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ACA Website: Is Government Technology Doomed To Fail?


This is TELL ME MORE from NPR News. I'm Michel Martin. We're going to spend some time today talking about health issues. We'll hear about why cancer is a growing cause of death in Africa and we'll hear about why leaders of a Native American tribe believe that offensive team names can actually be harmful to the health of their people. That's coming up.

But first, we want to talk about something that was supposed to make it easier to get healthcare in this country, especially for people who do not now have it. We're talking about the president's signature healthcare law - the Affordable Care Act. But as you probably know by now, the rollout has been anything but easy. It's been marred by political infighting to be sure, but the serious technical problems have really infuriated the public and lawmakers on both sides.

And the president was forced to defend the law again yesterday in a speech after reports that many insured people were notified that their existing plans are being canceled. We wanted to learn more about both of these issues so we've called on Mary Agnes Carey. She's a senior editor correspondent for Kaiser Health News. She joins us from time to time to talk about the Affordable Care Act and other issues in healthcare. Welcome back. Thanks for joining us once again.

MARY AGNES CAREY: Thanks for having me.

MARTIN: And for the technical side, we've called Clay Johnson. He's the CEO for The Department of Better Technology. That's a nonprofit that develops technology for governments. He also worked on Howard Dean's 2004 campaign and is a cofounder of Blue State Digital, which worked on digital strategies for President Obama's 2008 and 2012 elections. Clay Johnson, welcome to you. Thank you so much for joining us.

CLAY JOHNSON: Thanks for having me.

MARTIN: So, Mary Agnes, let me start with you 'cause the president said for years that people who like their insurance, who like their existing healthcare program, would get to keep it under the Affordable Care Act. And now the House Republicans have put an ad out calling him out for that promise.


PRESIDENT BARACK OBAMA: If you like your insurance plan, you will keep it.

UNIDENTIFIED WOMAN: It's not the truth. You don't get to keep your premiums. You don't get to keep anything.

OBAMA: Let me repeat this - nothing in our plan requires you to change what you have.

UNIDENTIFIED MAN: The guys I work with, they've gotten the same things, the same letters. And then, you know, when we called Blue Cross Blue Shield they're like, we've been dealing with this all day long, every day.

OBAMA: If you like your current insurance you will keep your current insurance.

MARTIN: I think we get the idea. So what happened?

CAREY: What happened is that for about 5 percent of Americans who purchased in individual market - that's about 14 million people - hundreds of thousands of those people are getting these letters that say, your plan is being discontinued. It could be because it doesn't satisfy the requirements of the Affordable Care Act. It might be that the insurance company simply doesn't want to sell it - insurers have had that ability in the individual market to change plans, year in, year out. But they're getting these notices and, for a lot of people who have the coverage they like, they're wondering, why is my policy being covered?

MARTIN: Isn't this something that the administration should have anticipated?

CAREY: I think that's a fair assessment, because they know - they've said themselves - there's a lot of churn in the individual market, a lot of turnover. And they've also talked about how skimpy some of these plans are. Now some people like these policies, right?

They may want a policy that doesn't cover maternity coverage. They don't want - they don't want preventative care coverage, no out of pocket cost, no co-pays deductibles and so on, which is required by the ACA. So when those plans would be renewed, if they had - you know, if they don't follow these particular requirements, or they've changed in a variety of ways since the law came into focus, people are going to lose that coverage. So I think it's something they should have anticipated. I have a feeling that they were trying to calm the people who have employer-sponsored coverage, because...

MARTIN: Which is the majority. Is it not?

CAREY: The majority, it's like 85 percent of people, right? And so for people in the employer market, they're not on the exchanges. They don't have to change their plans. But we've got to remember that, even in the employer market, our employers make that decision every year. What plans they're going to offer, which plans they're not. So you might lose your coverage even with your employer if they decide they want to go with a different carrier.

MARTIN: So what do people do who lose their coverage? What do they do now? Or who's existing policies are being canceled? What do they do? They're supposed to do what? Go to the website, right? And get - figure out new plans?

CAREY: Yeah, that could be a problem.

MARTIN: OK, which brings in Clay Johnson - without getting too technical about it, everybody - the Health and Human Services secretary, Kathleen Sebelius, the president himself - nobody is defending it. Is this as bad as people say?

JOHNSON: This is as bad as it gets. Although it's sort of predictably bad. You know, 94 percent of the time large federal IT projects fail and this is no exception. Usually, the successes are the exceptions and not the rule. It's...

MARTIN: Why is that?

JOHNSON: I think it's because of the way that we hire people on the inside of government to manage these projects. And the way that we hire contractors in order to implement the work. Look, from my experience, I like to say that a successful information technology project requires three things. It requires time, it requires money, and it requires talent. And the government had plenty of time and they had plenty of money, so it must've been talent that was missing.

In this case, we have about 1,800 pages worth of regulations that determines who can win contracts and who can't. And as a result, I think, in technology, some of the smaller, more innovative businesses are not getting selected for these contracts. And you have larger companies that have entrenched themselves and almost guaranteed themselves the business, winning these contracts, and therefore, not having to compete, not having to modernize themselves and continually failing at implementing stuff like this.

