Saturday'’s the deadline – it’s the last day of November and the day the Obama administration promised its health insurance website would be working smoothly for “the vast majority” of people.
Officials say there won’t be an obvious “before” and "after” picture of HealthCare.gov. "November 30 does not represent a relaunch of HealthCare.gov. It is not a magical date," says Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services, which operates the site.
To show how serious they are, CMS took the website down for an extended maintenance from 9 p.m. ET Friday, Nov. 29 to early morning Saturday.
Bataille said technicians added new servers to speed up the process. "The site is performing well today with low overall error rates and response times despite heavier than usual weekend traffic. We are making additional hardware upgrades and software fixes tonight as part of a planned set of improvements to improve speed and reduce errors," she said in a blog post. CMS plans another update Sunday.
But if you really want to know it's working, look for insurance company ads. So far, insurers have been a little bit quiet about the site which, after all, is supposed to be driving them lots of business.
"As the technical issue get worked out, health plans are going to get more and more engaged," says Robert Zirkelbach of America's Health Insurance Plans, meaning they're waiting until it works better before they start a full-court press of ads.
The administration says the site, which crumpled almost as soon as it opened on Oct. 1, is now working for just about everyone. “We’re happy to report that 90 percent of users are now able to create accounts,” the Health and Human Services Department said in a statement Tuesday night.
“Two key factors are whether the site can handle the volume of people who are expected to want to enroll through the end of the year and whether the process is smooth and error-free,” says Larry Levitt of the Kaiser Family Foundation, which has been monitoring the rollout. “It doesn’t have to work perfectly for everyone.”
CMS says it can now handle 50,000 users at the same time, or 800,000 a day, which was the original specification. CMS also cautions that it may not work perfectly for people with complicated situations.
But Zirkelbach says the "back end" of the site — the part where the policy actually gets bought and paid for — is still rough. "Health insurers are still seeing enrollments that are duplicated, missing information, things like that," he said.
And one big piece is missing: so-called direct enrollment. If that ever works as it should, people should be able to go directly to a health insurer's site and sign up with a small detour to HealthCare.gov to see if they are eligible for a subsidy. That function is barely working now.
Nonetheless, the government says it is ready for an end-of-the-month rush, combined with a post-Thanksgiving pile-on.
“Health care is going to be a popular topic of conversation over the holidays,” Levitt said. The Monday after Thanksgiving has, in the past, been a popular day for people to sign up for Medicare Part D (the prescription drug coverage plan) and Medicare Advantage (Medicare provided by a private insurer) coverage, for example.
The White House knows it cannot count on the insurers for now so it's turned to advocacy groups. Organizing for America, which campaigns for President Barack Obama, plans a public relations blitz called “Health Care for the Holidays”.
“Are your family members traveling home for the holidays? There are a few things they’ll need to sign up for health coverage,” it advises. Their “packing list’ includes W-2s and Social Security numbers.
“Don’t forget to follow up: ‘Have you signed up yet?’” it urges.
AARP, the group for people over 50, has its own campaign, with e-cards ready to send out to adult children. One choice: “Get health insurance so I can stop pestering you to sign up and start pressuring you to get married.”
The White House has asked Democrats to reach out to constituents, and urged them to tell success stories.
The right-leaning Heritage Foundation has counter-programming e-cards. “Let’s be thankful the government doesn’t regulate how much we can eat at Thanksgiving dinner,” one reads.
A little worried about all this propaganda working too well, the White House and HHS officials have asked groups like Enroll America and labor unions to hold off on driving traffic to the site until it’s clear what it can handle. HHS Secretary Kathleen Sebelius advised shoppers to "Shop HealthCare.gov during off-peak hours (mornings/nights/weekends)."
The health insurance exchanges are the centerpiece of the 2010 Affordable Care Act. They’re the main vehicle for getting insurance coverage to the more than 40 million Americans who don’t have any now.
No one expects all those people to sign up on the exchanges, however. The Congressional Budget Office originally projected that 7 million people would sign up for private insurance on the exchanges the first year, with another 9 million signing up for Medicaid in states that are expanding their programs.
It’s not clear whether the publicity surrounding the slow start has put a significant number of people off. During the first month the exchanges were open, HHS says about 26,000 people signed up on the federal exchange, operating on behalf of 36 states, while close to 80,000 signed up on the state-run websites.
Some states say they have done much better since then. New York says 76,177 have signed up on its exchange.
“The way we are going to be evaluating success will be based largely on anecdotes,” Levitt says.
It may be hard to tell, given that critics of the site have been pushing out tales of woe from people who said they couldn’t sign up, found their insurance premiums were more expensive than they had expected, or found their favorite doctors or hospitals were excluded from the new insurance networks. The White House has countered with first-name-only anecdotes of people who have succeeded in enrolling.
Hard new numbers from the administration will come in mid-December, when HHS will release enrollment numbers for November.
“More important than how many sign up is who signs up,” Levitt says.
Experts agree it will be important to get the right mix of sick vs. well people into the exchange plans. Insurance companies will go broke if they have to cover too many sick people without premiums from healthy people to balance them out.
That’s why there’s been so much attention lavished on the “young invincibles” — young adults who don’t yet have the chronic health conditions that are so expensive to pay for, and who may be wary of shelling out for health insurance.
The administration’s already had to admit that parts of the system don’t work. On Wednesday, it said small businesses will have to wait until next year to use the exchanges. It’s extended the open enrollment period for people who want health insurance to start on Jan.1 – they get an extra week now, until Dec. 23.
But the White House has repeatedly reminded people that they have until March 31 to sign up for insurance to get credit for being covered in 2014 and avoid the tax being levied on those who don’t have health insurance.