollout or qualifying its failure by providing alternatives, and move in our engagements with critics toward defending the ACA as policy and a set of goals instead, conceding that the rollout has been badly botched—and not just on the website.

Here's my story. Of particular note are the post-website bits.

Background and Disclaimers

Let me start by saying that I voted for Obama twice. I have a bumper sticker on my car that says "I <3 Obamacare" that has caused a certain amount of grief for us in my current home state. I was at the Healthcare.gov website the moment it launched.

I'm not someone who was inclined from the start to be critical of the ACA or of any particulars of its implementation. More to the point, I'm just the sort of person—family with kids, a mix of self-employment and part-time employment that may add up to a nice income but doesn't come with any kind of group insurance—that the ACA ought to be targeting most.

Website Experience

By now we've all heard of the poor website experiences. I experienced these, too.

  • Couldn't create an account on the first several tries
  • Then couldn't get it to verify with the email click-back
  • Then couldn't get the entered password to work
  • Then couldn't log in

I burned through about two weeks and five separate email addresses trying to get a working login (you can't reuse an email address to create a new account). Aside for the geeks: I'm no technophobe. My consulting work is precisely in web development and systems integration. I can code in a pile of languages, going all the way back to FORTH and K&R (before ANSI) C on various RTOSes. This was not ham-handedness on my part. It was me trying to kludge my way into a system with obvious issues.

"Working" Login 1: Finally around mid-October I got a login working. Started filling out an application. Was repeatedly unable to get more than 2-3 questions in before the system would error out on me and ask me to try again later. Fine.

About a week after that, was finally able to get through all the questions—sort of—on that login. Got stuck in a user interface loop—would go through the answer, save, answer, save rigamaroll all the way through to the last question which, strangely, was presented without greying out the previous question—two active "save" buttons on the same page. When I "saved" on either, the page would scroll right back to the top and put me at the first question again. All my data was still there, so I'd "save, save, save, save, save" through dozens of questions again, get down to the last questions, "save" on either of them, and—back to the top.

I went through the loop about 10 times over 2-3 days before I decided that that account instance and the data associated with it was effectively borked relative to the UI flowchart.

Decided to burn another email address, create yet another new account, and start all over again.

"Working" Login 2: This time, answered all questions (yet again) all the way through to the end. Only one save button. Clicked. Page load starts. Hallelujah! Or so I thought. Actually, one step further than before turned out not to be the vaunted "list of options" but rather a message saying that my application couldn't be submitted and I should try again later.

Logged in again later only to find...that my application was blank. Answered all the questions again, got to the last question again, "successfully" saved again, and...couldn't be submitted, try again later.

Tried one more time the next day. Same result. Decided to burn another email address and create another account.

"Working" Login 3: This time, answering the questions was messy. Data was appearing in the wrong places and in buggy ways—fields for my kids' names and SSNs would came up populated with my name and SSN already filled out, or my wife's name and SSN, even though it was the first time through the form; validation errors saying they couldn't verify the immigration details provided even though they had been marked as citizens and no immigration details had been provided for them, the system asking me to choose a family member's address from multiple instances of the same address, and so on.

Fought my way through the form entering and re-entering data in circles, gradually zeroing in on "completeness" with some measure of accuracy.

Finally was able to save. This time, was asked to sign electronically. Hallelujah!

Only—when I checked the status, it told me that my application was incomplete. Went back into it and naturally half the data was missing. Okay, Joe. Re-entered everything. Signed again.

Got a—sort of—approval notice. Hallelujah!

Only—still no options. Instead, got a message saying that myself and kids had been approved, but my wife was missing identifying information. I'd been afraid of that, with all the data messiness in the form that time through. Said it couldn't give options for the family until I called the call center to provide her identifying information and complete her part of the application.

Beyond the Website: Bigger Problems

Here's where things get ugly.

I'd imagined that I was now home free. Call the toll-free number. Provide whatever data (SSN, presumably?) hadn't made it into the system. Get options.

After all, they were (and are) directing people to the phone system. The phone system "works."

Not really.

Call 1, Problem 1: They couldn't find my application. The one whose approval (but for wife's missing information) I'd printed out. Couldn't find it under my name, SSN, or phone number. Since I'd just printed it out, I offered the application ID number. Operator disappeared for a while to figure out whether they could use it. Finally he decided that they could, but I'd had to volunteer and push for that, otherwise—no "us" in the system.

