How to Protect Yourself From Obamacare

[Red Arrow]

Apparently, much like the healthcare bill, the exchange sites were clumsily cobbled together just to get something out there.

There's never time to do it right the first time but there is always time to fix it later.

[heironymouspasparagus]

There's never time to do it right the first time but there is always time to fix it later.

That's the story of any engineer's life.....

Oh,....yeah....going through that now....just like always....


Since we are talking software for a minute - anyone here ever use or hear of 1and1.com for web hosting?  (Compelling advertising and pricing...)

[nathanm]

Gaspar, you seem to have trouble counting. 8.6 million uniques in four days is 2.1 million a day, which puts you in spitting distance of being one of the top 10 sites on the Internet, although as I'm sure you're aware, the top 3 are all around 3 or 4 times as popular as #10. And you ought to know that unique visitors and hits are not equivalent. And the person quoted in the article should know that web browsers cache assets or that any unexpectedly large amount of traffic is "just like a DDoS," even if it comes in the form of people clicking on a link from freakin' Reddit. I just checked, healthcare.gov's caching is not broken like some other sites on the Internets. Even the bloated login page that has 2.8MB worth of assets loads in half the time facebook does.

That said, Alexa (you know how..reliable..that can be) shows a significant dropoff after the first couple of days, which would explain why the site seems to be working fine now.

In any event, it's a hell of a lot easier to snipe from the sidelines than it is to build a system that will handle a wave of traffic like that. Most companies take years (and have years) to get it right.

All that said, they could have stood to combine some CSS files and otherwise clean things up, but it wouldn't have made a big difference as far as the performance on the server side. Static file serving is fast.

[Gaspar]

Gaspar, you seem to have trouble counting. 8.6 million uniques in four days is 2.1 million a day, which puts you in spitting distance of being one of the top 10 sites on the Internet, although as I'm sure you're aware, the top 3 are all around 3 or 4 times as popular as #10. And you ought to know that unique visitors and hits are not equivalent. And the person quoted in the article should know that web browsers cache assets or that any unexpectedly large amount of traffic is "just like a DDoS," even if it comes in the form of people clicking on a link from freakin' Reddit. I just checked, healthcare.gov's caching is not broken like some other sites on the Internets. Even the bloated login page that has 2.8MB worth of assets loads in half the time facebook does.

That said, Alexa (you know how..reliable..that can be) shows a significant dropoff after the first couple of days, which would explain why the site seems to be working fine now.

In any event, it's a hell of a lot easier to snipe from the sidelines than it is to build a system that will handle a wave of traffic like that. Most companies take years (and have years) to get it right.

All that said, they could have stood to combine some CSS files and otherwise clean things up, but it wouldn't have made a big difference as far as the performance on the server side. Static file serving is fast.

There is a big difference between hits and actual traffic.  Your opinion echoes that of our developers.  They built this thing over three years, knowing that they would need significant infrastructure to manage it.  The point is that the code shouldn't' have been the weakness.  Here's the registration script https://www.healthcare.gov/marketplace/global/en_US/registration.js They are not doing anything earth-shattering with the online signup forms, but the data is another issue.  Connecting to all of the legacy data systems probably presents a challenge, but $634 million dollars should have been enough to configure the proper connectors to send and receive an insurance application, but that's not what they are doing. They are trying to use the system as far more than it should be used for.  They are pulling IRS data, law enforcement data (at least Maryland's exchange admits that your application information can be used for law enforcement), credit scores, and God knows what else.   After they have put together this "information package" they then pass it to the appropriate exchange offerings in your state.  As John McAffee said last week:

'What Idiot Set This Up?' 'This Is A Hacker's Wet Dream!'"
"It's seriously bad," McAfee said. "Somebody made a grave error, not in designing the program but in simply implementing the web aspect of it. I mean, for example, anybody can put up a web page and claim to be a broker for this system. There is no central place where I can go and say, 'OK, here are all the legitimate brokers, the examiners for all of the states and pick and choose one.'"

As for the insurance companies like BCBS, all they want is a complete application from the exchange.  We fill these out every year.  They are not rocket science, and with the elimination of the pre-existing conditions requirements, they are even simpler.  It's hard to defend what they have delivered for over half a billion dollars.

