♪ . >> this is al jazeera america live from new york city, a look at today's top stories, house minority leader says democrats are confident that a plan will go through in time to raise the debt ceiling and avoided default. her comments came this afternoon shortly after the leadership met with president obama, moments later a spokesperson said the house will vote tonight, the vote intended to reopen the government, also a new alert from the associated press. the agency has put the triple aid credit rating under review, for a possible downgrade. a suspect in the deadly bombings of two u.s.

embassies has pleaded not guilty in a new york city croom. he is facing charges for his alleged role in the 1998 bombings. police in london are confirms the arrest of four suspects under british antiterrorism laws surveillance footage from outside a west london restaurant on sunday. shows one of the suspects a 28-year-old british man taken into custody. those headlines inside story is next on al jazeera america.

♪ >> we're two weeks into the open enrollment of the affordable care act. only one in ten people who have tried have been able to get on the online exchange. the problems started a long time ago, not just since the roll out. why has this happened, and what can be done to fix it? but first this background. >> a rocky start for the roll out of healthcare online exchanges may have been because

of a series of lapses in the design and supervisors of healthcare.gov . "new york times" investigation discovered that management of contractors and federal coordinators building the healthcare.gov site was problematic from the beginning. the centers for medicare and medicaid services took the lead role of commanding the project without the infrastructure and manpower to handle the various activities of contractors working together. medicare and medicaid agencies were in charge of coordinating the work of more than 50 contractors. "the new york times" reported, quote, confidential report from the health and human resource department show senior officials repeatedly expressed doubt that the system would be ready on time with lack of resources and other factors. from the beginning politics has

been intertwined with the policy. the affordable care act implementation in spite over the debt ceiling moving forward obamacare will be a campaign issue for democrats and republicans. >> until democratic friends it's going to be the political gift that keeps on giving so the shutdown will be old news next year. obamacare's faults will be front and center in 2014 if we don't screw this up. >> reporter: in a recent poll healthcare exchanges received poor reviews. the majority say the launch of healthcare.gov have not gone well. 30% surveyed said they did not know enough about the website to share their thoughts. anand a mere 7% say they believe the roll out of the healthcare exchanges have gone well.

of the 17 states running their own exchanges only a few have reported numbers. kentucky's exchange has enrolled 90,500 people. washington state report 25,000 have signed up for coverage. >> we're going to begin our discussion of our online healthcare exchanges at the state level. connecticut is running it's own exchange. joining us now is chief executive officer of access health, connecticut state-run health insurance. thank you for being with us. tell us, how are the numbers doing? >> we're doing well. we've processed 2200 applications covering 4,000 people. we're taking in about 1200 phone calls a day and 33,000 hits on

the website and we're helping the customer. >> has there been an issue where there was difficulty movingings about initially to have this number? >> we didn't have a that type of ramp up. we were stable beginning october 1st. our system did not have the glitches that some others had, and we're grateful for it. >> how many people are you hoping to enroll? >> our goal is to enroll 100,000 people between now and the end of march. and honestly this enrollment so far, this 2200, or the 4,000, was ten times of what i expected at this point? >> really? you thought it would be less coming forward? >> when you look at the massachusetts experience, enro

enrollees took on 18 touch points. that's the call to the call center, it is a visit to a website. it's a discussion with a broker or an assister. because it's an extensive purchase and complicated people take the purchase very seriously and want to make sure they're making the right decision. many of us thought this would ramp up more slowly. >> do you think some of the criticism directed to the federal sites are unwarranted? people need more information, more reassurance and more time to make some decisions? >> well, you know, i may be overly sympathetic, but the implementation process is mind-numbingly complex. they were working on roughly ten times more states than except expecting, so i'm sympathetic with what the exchange is going through. i know they're working very hard

to correct it and i'm confident they'll make those corrections. >> through your call center what are people asking? where are they hung up? what do they want to know more about? >> well, the questions fall into several categories, but in general they're about pricing, rates, subsidies, and plans of benefits. >> in terms of families considering coverage, for example, these are people who have not had healthcare before and now have the opportunity for healthcare, what have you been able to report to them? >> we're actually servicing a variety of different types of people. if you look at our membership, enroll yeees so far? some are enrolling for expanded medicaid. some are for above the medicaid eligibility level, and half of that group are eligible for subsidies, and the other are

not, meaning they earn above 400% of the poverty level, we're serving a large number of folks. >> how long did it take to build your site, how much did it cost and how many people are running it now? >> it took 10 months. it would take a private sector firm to do in three years what we did in ten months because we had no choice. the october 1st deadline was the october 1st deadline, so we made extraordinary progress in my judgment in ten months. there are 42 staff people working at healthcare connecticut and worked on the it system. >> if you were able to do this in ten months which the federal government has had years to get to this point. >> i'm not in a good position to judge the complexities of the federal system. i know for connecticut we had to

