Technical problems continued to frustrate people attempting to access the new state health insurance exchange on Friday
The issues with marylandhealthconnection.gov, the online exchange set up under national health reform, prompted some analysts to suggest that the system's software and servers aren't robust enough.
"They seem to be building this system on the go," said Robert Laszewski, a Washington-based insurance industry consultant. "It was not adequately tested, and it was not ready for prime time. That is perfectly clear."
Consumers are supposed to be able to visit Maryland Health Connection, create an individual account and browse a variety of health insurance plans before buying one, much as they would book an airline flight. The exchange was created to provide a place for Maryland's 800,000 uninsured to find health coverage.
Problems began immediately after the exchange launched Tuesday, as people tried to create accounts and log onto the site.
State officials blamed the account creation process, in which people were routed to a federal questionnaire to verify their identity. The system, they said, became overwhelmed when so many people tried to access it.
But even after logging onto the site, many people complained about encountering error messages, frozen screens and other problems.
It is unclear how many people have been able to enroll in plans. Maryland Health Benefit Exchange, the quasi-state agency that oversees the exchange, said it will not have a count until next week.
Other states, including those with sites run by the federal government, have had similar problems that stem from servers and software that couldn't handle a large number of users.
Maryland officials warned that there might be problems with the site before it launched and have been working to address issues.
Critics, including Laszewski, said the system should have been built to handle a high volume of users.
Technicians have made improvements to the website that have allowed more people to create accounts, and they plan the first upgrade of the software in the next few days, Becca Pearce, the exchange's executive director, said in a statement.
During upgrades, users won't be able to access certain parts of the site. The site will also be taken down every night between 11 p.m. and 5 a.m. to fix problems.
Pearce said that as problems are fixed, others crop up.
"The first few days of live use of Maryland Health Connection has helped us identify ways in which we can make the system better," she said. "We remain focused on continuing to steadily improve the user experience, and we will continue to provide timely information to users."
Pearce did not respond to questions about problems with the software.
Noridian Healthcare Solutions LLC, the North Dakota information technology company under contract to build the software, did not return calls.
The Maryland Health Benefit Exchange agreed to a $65 million contract with Noridian last year, saying in board minutes that the company had "an excellent technical proposal and strong software solutions."
But several outsiders think the problems lie with the software.
Requiring people to create accounts to access the system may be one of the problems, said Jonathan Wu, co-founder of consumer finance website ValuePenguin, who has a computer science background. Some states, including Kentucky, let people browse insurance plans without an account, which was only needed to purchase insurance. Kentucky did not have as big a backlog, he said.
"It's kind of an architectural and software issue," Wu said. "You are not accounting for how people want to use the system."
With personal accounts, the computer system has to work harder, storing information about everyone who accesses the website, he said. It also has to repeatedly confirm the identity of the person, which also can bog down the system, Wu said. He noted that all the functions on the website that don't require an account have run smoothly.
"It has to match your account every step you make," Wu said. "This causes extra overhead."
Pearce has said the log-on information is meant to serve as a security function to protect people's identity.
The way to fix the problem, Wu said, is to add additional server capacity to handle the traffic volume, or improve the software, which is a much more complicated and time-intensive task.
Community groups tapped to help Marylanders enroll in insurance plans have needed to adjust to the unexpected problems with the exchange.
"It's been very, very challenging because the Web portal has not been at the highest level it should or could be," said Kathy Westcoat, executive director of Health Care Access Maryland, a Baltimore nonprofit that is helping to enroll people.
Westcoat's group has stopped using the website because it was taking several hours to process people. The organization is using paper applications instead. That means applicants won't know the same day if they qualify for insurance. It is also harder to compare plans.
Westcoat has said she has noticed small improvements each day.
Columbia-based Healthy Howard Inc. said it also continues to use paper applications because of reports of continued technical issues.
Amanda White, a senior analyst with software provider Deltek, also said software issues seem to be the problem, but the backlog shows that people are interested in finding out about insurance plans offered under reform.
"This isn't necessarily a bad thing," she said. "They are working diligently to address all the problems as they come up. It's not like these problems aren't going to be fixed."
Pearce also said the interest bodes well for the law's success. "We appreciate the sustained, strong interest in Maryland Health Connection and in accessing quality and affordable health care," she said.
Westcoat said while people are frustrated, many still want to shop for a health plan. They have until March to enroll, but must sign up by mid-December for coverage starting Jan. 1.
"We are just trying to send the message that there is time," Westcoat said.
Howard Kahn of Pikesville has tried since Tuesday to establish an account for his son. He was able to fill out a form Thursday, but the screen froze. He telephoned a call center but said he'd rather create the account himself, so he can take his time. He still could not access the site Friday afternoon but said he will wait for the state to work out the kinks.
"I am frustrated that it hasn't worked all this time," he said. "I believe it is extremely important that everybody who wants to take advantage of this momentous change will be able to do so. It is unfortunate there are technical difficulties."