Call 1, Problem 2: He pulled up the application by ID number (I still wonder what sort of shape it was in, given that it couldn't be associated to my SSN, name, or phone). He promptly told me that the kinds of data needed he wasn't qualified or allowed to accept. A representative would have to call me back in 4-5 days before 10:00 PM and they would be qualified to accept and add the data to complete the application.

Call 1, Problem 3: No callback. Fourteen days later and I still hadn't had a callback.

Well, I got it today—but I was otherwise engaged (middle of the business day, middle of a meeting, hadn't made space this week as I had previously because I wasn't expecting the call anymore) and the rep had to leave a voice message.

Voicemail 1, Problem 1: The voicemail gave two numbers, then told me to be sure to call "this" number back. When I do, it said, the system will recognize my number and I'll be immediately asked if I want to be transferred to the Advanced Resolution Center, where an operator will help me with my particular issue. This "opportunity" for immediate transferral will only be available for 30 days. Um, okay. Which number is "this" number?

Voicemail 1, Problem 2: Called them both. Called them both from both of my numbers, just in case I'd applied with my second number for some reason. Didn't matter—the system didn't offer me any transfer to any center. In the first three calls, it dumped me into the general customer rep queue—the one that hadn't been able to help me the first time around. The first three times, I was told that the wait would be at least 20 minutes. The fourth time (having tried all combinations of my number and their number) I decided to wait and speak to a rep. This time, I got one immediately—though 30 seconds ago I'd been told that the wait was over 20 minutes.

Call 2, Problem 1: Once again, the rep can't find my accounts at first. We do name, SSN, phone number. Now he's trying other systems/other things. We start going through all the email addresses I've used to create accounts. Finally we strike pay dirt.

Call 2, Problem 2: With my account found, I tell him my story and that I just need to finish an already approved application by providing some (presumably missing) identifying detail for my wife for our application to the Advanced Resolution Center. He says that he doesn't know what the Advanced Resolution Center is or how to connect me to them. He goes to ask. He comes back. He offers to help me himself instead, without saying whether he's discovered what this center I'd been referred to earlier in the day (supposedly at this very number) actually is, or why, if someone in his position can help me, they couldn't help me the first time around, and why, if someone in his position can help me, the callback earlier in the day had referred me to the Advanced Resolution Center and provided me with clear directions for reaching it (even if they didn't turn out to work). I decide not to look a gift horse in the mouth, and to let him help me instead.

Call 2, Problem 3: He asks me which application I need to complete—he's got three in the system for me. I tell him that I don't know; so far as I'd known, only one had ever been submitted, though I have many logins and have made many attempts—many more than three.

Call 2, Problem 4: He asks if he can go into them to see which one is the one that needs to be completed. I say yes. He tries them all. He says they're all empty. Between the two of us, tossing identifying details and numbers back and forth, we can find no trace of the completed application that was already approved (but for missing identifying detail) the first time around, and whose conditional approval is sitting in front of me.

Now at this point, I have to interrupt the narrative of problems and say that he did offer to help me to complete a telephone application at this point. But it was at 10:00 PM tonight. And my application is long. Multiple employers (all part-time). Consulting work. Details. I am not interested in playing an hour-plus game of telephone at 10:00 in the evening. So I turned him down. Maybe that would have worked out perfectly.

But what I did instead was ask about how the paper application is handled. I had already acquired the paper application based on my previous experiences, but handn't completed it becasue I had some questions based on my admittedly cursory glance:

  • Why is it so much longer than the online application for my state on Healthcare.gov?
  • If I submit a paper application and am approved, what is the next step for me? How do I take action? Also a paper-based process? An online-based one? A telephone-based one? How long will it take?

So I asked him these questions.

Call 2, Problem 5: His answers to these questions.

  • The paper application is long because it incorporates all questions for all states.
  • Once they receive it, someone just like him (his words, not mine) will sit down, log into the system, and fill out the smaller state application electronically for us, selecting only the needed answers from all of the answers we've provided based on the questions that the system asks them. Then, the approval process runs through the same system as Healthcare.gov.
  • I will get results by logging into Healthcare.gov.