make hard decisions in january about scoping back original functionality that we had because our primary goal was to have a stable system. we scaled back 30% of our original functionality to make sure that we were stable and up and running on october 1st. >> thank you so much for joining us. we'll take a break. when we come back we'll discuss the problems and fixes ahead for the online federal federal exc. this is "inside story." >> the most important money stories of the day might affect your savings, your job or your retirement. whether its bail-outs or bond rates this stuff get complicated. but don't worry. i'm here to take the fear out of finance. every night on my show i break down confusing financial speak and make it real.

what happens when social media uncovers unheard, fascinating news stories? it drives discussion across america. >> share your story on tv and online. >> welcome back to inside story. tonight we're giving the affordable care act a checkup. open enrollment began october 1st. the online exchanges have not been user friendly. we'll talk about the problems and the fixes. joining me now, dr. donald, who works at the administration of medicare and medicaid services. he was democratic candidate running for governor of massachusetts.

from new york, executive vice president of strategy and market development at a software analyst companies. and in studio jeffrey young, healthcare reporter at the huffington post. let me turn to you. we've all heard the horror stories, how bad is it, and has it gotten any better? >> if you spend any time for healthcare.gov , if you go on there constantly you can see there are slight improvements in the performance but ultimately that doesn't matter because you cannot go on, create an account, log in, find out if you're eligible for subsidies and purchase a healthcare plan. it's discouraging people. >> many are run through the state-run exchanges or federal exchange? >> there are 16 states that have their own exchanges that are

separate from healthcare.gov . they're having more success in places like kentucky, washington state, california, they're enrolling people. they've had their technology problems, too. hawai'i has had some bad ones and maryland is slow to start out. but they're showing the model for these online exchanges could be workable if the online exchange itself functions. at the federal level the government has not said how many people have signed up, but to anecdote tall accounts, it seems to be a very low number. >> dr. donald, you were the first person in charge of this. what in your view has gone wrong and so seemingly terribly wrong. >> i don't think it's so terribly wrong. we're seeing th that it's implementing critical changes, and it's a big task that

involves interfacing with a number of systems. if this wasn't politically charged this is a set of problems you would expect in a set amount of roll out. >> if i could turn to you, do you think there were decisions made that perhaps could have exacerbated the situation or other decisions that would have made the results in the early days different? >> the technology here is really the flash point of the issue. one of the things that we see looking back on how this project has run, i agree with don, what he's saying, it is a complex undertaking, it's a complex implementation. these types of complex projects are often prone to problems. when you look back i think that there was an attempt and partly due to federal acquisition process to contain the cost,

partly due to the situation, the cost control situation in washington today, to contain the costs up front. sometimes when you try to do things more cost effectively up front, that can come back and cause problems in the roll out phase and further in the life cycle. >> did the cost constraints plus the expansion of what the federal government was asked to do have an impact on this moving out in a smooth way? >> oh, yes, as a whole it was implemented under tight resource constraints from congress. it would have been better to have more resources. they know they're under tight r resource constraints and they'll see their way to solution. i think lev is right, i we could

have been there faster, but i think we'll get there. >> is this shoul something thatd have gone to a private specialist company used to dealing with complex web architecture? >> well, you have to have both parties involved. after all, this technology advance involved interfaces between the medicare database, the internal revenue services, the treasury department, labor departments as well as the states and expansion of states that are taking over the site of that. you have to have many parties involved. the outreach to consultants and those who could help were good. and i'm fully confident that the staff working on this both inside and outside of government will be i believe to solve it. >> the question for the public is how much patience do they have if people have been trying to get on the website and trying

to get information, how long is the piece of string here for people? >> maybe part of that, part of the answer oh to that is maybe a more important question, how much time does the government have to get this right so people can buy their health insurance so it kicks in on january 1st. if you all right have insurance that you purchased for yourself you need more for next year. if you're uninsured and you've been waiting you probably want it as soon as possible. you have to have it in place by the 15th of december to have it in place by the 1st. to pick up on something that dr. burke was saying we're two weeks in a six-month enrollment process. and we could also look at it like we're two weeks into the enrollment service and it's still not work. the government has been opaque in wha what has to be done to gt

work. for the system not working properly, and then they turn around and they're subject to a tax penalty for not being insured, that's not fair. >> if it was not a smooth roll out, is it possible that the tax penalty could be extended? >> we're doing our best to make sure that the enrollment would work for those who wanted t to e enrolled. i'm fully confident that people are making it ope possible for anyone who wants to be enrolled. this is a very important undertaking and we need to take the long term and big picture in mind.

