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At the three-week mark, it’s time to admit that the problems with Healthcare.Gov are more than opening day jitters and huge lines at the box office.

On one hand, the sheer number and complexity of the business functions that Healthcare.Gov is intended to perform require extremely sophisticated and high-performing software and hardware.

On the other hand, it’s really messed up. And the President owned up to that yesterday.

The federal marketplace has been compared to sites such as Travelocity or Amazon, and ease of shopping is certainly an essential component of the consumer experience. But if you’re one of the 7 out of 8 enrollees who will qualify for premium tax credits to lower the cost of coverage, you need to know how much money you have to spend before you purchase a plan. And that requires a complicated eligibility and verification process. Rather than critique the performance, let’s take a closer look at what’s involved in the whole production:

  • Act 1 – Privacy, security and anti-fraud. The system must verify your identity, after you’ve set up an account with a long, intricate username and password for added security.
  • Act 2 – Determining eligibility for financial assistance. Since most applicants will qualify for financial assistance to offset the cost of premiums and lower cost-sharing, the system must conduct an eligibility review, which is more involved than applying for credit. The system has to figure out the size of your family’s tax filing unit (aka household size), as well as both your current monthly income (to screen for Medicaid/CHIP) and your projected annual income. The system must also determine if you have access to “affordable minimum value coverage” through an employer.
  • Act 3 – Verifying the data. The system must confirm your social security number, citizenship or immigration status, and income. All of this has to be done under the strictest privacy and security standards, while it checks data from various sources including the Internal Revenue Service, the Social Security Administration and the Department Homeland Security.
  • The Finale – The shopping experience and enrollment. As a consumer, your shopping experience will be different from others because you live in different states and your eligibility information has to be translated into what your “unique” cost will be based on the plan you select and how much financial assistance you’ll receive. Once you’ve selected a plan, the marketplace provides an opportunity to pay your initial premium and then must transfer your information to the health plan for final enrollment.

Implementing any one of these components is complicated but integrating them into a seamless experience is even more challenging. Add to this an unprecedented volume of interest and demand, and well, you’ve read the critic’s reviews.

As off key as the federal marketplace IT glitches have been, it’s hard to deny that people are excited about their coverage options. To borrow a phrase from Heather Howard at the State Health Reform Assistance Network, “glitches can be fixed, a lack of demand would be a bigger problem.” Thank goodness the state-based marketplaces demonstrate how it is meant to work, with Kentucky stealing the show. And off Broadway, there’s an unsung hero and more seasoned star – Medicaid – quietly contributing to the ACA’s coverage goals by signing up tens of thousands of individuals.

While Healthcare.Gov remedies its production flaws and weak performance, let’s not forget that the website is not the swan song. It is simply one tool to connect the millions of people who have been unable to afford the price of admission to health coverage. Meanwhile the ACA’s no wrong door approach to coverage means people can apply over the phone, in person or through the mail. Recent updates to the HealthCare.Gov home page provide new links to these other paths to coverage. After all, the show must go on!


This post was authored by Tricia Brooks and originally appeared on

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