Call 2, Problem 6: His inability to answer my obvious follow-up questions. If I submit a paper application, which of the many logins I've already created will be the one to which the paper application gets attached? He doesn't know. He suggests the first one. The first one is one that I couldn't get verified with the email click-back early on. I've never logged into it and still can't log into it. He suggests they're all connected by SSN and it may appear in all of them. But when I say, "So it doesn't matter which one I log into, it'll show up in all of them?" he seems to balk. I ask about the duplicate application problem—right how, Healthcare.gov only allows one application per login. Every login I've managed to create and actually be able to log into has an in-process or existing application. Will this present problems for a new application? No clear answer.

Final disposition: He's going to escalate my case. Someone will call us back (once again) in 4-5 business days. Humf.

Bigger Picture

Website trouble is one thing. This has been presented as a systems integration problem and I've agreed with this—the obstacles are huge on this front, and I've said so in comments. On the other hand, some of the UI experiences outlined above (looping UI with no exit, data being transposed into later fields, different UI flows in successive registrations) suggest a total coding mess, maybe even on the client side, not just systems integration issues—though I don't want to claim anything here because at the end of the day I just don't know and haven't done any technical detective work to try to make an educated guess.

But what about:

  • Call center personnel that can't address the need to add simple missing details to an otherwise already approved application? I still have the "congratulations, you're all eligible, we just need one more detail before we can show your options" printout in front of me.
  • Escalation callbacks that don't happen even close to within given time frames?
  • Already submitted and verified data, the subject of the callbacks in the first place, disappearing without a trace in their systems, well beyond what ought to be the geography of the website itself or its backend?
  • A paper process that involves requiring end-users to fill out extensive applications on which only some data is ever used, then paying countless reps for the countless hours required to process each of these into the system selectively and adaptively, with all the room for human error that ensues, rather than paying up front, once, to produce per-state PDF forms the first time around, saving end-users extra work and turning the entry task into rote data entry at most?
  • Completely incorrect instructions/explanations in escalation callbacks that describe processes and departments unknown to reps in the main queue?
  • An apparent almost total lack of knowledge about how the paper application works, or how end users will receive its results, or how these will interact with existing logins?
  • Different website errors and behaviors on serial registrations that suggest ad-hoc bug fixing and development still without testing and without any attention being paid to existing data, accounts, or their states?

Folks, until today I was dubious but willing to still chalk this all up to "website trouble." The challenges are extreme. But the call center stuff? The missing Advanced Resolution Center? The total fogginess on what the paper application process actually looks like, or how its results will be accessed and acted upon? And the suggestion that reps are sitting down and actually filling out entirely new applications on end-users' behalves by selectively pulling from the paper application on a state-by-state basis, using the same infrastructure that's driving Healthcare.gov into a ditch?

This isn't "website trouble." This, at the end of the day, is a big, big project and organizational management SNAFU, IMHO. It's bad. And after today, I'm not at all convinced that things will improve significantly by January 1st.

I hope they will...But there's only so much that Google can do to assist. Once we're beyond the website and into this level of messiness in the organizational side of things, it starts to look like someone(s) are just really bad at running things.

The Takeaway

We can't be too smug about this. Until now, I've been telling people I know that are critics the website will get fixed, that it's a massive technical undertaking that had impossible deadlines and impossible complexity, that people can just call in or complete a paper application.

Silly me, I was saying those things on faith.

Now that I've had more experience with the call center and had the discussion about the paper application, I think we're going to have to be careful about suggesting that people are overly critical of the rollout.

As far as I can tell, it is, in fact a train wreck. Best to admit this up front and defend the principle behind the ACA and its eventual goals. Defending the rollout (not just of the website) looks to be a losing proposition; let's be sure that we acknowledge that it's a horrible rollout while still defending the absolute necessity of healthcare reform and the idea that the ACA itself is not the same thing as its rollout, and that it's needed policy, regardless of how badly things have gone at the beginning.

And if anyone has a direct number for the "Advanced Resolution Center," I'd love to have it, if this mysterious department exists.

Maybe they can find the completed application approval that mysteriously disappeared, along with the application itself, and help me to put in the five seconds worth of data that was missing the one time I managed to actually get Healthcare.gov to "work" for me. I have the approved application number sitting right here in front me.

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