When the federal health exchange marketplace opened Oct. 1, we visited jazz musician Suzanne Cloud in Philadelphia. She tried to start an account early in the morning, but technology thwarted her plans.
She wasn't alone, as it became clear quickly that the unprecedented system for Americans in 36 states to shop and enroll for health insurance was broken in several places. A week into her failed attempts, Cloud stayed positive.
"I keep reassuring folks who are saying, 'Oh my God, I can't get in.' I go, don't worry, you will," Cloud said, in early October.
So now that one month has passed, we visited Cloud again. After trying to get through to shop and enroll in health insurance every three days or so for the past month, she's still blocked.
"I haven't even seen the marketplace yet," she says.
Despite Obama administration claims that the system is improving daily, things haven't gotten easier for Cloud and other users. The system's been intermittently out, going down at least twice this week for a total of about 36 hours.
Metrics on the system's status or improvements are difficult to get and interpret. Early numbers in administration "War Room" notes released by the House Oversight Committee show that the health exchanges enrolled only 248 Americans in the first two days after the marketplace opened. But Health and Human Services Secretary Kathleen Sebelius testified this week that full enrollment data are still unclear.
"The system isn't functioning, so we aren't getting that reliable data. Insurers who I met with said that is the case," Sebelius said.
Behind the scenes, a few dozen programmers with experience at technology companies Google and Red Hat joined the "tech surge" to clean up the broken site code. But adding dozens of new contract tech workers means they have to get paid. So we asked Julie Bataille, spokeswoman for the agency overseeing HealthCare.gov, for the total taxpayer cost committed for the federal exchange, and she said, "Total IT spending is in the neighborhood of about $630 million."
That kind of money could buy you the NBA's Miami Heat franchise or the entire mall clothing brand Hot Topic. It could also run the city of Louisville, Ky., for a year.
"The talent that [the government] did have was very expensive," said Clay Johnson, a programmer who built President Obama's 2008 campaign site. He estimates the HealthCare.gov system could have been built for a tenth of the cost had the government hired better talent — and taken a more open, agile approach to software development. Now, the tech surge is led by contractors who built the broken system in the first place.
"I'm pretty outraged at the fact that it's more profitable for a contractor to screw up than it is for them to do their job," says Johnson, who's been a fierce critic of the government's procurement structure.
As the cost picture becomes clearer, the administration is promising full enrollment numbers by mid-November. Nov. 30 is the administration's self-imposed deadline for fixing the site.
Cloud says she's not giving up, despite her month of failed attempts. After her online and phone registrations hit snags, she'll now apply on paper. She received a paper application Thursday night.
"I guess I'll fill it out. You know, what else can I do?" Cloud says.
Who else will enroll, and will they be satisfied with the insurance plans? The answers to those questions have not only policy implications but political ones, too.