[Townsend]

TW FB post:

State Rep. Mike Ritze, R-Broken Arrow, called for Oklahoma legislators to "nullify" the federal Affordable Care Act. Another panelist encouraged people not to pay fines for not having health insurance, saying, "The IRS doesn't even have a mechanism to enforce it." Still another told the audience that as far as resisting the law's requirements, "There are other things that you can do that I will talk to you about later when the camera's not rolling."

http://www.tulsaworld.com/homepagelatest/tulsa-county-republicans-encouraged-to-evade-obamacare-law/article_dd3618b8-315a-11e3-b48d-0019bb30f31a.html

[Townsend]

Health Exchange Tech Problems Point To A Thornier Issue

http://www.npr.org/blogs/alltechconsidered/2013/10/08/230424841/health-exchange-tech-problems-point-to-a-thornier-issue?utm_content=socialflow&utm_campaign=nprfacebook&utm_source=npr&utm_medium=facebook

One week after its rocky rollout, the federal site to help you sign up for health insurance exchanges went down again overnight for additional software fixes. The Obama administration says the technology powering the marketplaces buckled under unexpectedly high traffic. But the ongoing software hiccups for healthcare.gov point to a much thornier problem: procurement processes.

Procurement, the process by which governments decide which contractors to hire for various products and services — like software — is not a sexy topic. But it's linked to the software problems that continue to plague the behemoth system built to help millions of Americans enroll in a health insurance marketplace under the Affordable Care Act.

The shorter-term tech problem is too many people taxing a complex software system that was rushed to launch. President Obama's Chief Technology Adviser Todd Park told USA Today that contractors built a system that could handle 50,000 people using the site at once. But when coverage signup opened Oct. 1, the traffic was five times larger than what officials planned for.

"We are doing several things at once, including adding server capacity and making software changes to make the system more efficient to handle higher volume," White House press secretary Jay Carney said on Monday.

(High volume may not mean high enrollment, but we don't know until the administration releases enrollment numbers in another month.)

It's an unprecedented system, too. In order for the exchange marketplace software to check on which coverage and subsidies you're eligible for, it has to ping requests to the Internal Revenue Service database, Social Security records and Homeland Security data within seconds.

"It's called an integration catastrophe really where you've got lots of different software talking to lots of different things, and an unprecedented amount of scale," says Clay Johnson, a programmer who worked inside government as a White House Innovation Fellow. The fellows looked for ways that the federal government could improve its tech services and save money. He says that while healthcare.gov is glitchy, the real "cancer" is how the government selects the contractors hired to build these IT behemoths.

"One might look at this and go: Why can't we get the smartest people from Facebook and Google and from Twitter to come and work out these problems?" Johnson says. "The problem is that the way that federal contracting works is so burdensome that the only people who get contracts like this are experts at lobbying and experts at regulations that require you to get these sorts of contracts. And they're not experts at doing the job of building these websites."

The primary contractor behind the federal health exchange software is a global firm called CGI Federal, which didn't want to comment for this story. Johnson says it's not that CGI or other contractors behind healthcare.gov are bad. They're probably just not the best, because the best people at these tech solutions don't bother applying.

"In order to fix these problems in the long term, what we've gotta do is encourage the federal government to open its doors to smaller, more agile vendors who are better at solving these larger problems," Johnson says.

He calls for a cultural shift, simplifying the bidding process so more firms compete against incumbents, making everyone up his game. Johnson proposes starting small, with tiny contracts, because changing a deeply entrenched contracting environment is a systemic and long-term challenge.

[Conan71]

Maybe they contracted it to the guy in his mother's basement?

[Townsend]

Maybe they contracted it to the guy in his mother's basement?

That guy and Star Wars kid.

[nathanm]

They built this thing over three years, knowing that they would need significant infrastructure to manage it.

Bad specs (IOW, a serious underestimate of traffic) leads to bad performance. And it was made doubly worse by the need to connect to legacy systems. It's easy enough to toss some more web servers at the problem. If you're beating up one of the IRS' database servers, on the other hand, that's not something with a quick fix. That was my point about most companies having years to get it right. They launch a product and its traffic builds slowly over a period of time. Granted, HHS could have phased in the introduction of the exchanges, but I understand their desire to reduce confusion by having them all go live on the same day. There's enough confusion around the law as it is.

[Red Arrow]

Granted, HHS could have phased in the introduction of the exchanges, but I understand their desire to reduce confusion by having them all go live on the same day.

Anyone else remember when Oklahoma car tags were all due in January?  What a mess that was.

[nathanm]

So the Tulsa World had this article about people getting kicked off Insure Oklahoma: http://www.tulsaworld.com/news/low-income-oklahomans-falling-into-insure-oklahoma-gap/article_ab172674-2e4f-5401-af61-99df7ea7e3c4.html

I'm a bit confused, though. She says her IO premium is $75 a month, which is clearly so low as to be heavily subsidized. IO's maximum out of pocket is 4%. ($75/0.04)*12 is $22,500 a year, which is less than the poverty line for a family of four and thus still eligible for Insure Oklahoma. If she actually makes a thousand dollars more a year, her maximum premium on the exchange is only 2% of income plus she gets cost sharing on the deductible (which doesn't apply to PCP visits and such), leaving her with a $500/yr out of pocket max. So at worst she'd be paying an extra $4 or so a month including the necessary saving to have $500 to pay the deductible.

