Just a few notes from Day 1 of the Exchanges and what they mean:
About 2.8 million people visited healthcare.gov – the main website for the 36 state exchanges being run by the federal government – between midnight and mid-afternoon, theU.S. Department of Health and Human Services said….
Kentucky’s exchange, kynect, saw 57,625 unique visitors from its midnight launch until 2:30 p.m., according to the Kentucky governor’s office. Nearly 2,000 applications had been started, with 1,235 completed. The kynect contact center fielded 3,243 calls and 110 e-mails. The average visitor stayed on the site for 11 minutes….
Between the Federal and the State exchanges there were ten million web hits. The financing and actuarial tables work out if roughly seven million people sign up for insurnance. The first day conversion rate in Kentucky and other states are fairly low. That is expected as buying health insurance is a big deal with a lot of options. Pricing, networks, benefit configurations are being released for the first time in a comprehensive manner. People should take time to look at their options, figure out what two or three really meet their needs and then think about trade-offs. My company has been modelling a repeated shopping experience for months now and that is probably what we will get. People will come in, look around, narrow their choices, and leave. Then they’ll come back a couple more times until they choose. I expect spikes in enrollment around the 15th and 30th of the month as well as another spike right after Thanksgiving as people sign up for coverage that can go into effect on Jan. 1.
huge interest and balky technology that led to a series of glitches, delays and even crashes that marred the first hours of the centerpiece of President Obama’s health law.
Responding to mistermix — this system was load tested — the load was just more than anticipated and was more active than anticipated. Thankfully servers are reasonably scalable, and fixes were going into play by mid-afternoon.
The big takeaway is that people are interested, and the technology side of the equation should be quickly patched.
Seven million new people are needed to sign up for the Exchanges including a little more than 2 million young people. I think we’ll hit that by Thanksgiving if yesterday is an indicator. As a side note, it is seven million covered lives, not seven million contracts. This is a slight difference. If I insured my family on Exchange, we would be one contract but four covered lives. I think it is safe to say that of the 10 million hits, those hits represent at least and probably a good deal more than 10 million potentially covered lives. Having enrollment in Exchange go over 7 million would be a very good problem to have.
amk
Excellent.
elisabeth
I was number 1599 to register for Vermont Health Connect yesterday late afternoon. System was slooooow and had some tech issues but as I’m about to need non-employer based insurance and it seems Vermonters are interested in the program I can live with the annoyances.
WereBear
I thought it was great that President Obama mentioned that Apple gets slammed with demand when they are popular.
Everybody knows “site goes down” equals “lots of people interested” for freak’s sake.
amk
7.5 million visits in NY alone? Do the current policies there suck?
Richard Mayhew
@amk: The technical term for the quality of New York state individual market health insurance policy is “sucks donkey balls”
As I noted in a previous post, New York state is a “community rating” state without a mandate and without subsidy. That produced adverse selection death spiral where the only people who could afford insurance were those who already were very sick. $1200 a month for a single person and crappy coverage was common.
Exchange is community rated, but it has a mandate and subsidies to bring relatively healthy people into the pool.
Jack the Second
@amk: Isn’t New York one of the states which had guaranteed coverage but no mandate?
Joni
They are investigating whether these loads were caused by sabotage – digital denial of service DDOS attacks
Tripod
I noticed a lot of just registered, one post FUDs at the GOS. They got swamped by the sheer volume, but they were posting complete bs.
OTOH The alleged fellow travelers pre failing the program, like Duncan Black and his handfull of miscreant posters, boy, what a bunch of assholes.
fka AWS
I think you mean mistermix there.
TS
Computer systems are ALWAYS load tested and the load is ALWAYS more than anticipated. The contractors who do the anticipating are always wrong. Probably belong to the same school of thought as Bill Kristol and the unscrewed polling guy.
And of course – the only thing the media can talk about is – all those glitches – why wasn’t the government ready! Main reason cause the GOP wouldn’t fund it – but the media doesn’t mention that.