we keep hearing two weeks, two weeks, two weeks, fair enough. if this were a private sector, and if it was a behemoth of google or amazon, would that be logical? >> it's kind of a big bang project. we've had a deadline set by the administration to have this up and running by a certain time. you would typically run this out in incorrupted, d--in incrementa time. you would roll out one piece and then add something on top of that. you made slip your deadlines because if you run into situations for two weeks, obviously a lot of revenue is at stake and your customers could go to your competition.

here there are other alternatives, of course, but each is run differently. you know, the types of choices that you make become different. so the level of technical oversight that you need to stay on track becomes much higher. >> we're going to take a short break and come back for more discussion in a moment. from washington, this is "inside story."

millions who need assistance now. we appreciate you spending time with us tonight. up next is the golden age of hollywood going golden but elsewhere. why l.a.'s mayor has declared a state of emergency for the entertainment industry there. next.

>> welcome back to "inside story." the discussion of online

healthcare exchanges under the affordable care act. the administration traitor for medicare and medicaid services. and from new york, executive vice president of strategy and market development at caps, a software analysis company. in studio, jeffrey young, healthcare reporter at huffington post. this question of money testing time, you talked about congressional restraints and the kinds of budget constraints put on the system. would more money have made that much of a difference, and is that what is needed now? >> wallet me say first that i'm confident that even under the restores constraints that we have now this will work out the way it should. i have faith in staff and commitment to make this very good law a reality. of course f there had been increased resources at the state, things would have gone faster and more flexibility for testing, but i don't think the

problem is as dire as the political agenda is attempting to make it look now. >> jeffrey, in one way the political agenda favors obamacare, obamacare, the affordable care act has been a centerpiece of the government shutdown issue and it means that attention here has been completely focused away from those websites and issues. in fact, the focus has been on capitol hill and the government shutdown and we're not focusing on what the consumer experience has been. >> probably for the administration. it's not as if nobody is looking ac mandarin this, we're talking about it today, but what are legitimately more pressing issues. if you're having a problem with the health exchange now it might mean that you don't have

insurance in january, but if congress doesn't figure this out in the next few days we could be defaulting, and it wouldn't make sense. but if they fix healthcare.gov in the next week or so, and they did, and everything was operating more smoothly, by the time that the smoke cleared from this business on capitol hill there won't be anything left to criticize and this would have gone under the political radar. >> is this fixable in that type of time frame or is this a big architecture piece? >> as you said before, the government has been opaque of what the actual issues are. some of us in the it and safety software analyst industry, we can see basic technology issues of efficiency and things like that that seem to be potentially causing some of the problems, but of course we can't see deep inside the patient, as it were. i think give the types of issues

that we've seen here, this is something that you could do some things that are quick, quick fixes, a couple of work arounds, more servers added in the server room and things like that, but i think for--one of the things that we have to consider is going forward. this is just the enrollment process that we're seeing for this time period. after that there is a number of other functionalities that have to happen with this system and it's life cycle. i think these glitches will take a little while longer than a couple of weeks to fix fully. what i'm personally concerned about just looking at what is going on here there are going to be more glitches to come as we move through the patient life cycle that this system has to manage. >> one of the things that got my attention was the statement from robert gibbs who was president obama's former press secretary who said yesterday when they get it fixed i hope, quote, they fire some people who were in

charge of making sure that this was supposed to work. we knew there would be glitches but these are gordon th go beyof what is expected. do you think this is something on which people's heads would roll and people should be politically held accountable for this? >> i don't. i saw the staff at cms and contractors burn midnight oil, they deserve thanks from the nation for their attempts so far and what will be ultimately be successful attempts. this is a very hard process. rolling out part d medicare was hard, getting drug coverage to millions of seniors was difficult. and the state exchanges have had their problems and massachusetts had their first one and i remember that took awhile to get it up and running properly. we should look at the successful states, california is running very well, and we'll learn a lot from them. this is an enormous process for

the enrollment roll out and it will go well, that's what i think and that's what i'll continue to think. >> jeffrey, what are you going to be focusing on and looking at? >> the most important thing is whether this portal to health insurance becomes useable to buy the coverage that they are legally entitled to have. dr. burke's points are all well taken and in a week or so the website is working just well enough we'll forget this happened pretty fast, but it's still an open question. >> that's where we have to leave it, thank you, dr. burke, and everyone thank you, thank you for watching, and good night.

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