Am I missing something here, or is TW just burying the fact that an exchange plan would be no worse and possibly better than her existing coverage (assuming I'm working back to income correctly)? Seems like they could have found someone at 175% of poverty (a bit more than $40k a year for a family of four) who would have to pay 5% of income for the premium alone and doesn't get the aggressive cost sharing that people lower on the income scale do. If she does make that much, why are her IO subsidies so much higher than they should be? Or am I misunderstanding and the 4% only applies to people covered through the employer-based IO program?

[Conan71]

^^No answer to that though I can tell you BCBS premiums did go up at roll out the first of the month.  My wife quoted a health policy to a prospective client in her mid '20's last month.  For this plan: 80% coinsurance, $5,000 deductible, $40 copay, and $10/50%/100% on Rx plan........prior to October 1st, $78.00 per month. Post October 1st..........$186.77 per month. Her client doesn't qualify for a subsidy.

Welcome to Obamacare! 

[patric]

^^No answer to that though I can tell you BCBS premiums did go up at roll out the first of the month. 

My understanding was that Blue Cross Blue Shield is wanting existing policyholders to switch their old plans, hence the price hikes.

As for the Tea Party citing website overload as proof that ACA is the "worse law ever," I guess I could apply the same logic to Cher being a terrible singer because I wasn't able to buy concert tickets online. 

Come on, the TP anarchists dont have connections with some clever 14-year-old that could put together a DDoS attack?

[Conan71]

My understanding was that Blue Cross Blue Shield is wanting existing policyholders to switch their old plans, hence the price hikes.

As for the Tea Party citing website overload as proof that ACA is the "worse law ever," I guess I could apply the same logic to Cher being a terrible singer because I wasn't able to buy concert tickets online.  

Come on, the TP anarchists dont have connections with some clever 14-year-old that could put together a DDoS attack?

It's not a matter of "wanting" their policyholders to change plans.  That's the direct result of the new federal mandate.  That's why so many people are royally pissed off, hence the standoff with HOR Republicans.

[nathanm]

^^No answer to that though I can tell you BCBS premiums did go up at roll out the first of the month.  My wife quoted a health policy to a prospective client in her mid '20's last month.  For this plan: 80% coinsurance, $5,000 deductible, $40 copay, and $10/50%/100% on Rx plan........prior to October 1st, $78.00 per month. Post October 1st..........$186.77 per month. Her client doesn't qualify for a subsidy.

Welcome to Obamacare!  

And what were the lifetime limits and out of pocket maximums before and now? I ask because I overheard a conference call the other day where an insurer was complaining about another insurer's excessively high deductibles on their exchange plans.

BCBS is perfectly free to continue offering the old policies to people already on them (and possibly even those who sign up before the end of the year, not sure on that).

..and deciding to look for myself I find that the old plan, which is listed on their site as $56.00 a month for a 25 year old female nonsmoker, has a $2 million lifetime benefit limit, a $15,000 a year max out of pocket, does not cover immunizations at all, mental health services at all, is straight coinsurance for all covered services, and the prescription drug coverage is 50% after a $200 deductible up to a $750 a year maximum benefit. The one listed at $88 is identical except for a lower deductible of only $1500 and thus a $11500 out of pocket maximum.

The Silver-level exchange plan with the same network (Options Silver PPO 004) costs $181.08 for this hypothetical 25 year old and has a $3000 deductible, $6350 out of pocket max, and 80% coinsurance, a $35 copay for office visits and no lifetime maximum. On that plan, preventive care is covered 100%, outpatient surgery is 100% covered after the copay and deductible, and prescription drugs are $0 or $10 for generics and $50 for preferred brand names.

Blue Choice Bronze is closer to the existing coverage (that is listed on the website, anyway), and has a $5000 deductible, $6250 yearly out of pocket maximum, 100% coverage for preventative care (before deductible), and 80% coinsurance, except on outpatient surgery, which is covered 100% after the deductible but with no limits. Even that plan is better than what I can buy on the website today.

Part of the reason for the regulations on what insurance plans have to offer is that many people have been going around for years with insurance that doesn't actually pay enough to keep them from stiffing the hospital/doctor/whoever in a crisis because of lifetime limits or the lack of a yearly out of pocket maximum. Obviously, providing better insurance costs more money. That's the cost of personal responsibility.

Edited to add: If it does turn out they are overcharging, that's OK. It just means a refund to policyholders next year when they don't meet the medical loss ratio requirement.