Baud
@Tripod:
There wouldn’t have been any website glitches if we had a public option.
Snarki, child of Loki
I’m sure it’s just a matter of HOURS before the “unskewed polls” guy opens up his pie-hole to explain how none of the website traffic numbers can be trusted, and the public interest in getting health insurance is really much MUCH smaller than the MSM is reporting.
Hilarity ensues.
Violet
Richard, I posted this last night, but thought you’d be interested since health insurance is your beat:
“A friend has a friend who works at a Koch Industries company. They got a letter today telling them they would not have health insurance through the company beginning in 2014 “because of Obamacare.” Aren’t they big enough that they’re going to have to pay a penalty?
The friend has a health condition, so this is going to hit her harder than some. ”
Do you know how many companies are going to stop providing their employees health insurance? In this case, it seems that the Koch brothers are just being dicks. But if they think they can pay the penalty because it’s cheaper and easier, then they can’t be the only ones.
ericblair
@WereBear:
There’s an old Microsoft maxim that it’s easier to make users fault-tolerant than systems fault-resistant, and it’s already happened pretty universally. People are used to sites getting hammered.
Also, there will be more glitches to come, but considering the American user experience with health insurance up to now it’s hard to see how any Obamacare fuckup could be worse than the status quo that people are used to.
Jomo
There is belief that the loads in NY were caused by a digital denial of service attack whereby bots as programmed to overwhelm the servers. They are launching an investigation
Richard Mayhew
@fka AWS: yes
amk
@ericblair: I saw a tweet in effect saying yeah, there are computer glitches, so let’s go & die peacefully without healthcare.
mistermix
@fka AWS: Yeah, my comments yesterday reflect my generally low opinion of how info tech services in government are delivered, with a bunch of middle-layer contracting firms sucking money out of the pipeline and providing little value, than a ding against the exchanges. I’ve had a few experiences seeing how many layers of non-workers are involved for each actual worker. (Not that corporate tech projects are much better, but that’s another topic.)
I’m very skeptical that the New York exchange was properly load tested because it was still failing when I checked it yesterday evening, after they’d posted a notice not to try it today, and so forth.
That said, part of the load is probably rubberneckers like me who are on an insurance plan via my spouse’s work at the moment but might end up buying from the exchange if circumstances change.
amk
@Richard Mayhew: Thanks. Why a so called blue state would have such sucky options?
Sister Rail Gun of Warm Humanitarianism
@mistermix:
Or who are hoping that the exchange offerings will be better than the available group plans. My employer gives us the option of the group plan or the company covering the cost of our choice of individual plan up to a certain amount. I can’t think of a better way to get the benefit of the exchange through their wingnut brains than to go, policy options in hand, and opt out of the group policy.
It’s a tiny company, less than 20 FT and PT employees, so adding “yanno, the company could buy everyone this same plan” would be a bonus.
Premium increases over the last couple of years have forced them into increasing the deductible just to get the cost under control. They’re better than most; they’ve also provided an escrow account to cover the deductible.
dmsilev
@Snarki, child of Loki:
I think you mean “explains how none of this matters because the web server software is gay”.
weaselone
@Violet:
It would have been cheaper and easier for them to not provide insurance to their employees even in the absence of the ACA. They’re just using Obamacare as an excuse to cut compensation to their employees and act like the petulant asshats they are. It’s not as if they are are cutting the HC, but increasing salaries by an amount equivalent to what they were paying towards insurance. Plus some of their employees might actually buy the BS they’re peddling and vote for Republicans.
Feudalism Now!
The exchange in New York is going to be one of the poster children of ACA. It already is to certain extent. I am skeptical of the DDoS attack being pushed by the NY AG. The load was comparable to other states and the federal site. It could be that a couple of Freepers decided to launch a RedState bot army, but they would be a minor addition to the server load.
