Obama Sweats Details With Nightly Reading on Health-Site Fixes

By night, President Barack Obama gets a rundown of Zients’ progress from White House Chief of Staff Denis McDonough during their evening stroll along the South Lawn. A fuller report follows in a briefing book Obama takes upstairs to the first- family’s quarters for late-night reading.

As the Nov. 30 deadline for repairing the Affordable Care Act’s website approaches, Obama is sweating the details, down to the timeline for technical fixes. He’s armed with questions every Thursday, when he and Vice President Joe Biden meet with Zients, a former budget aide asked by Obama to help fix the website, Health and Human Services Secretary Kathleen Sebelius and other officials in the Roosevelt Room for a progress report.

“We have a healthy degree of humility to understand that we’re going to have to fix something and then double check, triple check that it’s actually working,” said White House communications director Jennifer Palmieri. “We are going to meet the metrics that we set out.”

This article is based on interviews with administration officials and industry representatives involved in the efforts to fix the site. They spoke on condition of anonymity to provide a first-hand account of the push to reset the insurance exchange website during the last several weeks.

Anxious Lawmakers

With the president’s job-approval ratings down to their lowest point in two years and Democratic lawmakers anxious about the health-care plan’s impact on their re-election prospects next year, the nation is about to find out if the Obama administration is up to the challenge.

Some in the health-insurance industry are skeptical. Companies continue to see high error rates in enrollment data they receive from the website and executives doubt it will be able to handle a surge in enrollments from people who want to start coverage Jan. 1, said industry consultant Robert Laszewski of Health Policy and Strategy Associates in Washington.

“The general sense is that healthcare.gov will not be functioning in any way close to what you need for relatively high numbers,” he said. “There is this enormous pessimism that this thing will be fixed enough to handle the flood.”

Error Messages

The race to find a fix began while the government was partially shut down and millions of Americans were trying to shop for insurance only to get error messages. On Oct. 15, Obama rebuked his staff in the Oval Office for setting expectations too high for the Oct. 1 rollout.

After two presidential election victories built on savvy use of digital technology, Obama’s failing website had become the butt of late-night comics’ jokes. Not only his political standing but his legacy was on the line.

McDonough turned to Zients, 47, who has worked as acting budget director and was scheduled to start as Obama’s top economic adviser Jan. 1, for help. The former management consultant and business entrepreneur saw his reentry to the public sector accelerated to Oct. 18.

For the next six days, Zients pored over the complex, interlocking systems behind the malfunctioning federal exchange website that consumers in 36 states must use to purchase insurance. Fourteen states created their own sites.

‘Turnaround Guy’

The internal data was as nightmarish as the external rollout that was producing hundreds of bad headlines each day. The software code underlying the site was riddled with errors while other portions contained placeholder language that programmers typically use in preliminary drafts. Only six people had managed to enroll on the day the website made its debut.

Even so, Zients, who has been dubbed by White House staff “the turnaround guy,” walked into the Oval Office on Oct. 24 with his assessment: This is fixable, he told a relieved president and other officials, including Sebelius and a knot of senior advisers.

Obama, chastened by his faulty comparisons of the website to electronic commerce successes such as Amazon.com and Kayak.com when the enrollment period started, wanted to be conservative when promising improvement. By the end of the meeting, Zients persuaded him that Nov. 30 was a realistic goal.

As the administration announced the target date the following day, a group of White House innovation fellows and private contractors was already meeting in a three-story, bricks-and-glass, boxy office building in the leafy suburb of Herndon, Virginia, about 20 miles west of Washington.

Developing Metrics

Their mission: to come up with metrics to gauge progress. Scrawling them out on a wall board in a conference room, they included high error rates and slow response times for web pages. As of mid-October, the average load time for the site’s pages was eight seconds, an eternity for modern web users.

Federal bureaucrats and private contractors joined together in teams arrayed around website functions -- User Experience, Registration, Enrollment -- as they worked their way through a “punch list” of 60 fixes, often uncovering new problems as they went along.

In the early days, the rush to get people focused on the fix outdistanced the ability to accommodate the bodies as some computer programmers sat on the floor, propped against walls, as they typed new coding into laptops.

Throughout the process, Obama urged his staff to ignore the critical news coverage and stay focused on their work. When Sebelius faced tough questioning in a CNN interview Oct. 22 and congressional testimony Oct. 30, the president called her afterward each time to offer encouragement.

Community Organizing

In the weekly Thursday update meetings, Obama peppered his aides with queries at a level of detail that surprised some of them. He’d ask questions like “did they get Wave A and Wave B in?” referring to the title that developers gave a typical round of fixes -- each with some 30 different components.

He also brought his community organizer’s mindset to the sessions. At a Nov. 14 meeting, Zients was giving a progress update and Obama wanted to distinguish between technical problems and other issues. If people weren’t completing applications, he wanted to know what beyond website errors could be preventing that. Were people confused, was it that the form is too complicated, were there too many options, did someone need to follow up with a phone call?

As the fix-it crew expanded to include a broader team from QSSI, a unit of UnitedHealth Group Inc., working out of offices in Tysons Corner, a McClean, Virginia-based complex better known for being home to the region’s largest shopping mall, some evidence of progress began to emerge.

Transferring Subsidies

Henry Chao, the chief digital architect of the website, said in congressional testimony Nov. 19 that unfinished work is primarily in back-office payment systems needed to transfer tax subsidies to insurers. Those payments won’t begin until January.

By last week, the average load time for the site’s pages had dropped to less than a second, down from October’s time of eight seconds, according to data released by the Centers for Medicare & Medicaid Services, the federal agency responsible for the website.

As of Nov. 22, the teams had made more than 300 software fixes and hardware upgrades, Zients said, with 50 more set as a priority for completion by the end of this week.

Zients has warned publicly that the end of the month will not be “a magic moment” for the website. “The site will be better at the end of the month than it is today,” he said last week. “And it will continue to improve thereafter.”

50,000 Users

Deputy press secretary Josh Earnest said yesterday that the administration is on track to meet the Nov. 30 deadline, citing the steady improvement in the speed of the site and an error rate below 1 percent, compared with 6 percent when it was first rolled out.

Healthcare.gov should be able to handle 50,000 concurrent users by Friday, he told reporters aboard Air Force One traveling with the president. Earnest described a “queuing system” so that if more than 50,000 people are trying to use the site, they can choose to receive an e-mail from CMS when there’s less traffic and that can put them at the front of line.

Still, the White House remains cautious.

A day after the website opened for business, Lady Gaga on Oct. 2 posted a note on Twitter to her almost 41 million followers “It’s time to #GetCovered at HealthCare.gov.” It was re-tweeted more than 13,000 times, driving even more traffic to the crashing site.

This time, the president’s army of celebrity supporters is being held in reserve, said one administration official, making perhaps the true measure of Obama’s confidence to be the day pop singer Katy Perry promotes the website to her 48 million Twitter followers.