MARTIN: If you're just joining us, we're talking about some of the issues that have been coming up with the Affordable Care Act - issues is putting it mildly. I'm joined by technology developer Clay Johnson. Also with us, Mary Agnes Carey of Kaiser Health News, who's been helping us sort out all these issues around the Affordable Care Act before now. Clay, from a technical standpoint - we can see from a user's standpoint what's wrong with the website, you can't get in.

You can't use it in a number of places, not everywhere. There are some places where it is working and people are able to get in and have enrolled. But can you tell us from a technical standpoint, why is it so messed up? I mean, a lot of consumers these days have the experience of going online and buying anything they want from a stick of gum to a set of tires. So why is this so hard?

JOHNSON: Well, you know, it's interesting from a technical standpoint. There's a lot of systems that this has to integrate with. So it has to talk to the social security database and the IRS database and stuff like that. But for $200 million, that ought to be achievable. I think to really figure out why this is messed up, you have to sort of take a step back and go, why does this stuff keep failing? One reason why might be that in 1996, Congress decided to lobotomized itself. It got rid of its technology assessment office - the group of people that were advising Congress on technology issues.

And so when Congress is now making a policy or regulation that requires an information technology project, whether it be healthcare.gov today or recovery.gov, you know, five years ago, they generally do a bad job at figuring out the requirements and figuring out the reality of which this website is going to be implemented in. And then, coupled on top of that, you have, you know, an executive branch of government that can only choose from a handful of vendors that will generally charge you too much money and do a bad job. So between those two things, this is the outcome that you get. And we can sort of complain about healthcare.gov, but I think really the solution exists - the solution to these problems exists a step back.

MARTIN: Now the president said that this is going to be fixed in a matter of weeks, I believe he said. Do you believe him?

JOHNSON: Well, they've given themselves a deadline of November the 30. I think that's a pretty healthy deadline. They've put a lot of talent on the show now. They've got Jeff Zients who's working on it. He used to be at the Office of Management and Budget. He's a pretty smart, sharp guy. And they've brought in the Presidential Innovation Fellows. I used to be a Presidential Innovation Fellow last year. Those are some really smart and talented people. So I think that they don't have a choice but to do it. I think that, honestly, if they don't get this fixed by the self-imposed deadline of November 30, then it really puts the entire Affordable Care Act at risk.

MARTIN: And, Mary Agnes, what has Kathleen Sebelius saying about this, the Health and Human Services secretary? What's she saying about the big problem - both the technical problem, which I'm not saying is not a big problem, and also this issue of people having policies, that they say they liked, being dropped from them? What's she saying about that?

CAREY: Well, as far as the website, she's admitted it's a miserable, frustrating experience. She called it a debacle. They're working hard to fix it. And she acknowledged that yes, some people have gotten these notices. But what she tried to stress yesterday in testimony on Capitol Hill was that a lot of these plans may have been weaker than people realized. For example, it may not have had the hospital coverage that you thought you had.

There had been a lot of medical underwriting that prohibited lots of people from getting coverage. That has gone away. No more annual limits, no more lifetime limits. She tried to stress the benefits of these plans offered under the Affordable Care Act. But she also acknowledged, though, that yes, there are some problems with the website. During the hearing that I attended yesterday, the website was down the entire time. The Republicans on the Energy and Commerce Committee brought it up about six times. So she knows she's got a problem, but says they're on it, and they want to fix it and that they're moving forward.

MARTIN: Do people in the administration have confidence that it can be fixed? I mean, I understand - you know, there are things that they say publicly, and then there the things that they say to each other, OK? So what are they saying to each other?

CAREY: That they think they can get this fixed. They took two things. Number one, they set this November 30 deadline, and as Clay was talking about, they've got Jeff Zients in there, they've got other - they have a tech surge. They're not saying who's all working on the tech surge, but that they have that. So they're very focused on doing that and say that they believe they can finish it in time for that.

MARTIN: And, Clay Johnson, final thought from you. I understand you were watching the hearings yourself off and on. What impressions, if you don't mind my asking, did you get from the hearings?

JOHNSON: Honestly, my impression was that, you know, Congress has certainly lobotomized itself when it comes to these technology issues. You know, it was very much like watching people, who could neither read nor write, discuss a book. They sort of had no grasp of the issues, and so it degraded into sort of just talking points with no serious outcome really wanted by either side. And was really unfortunate because these processes - you know, the federal IT budget is $80 billion a year.

The total amount of contracting dollars that we spend per year is a half a trillion dollars. It represents one-sixth of the federal budget. That money could be spent better and, also, it could do a lot of good. And I wish our Congress would really start thinking more about how to spend that money more effectively.

MARTIN: Maybe you'll come out of your shell one day and tell us how you really feel, Clay. Clay Johnson is a chief executive officer for The Department of Better Technology. That's a non-profit that works to create better technology for governments. He joined us from member station WABE in Atlanta. Mary Agnes Carey is a senior correspondent for Kaiser Health News - we want to say once again, that's a news service. It is not affiliated with Kaiser Permanente. And she was kind enough to join us once again in our Washington, D.C. studios. Thank you both so much for joining us.

CAREY: Thank you.

JOHNSON: Thank you. Transcript provided by NPR, Copyright NPR.