We were unprepared for the volume of interest as a nation. The systems were projected off a MSM skewed polling and sound bite understanding of Obamacare. While Obamacare may be a soshulist plot, the ACA is a sound piece of common sense legislation. People are finding it to be a way to improve the American dream.
Violet
@weaselone: Yep. I don’t know if they are offering any salary increases to offset the cut in benefits, but I highly doubt it. It’s telling that the letter arrived on October 1st, the day the exchanges opened, and it specifically said they did it “because of Obamacare.” They are just dicks.
gypsy howell
I’m one of those hammering both the federal system (for me in my redneck state) and the NY system (to shop for my daughter who lives there, and is 26-ing out of our plan this month)
I think there must be millions like me who are lucky enough to have insurance right now, but want to see how much better we can do on the exchange next year.
No luck getting on yesterday or this morning on either one, but boy am I excited to see what our options are. All hail Obamacare!
NonyNony
@amk:
I think Richard answered that bit already:
They only did 1/3 of the things that make it work. Without the mandate young healthy people don’t share in the costs, and without the subsidy the folks at the bottom of the income pile have no way to share in the costs either. So it’s all on the backs of the folks at the top and in the middle who don’t already have insurance from their employers. Which makes for expensive coverage (and why this whole plan doesn’t work without the mandate – from what I understand New York is the poster child for why a mandate is needed.)
And to be honest – from what I’ve seen New York is only a blue state because New York City is incredibly diverse and racism/sexism/homophobia do not play well there and they don’t like actively kicking poor people in the gut. But it isn’t close to being a Socialist Worker’s Paradise by any stretch of the imagination – it has Wall Street as one of it’s major economic components after all.
negative 1
I spoke with several people (including my mom!) who are waiting at least a month to sign up, mostly because they want to make sure that they have the right plan before they pull the trigger. Purely anecdotal observation, but my guess is that easily three times the visitors yesterday will have visited the site and started researching before the month is out.
Belafon
@NonyNony: Interesting fact: The Bronx was one of the places that had to pre-clear under the VRA.
gnomedad
Important health tip for Hannity fans: if you need an ambulance, call 911:
Sean Hannity Wonders If New Obamacare Website Tech Glitches Will Delay Ambulances
gogol's wife
The headline on the NYTimes began with the word “Glitches . . .” I was furious. There are glitches on the first day of registration at my little college, so duh? Why isn’t the story about the wild popularity of the exchanges?
schrodinger's cat
Yesterday on snooze hour, an NPR and WSJ correspondent were cackling about how all those losery sick people are the ones that were signing up and the program needs young people to sign up to be successful. The WSJ reporter even tried to explain away the sheer number of people, by dismissively saying that she wondered how many of them were reporters or just curious. Anything but give Obama or the Democrats any credit.
Belafon
From DailyKos, Andrew Sullivan may be hitting his broken clock moment, but all the bells went off at the right time, The Nullification Party:
MobiusKlein
Eh, load testing is HARD. It’s very difficult to simulate all the facets of real internet traffic.
If you do any ip to geo-location lookup, your load test has to simulate the real (and unknown until deploy) dynamics of IPs.
A fast ramp up means you don’t have time to learn the sizes of your caches, DB hit patterns, etc.
Did you mess up your cache settings on your media? Your javascript files?
Too long of a cache and your mistakes are hard to replace. Too short, you’re screwed. How many open HTTP connections can you support in your pool. Is your load balancer set correctly.
It’s easy to snipe from the shores – how may times does this site go tits up?
mericafukyea
Jesus titty fucking christ on a stick. It was the first few hours of day one for fucks sakes and people…including some of the troll posters on this site are running around yelling…OH NOEZZZZ….IT”S BROKEN…OBAMACARE IS A FAILURE.
Of course everyone expects that from the fucktards on the right. Not from the fucktards on the left. If you don’t believe me just go to the orange satan dkos and witness left wing fucktard central. Including some fucktard posting day1 hour 1 that he had problems with the site therefore Obmacare is a failure. Oh and he went out of his way to say…”I’m credible because I like totally support obamacare”.
