The former chief information officer at the Department of Health and Human Services told FierceHealthcare there are no technical reasons for Healthcare.gov’s scheduled downtime during the 2018 open enrollment period.
This year's scheduled maintenance, which represents a significant increase from previous years, has also drawn the ire of four senators that issued letters to the HHS Office of Inspector General and Centers for Medicare and Medicaid Services Administrator Seema Verma seeking more information about why the scheduled shutdowns are necessary and how the agency arrived at their decision.
Earlier this week, Kaiser Health News reported that HHS plans to shut down Healthcare.gov overnight on Nov. 1, the first day of open enrollment, as well as 12 a.m. to 12 p.m. ET every Sunday except Dec. 10.
Assuming the Nov. 1 outage is 12 hours, the website will be down for 6.6% of the open enrollment period. A December 2016 report (PDF) by the U.S. Digital Service indicated that healthcare.gov's downtime during 2015 open enrollment was less than 1%.
“There are no technical limitations that are demanding this, certainly not 12 hours every seven days,” Frank Baitman, the CIO of HHS from 2012 to 2015, told FierceHealthcare. “The second issue is, if you have a will to make something work, you can maybe not make it perfect, but you can do a hell of a lot better than taking it offline 7% of the time.”
Baitman, who is currently a senior adviser at the advisory firm Oaklins DeSilva and Phillips, said the biggest cause for downtime while he was at HHS, including that first troublesome year of open enrollment, was coordinating with systems at other agencies like the IRS, the Department of Homeland Security and the Social Security Administration that still do batch processing and aren’t optimized for high volume, continuous data transfer.
To mitigate the impact, the White House, through the Office of Management and Budget, brought all agencies in one room to minimize the impact on the federal marketplace website, while accounting for the peaks and valleys of website traffic.
“If you’re going to do [an outage] you’re going to pick something like 2 a.m.- 6 a.m. ET,” Baitman said.
The planned shutdowns prompted four Democratic senators to ask the OIG to include specific questions about Healthcare.gov downtime in a recently added review of enrollment systems. In a letter (PDF) to Inspector General Daniel Levinson, Brian Schatz, D-Hawaii, Elizabeth Warren, D-Mass., Chris Murphy, D-Conn., and Cory Booker, D-N.J., requested the agency address specific questions regarding the reasons for the planned downtime.
The HHS OIG added a review of Federal Marketplace enrollment systems on September 15, before reports surfaced about Healthcare.gov scheduled downtimes. The review includes “inquiries into operational readiness, internal controls and IT security.”
“Operations of the website, including any planned downtime, is within the scope of our planned work,” OIG spokesperson Tesia Williams said in an email to FierceHealthcare.
When asked if the review would include the questions outlined by the senators, she said the agency was “reviewing the letter and determining how best to address the inquiry.”
In a separate letter (PDF), the lawmakers asked Verma to explain why CMS made the decision to schedule multiple website outages, including what data or information led the agency to determine the planned downtime was necessary.
CMS did not respond to specific questions from FierceHealthcare about how they arrived at the decision. In a statement to KHN, an agency spokesperson said the outages are part of regularly scheduled maintenance, adding that “system downtime is planned for the lowest-traffic time periods on Healthcare.gov.”
As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!— Donald J. Trump (@realDonaldTrump) July 18, 2017
Baitman said its possible new technical issues have emerged since he left the agency, but he said the onus is on HHS to explain those to the public. Until then, between the shortened open enrollment period, increased website downtime and tweets from President Trump hinting that he is willing to let Obamacare “crash and burn,” Baitman finds it difficult not to be suspicious of the motives behind the shutdown.
“Given that the president has telegraphed that he wants to sabotage Healthcare.gov and the Affordable Care Act—he's been very clear about that—the suspicion is, I think, valid,” he said. “Do you really need 12 hours? They’ve already truncated enrollment from 12 to six weeks, and now you're truncating it another 7%.”
“That just seems as if they are trying to reduce or undermine enrollment,” he added.