Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, December 2, 2013

CMS notes “measurable improvements” in performance of for individuals

By Paul Clark

On December 1, 2013, CMS officials noted “measureable improvements” to the federal health care marketplace – — while acknowledging the work that still needs to be done. The early Sunday morning CMS update focused on improvements in the application and enrolment process for consumers, not on any back-end issues, such as communications with health insurance companies when individuals choose a health plan. CMS did not discuss the one-year delay in the ability of small businesses to sign up online for health insurance for their employees (see below).

Jeff Zients, the former deputy director of the White House Office of Management and Budget who, since October 22, has acted as a special advisor to CMS and HHS on fixing the website, and said that on December 1, was “night and day from where it was on October 1.” He highlighted the problems with the website when it launched, including “slow decision making and diffuse and unclear accountability.” Since late October the management structure has been changed to establish a command center of CMS personnel and lead contractors.

The new management structure allows for “real time monitoring” of the website, twice-a-day war room meetings, and an open bridge among members of the team to identify and fix problems quickly. The new team managed the process of working through a prioritized punch list of over 400 software fixes which was finished by November 30.

The team also installed a number of hardware upgrades which have improved redundancy, reliability, and scalability. The hardware upgrades improved the registration database at the beginning of the sign-up process; Zientz compared this with expanding a highway from one lane to four lanes.

The result. Average response time for web page loading has gone from 8 seconds in late October to under a second. The error rate has gone from 6 percent in late October to 0.75 percent at the end of November. System uptime, i.e., the time the website is available aside from scheduled down times, has been over 90 percent for the past few weeks,

The site can now handle 50,000 concurrent users. Users spend an average of 30 minutes on the site, which means that the site can handle more than 800,000 consumer visits per day. CMS has established a queuing system to handle times when more than 50,000 users attempt to access the site. The queuing system allows users to access educational material while they wait or submit an email address where they can be notified once the website is accessible, at which point they will be able to go to the front of the line. The queuing system has not been utilized yet.

Other channels. CMS spokesperson Julie Bataille also highlighted a “series of robust channels” other than for individuals to sign up for health insurance. She specifically mentioned a “direct enrollment” pilot program with 16 insurers in several states where individuals can bypass signing up online and work directly with insurers to shop for health insurance and determine possible eligibility for health insurance premium subsidies. Bataille said she was “encouraged by progress in this alternative channel for enrollment” and hopes to expand it throughout the country. She also noted that December 1 marked just two months into a six month sustained education and outreach campaign for individuals to sign up for health insurance.

Small business delay. On the day before Thanksgiving, November 27, the Obama administration announced a delay in part of the health reform rollout that affects small businesses. In effect, small business owners who wish to purchase health insurance for their employees for 2014 and take advantage of a tax credit worth up to 50 percent of the premium will not be able to do this online, but will have to work through an agent, broker, or insurer.

While small businesses – those with fewer than 50 employees – are not mandated to offer health insurance to their employees, the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) established the Small Business Health Options Program (SHOP) which provides for, among other things, a tax credit for the employer portion of health insurance premiums. SHOP includes an online health insurance marketplace, similar to the federal marketplace,, or the state-run marketplaces established in several states.

Since 2010, the Small Business Health Care Tax Credit has been worth up to 35 percent of employer-paid premium costs, and has provided more than $1 billion in tax credits to small businesses. For the 2014 plan year, the tax credit increases to 50 percent of the premium cost.

But just like has had problems getting off the ground, so has the online marketplace for small businesses. As a result, CMS is directing small businesses to work directly with an “agent, broker, or insurer that offers a certified SHOP plan and has agreed to conduct enrollment according to HHS standards.”

Small business owners have until December 23, 2013, to purchase insurance for their employees that starts January 1, 2014.

Insurance industry concerns. Regarding the part of the online enrollment process for individuals that directly impacts the insurance industry, America’s Health Insurance Plans’ (AHIP) president and CEO Karen Ignagni said on November 29 that “Until the enrollment process is working from end-to-end, many consumers will not be able to enroll in coverage. In addition to fixing the technical problems with, the significant ‘back-end’ issues must also be resolved to ensure that coverage can begin on January 1, 2014.”

MainStory: TopStory HealthCareReformNews HealthReformNews CMSNews

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.

A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.