Yea right…whatever. Orange satan is full of trolls…so what else is new.
Belafon
@mericafukyea: Yeah, I went and looked at his diaries. I didn’t dig into his comments, but he really didn’t seem like he was a supporter like he claimed.
TriassicSands
In the Abstract: As a supporter of government run universal health care coverage, I don’t think much of the PPACA. There are ample successful examples in other countries to allow the US to dispense with for-profit insurance companies and move to a system adapted to our own needs. Not all successful systems are single payer, nor do all eliminate private insurance companies, but the for-profit corporations can’t make a profit on the core coverage that every person needs. However, I believe that American corporations are so corrupt that they can’t be trusted to play any role in an American system.
In Reality: There is no way Obama and the Congress of 2010 were ever going to be able to create a “single-payer” system. The votes weren’t there and it wasn’t only Republicans who were the problem. So, the PPACA is a lousy, but necessary compromise and we still will need to take the next steps to a single-payer system. However, for now, the PPACA will make a huge difference in millions of lives, and opposing it is not only stupid, but also immoral. Republicans are continually voting to kill people — or to stand by and let them die needlessly.
That said, I doubt if there has ever been a government program I have wanted to succeed as much as Obamacare — and I don’t need insurance. But I know what not having insurance means in practical terms for the poor and many middle class people. Everyone deserves the peace of mind that health insurance brings, whether it is the knowledge that serious injury or disease will be covered or that financial ruin won’t be the result of expensive health problems. So, I wanted yesterday’s exchange roll-out to be as glitch-free as possible, while accepting the fact that any major program implementation will always have problems. However, there was one sentence that should never have been uttered on October 1, 2013 – “There was more demand than we expected” (hence widespread problems). Yet, there was the president uttering those exact words.
Months ago, I suggested a phased roll-out, with the alphabet divided up into four more or less equal groups. The first week of October “A” through “?” would have their initial access to the exchanges. The second week, the second group would have exclusive access, and so on. Then, on November 1, the exchanges would all be open to everyone. That’s not some kind of genius-inspired solution to preventing overload problems. It’s obvious and it’s been done before for other programs. It’s unfortunate that someone in the administration didn’t insist on such an approach, because the one thing that the PPACA doesn’t need is to give fickle and sometimes desperate Americans the opportunity to think and say bad things about Obamacare.
I’d hope that most Americans are mature enough to realize that since coverage doesn’t begin until January 1, opening day problems are insignificant. There will be plenty of time for everyone who needs the exchanges. The people I feel the most sorry for are those who are so poor they don’t have computers, so they had to go to their local library to stand in line waiting for a computer, only to be unable to log on or accomplish anything meaningful. There’s an element of cruelty in that situation.
Before the exchanges opened on October 1, I visited the exchange site to see what was what. Things were changing in real time as I had a look around. The one thing that infuriated me was the warning that there will be people who live in Republican-run (mismanaged) states whose governors decided not to expand Medicaid who are so poor that they won’t qualify for subsidies (the way the system is set up) or be able to afford any insurance at all. That means that the barbaric thugs in the GOP are going to succeed in killing poor people and this major expansion of health care coverage will fail to reach millions of the people who need it most. The responsibility for that rests entirely on Republicans and Chief Justice John Roberts for allowing the states to opt out of Medicaid expansion. I hope Roberts gets the opportunity to read about individual deaths caused — directly — by his reactionary jurisprudence. May he eventually rot in (the) Hell (I don’t believe exists).
schrodinger's cat
Is our Punditubbies learning?
Friedman gets it right, and thoughtful kitteh approves.
