Audit: still working out technical kinks

After three completed open-enrollment periods, the first of which resulted in a calamitous rollout of the Affordable Care Act in 2013, still faces an uphill battle of technical improvements, a government watchdog said in an audit released Tuesday. still faces a litany of technical problems, despite having weathered two open-enrollment periods since its calamitous rollout, federal watchdogs said in an audit released Tuesday. 

The Centers for Medicare and Medicaid Services is still working to correct technical problems with the website that was for a time the failed face of Obamacare, according to an audit from the Department of Health and Human Services’s Office of the Inspector General. Some of the issues date back to the famously flawed launch in 2013.

Despite receiving 18 documented warnings in the two years following July 2011 that the website had problems, according to the audit, CMS decided to follow through with its launch of a system that wasn’t fully tested.

“As with earlier problems, changes to the system still require development of business requirements, technical development, website performance and security testing, and reconfiguration of monitoring and operations, such as website capacity,” found the review, conducted between March 2010 and February 2015.


The biggest persisting technical pain point for is its lack of an automated financial management function, according to the audit, which said the functionality was supposed to be delivered prior to the first enrollment but was delayed to prioritize other elements that needed updating in the faulty launch. 

In the interim, the OIG found that CMS could not confirm the accuracy of payments at the individual level made on the manual system.

CMS continues to work on the system, and at the end of the most recent enrollment period, it rolled out part of the financial system, the Enrollment and Payment System, to enrollees. It plans to complete work on it in 2016.

The website still needs fixes, the audit found, like “improving the transfer of account information to issuers and consumers” and improving “the accuracy of critical Federal Marketplace functions such as determining who is eligible and amounts paid to issuers.”

Now that’s third open enrollment period has closed, CMS officials interviewed by the OIG believe they will have the data to make the best decisions about the future of the website. Because the initial launch faced such inconsistencies in website operations and weeks of downtime that resulted in an extended enrollment period, information about the site’s usage then was uncharacteristic of typical visitors. 


CMS calls the third enrollment the “’first full enrollment period’ because this is the first open enrollment period for which they will have data to predict consumer use of the website for both first-time enrollees and re-enrollees,” the audit says.

“These estimates of website user behavior should allow for more precise measurement of needs for website capacity and consumer support,” according to the audit.

It’s because of the complex system design that these problems persist, according to CMS officials. 

“The complexity of the systems is surprising,”  a CMS official new to the project told auditors. “You could have a Ph.D. in [Federal] Marketplace data file transfer.”

CMS acting Administrator Andy Slavitt concurred with the OIG’s recommendation to catalogue lessons learned from the launch and apply them broadly in the future management of its large projects.


“Overcoming challenge and delivering results in this transparent manner will continue to make CMS a stronger agency,” Slavitt wrote in a letter responding to the report. “CMS is committed to continuing to meet challenges head on in our aim to exceed the expectations of the millions of Medicare, Medicaid and Marketplace beneficiaries we serve every day.”

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