Chris
@NonyNony:
The big Northern cities are the American melting pot – all kinds of different people tossed into the same place together and trying to make it work – in its purest form. That includes not just cultures and ethnic backgrounds, but politics and economic interests too. The liberalism in these cities largely comes from the “little people” banding together to build it from the ground up via things like labor movements and civil rights movements, but the business elites have their say too and no doubt always will.
Elizabelle
CBS Evening News led with the glitches in the online Obamacare program, but made it clear there is pent up demand for healthcare information.
Now to actually read your fine blogpost and the comments ….
Shakezula
That’s 7 million people who don’t have to worry they’ll be flat busted if someone breaks a leg or needs surgery. 7 million people who won’t wait until that nagging little symptom becomes a trip to the E.R. (which will save a shit ton of money). 7 million people who will be slightly less unhappy.
No wonder the Grand Old Parasites want to shut it down.
jon mcnally
While some excahnges are overloaded there are alternatives. Searchable health care program information is also available at healthpocket.com.
Mark Tomlinson
“Computer systems are ALWAYS load tested and the load is ALWAYS more than anticipated. The contractors who do the anticipating are always wrong.”
Nope.
1) Performance testing is almost ALWAYS left to the end of the schedule, squeezing the effort out of what little time is left to do anything at all about scalability defects. Due to poor project management, most systems are never tested at all.
2) Estimation of load is almost ALWAYS flawed, that’s why proper performance testing practices does more than test anticipated load – we should ALWAYS be testing beyond that anticipated load to the system’s breaking point.
3) Contractors who are under-qualified and un-trained will almost ALWAYS screw up some aspect of the performance test design, leading you to a false negative condition. Check the fine print on the statement of work for those cheap resources – especially the indemnities and liabilities clauses.
Performance testing and engineering is a niche skill and hard-to-find talent nowadays. My own experience of the last 20+ years doing load testing tells me someone either cut the budget on talent, cut the schedule for testing or just plain dropped the ball on the whole thing.
JustRuss
I’m not ruling out the “glitches” as more eleven-dimensional chess. Sure, the media will spin it as incompetence and the 27% will buy it, but they’re lost anyways. To everyone under 40, “server overwhelmed” means “tremendous demand”, so despite the media’s spin a lot of people are getting the message that Obamacare is really popular. I assume they could have chosen to roll the registration out slowly, starting in a few states and then expanding, things would have likely gone smoother. But they wouldn’t have generated nearly as much press coverage.
Plausible, or have I become an Obamabot?
West of the Cascades
Richard’s projection matches my personal experience … I’m self-employed with private insurance that is the legacy of a COBRA plan from six years ago because I was turned down for new private insurance due to pre-existing conditions. Fortunately, Oregon had pretty good insurance regulation that mandated my insurance company provide this sort of “portability” plan. That said, the premium is pretty high – $507 a month since I turned 50 – but the deductible is low ($750 per year, $3000 max out of pocket).
Coveroregon.com went partially live yesterday … very slow, throwing error messages all morning when I tried to look at what new plans I might have access to (I tried five or six times) … by the afternoon, it was working more smoothly, and I could get lists of potential plans. We’re about two or three weeks away from being able to buy new policies directly through that site — a roll-out glitch here — but we could go to an insurance broker right now and do it. I’m patient because I know I have until December 15th to sign up and still have coverage start January 1st.
What I saw yesterday was that there are three or four plans that would give me deductible/max out of pocket that are the same or very similar to my current coverage — and all of them were at least $120 to $160 less per month. I’m going to wait until I can see the details of those plans, compare them to my current plan (which the PPACA required my current insurer to send me a list of all of the benefits/co-payment rates/etc — that was NOT available at my current insurance plan’s website, not even at the “myuhc” personalized account page where I can track claims and so forth), and then make a decision about which new plan to switch to sometime in November.
I fully anticipate the screeching monkeys on the right to claim that Obamacare is not working because 7,000,000 people did not sign up for it on October 1st, though.
Person of Choler
Anyone here get signed up yesterday? Were rates and coverage as good as expected?