Obamacare launch hits early hitch as web traffic snarls up sites

By David Morgan and Caroline Humer

(Reuters) - The U.S. government launched the centerpiece of President Barack Obama's landmark healthcare reform on Tuesday, opening online insurance marketplaces across the country for millions of uninsured Americans, but technical glitches prevented early access for many.

The first day of the six-month open enrollment period on the state marketplaces, or exchanges, went ahead despite a partial federal government shutdown precipitated by Republican opposition to the healthcare law that deadlocked a spending bill in Congress.

According to early checks, the rollout of the most ambitious U.S. social program in five decades had a rocky start. A federally-run exchange for consumers in 36 states began posting error messages for at least 25 of them soon after the system opened for enrollment at 8 a.m. EDT, citing online traffic as a reason for the difficulties.

An Obama administration official said experts were aware of the issue and were working on it. The Department of Health and Human Services directed consumers to call centers and local community organizers to seek information.

The administration had predicted hitches early on because of the challenge of building a massive technology infrastructure in a short time. The problems could last weeks. Even before Tuesday's launch, officials last week announced delays for exchanges geared toward Spanish speakers and small businesses.

The snags are expected to contribute to a slow start to enrollment and will be a focus of the political debate over whether the 2010 Affordable Care Act, commonly known as Obamacare, will succeed.

Frustrated customers are likely to fuel opposition to the healthcare law from Republicans in the U.S. House of Representatives, who have voted more than 40 times to repeal or delay it.

"It's very significant for the political campaign but not for the enrollment campaign," said Jon Kingsdale, the former head of the Massachusetts state health exchange, which opened in 2006 and became the model for Obamacare.

"I don't know if it's two weeks or five weeks, but I don't think we're talking just days," Kingsdale said. He said if the problems persist until November, "that is really a big problem."

The exchanges, shopping places for people to find out whether they qualify for federal subsidies, will accept applications for the new plans until March 31. They are expected to sign up as many as 7 million people in their first year.

Republicans have fought for years to delay or stop Obamacare, blaming its requirements for pushing up the cost of health insurance for business and individuals. On Monday night, that battle triggered a shutdown of several federal government agencies after Republicans insisted that a routine funding measure include a delay in the law. The Democratic-controlled Senate rejected it.

"What I want is to keep the government running and at the same time to deal with the harms, the millions of Americans who are ... at risk of losing their healthcare, are facing skyrocketing insurance premiums," Texas Senator Ted Cruz, who has been leading the charge among Republicans in Congress to defund the law, said in an interview with CNN.

SUBSIDIZED INSURANCE

The websites will give many Americans their first glimpse of new subsidized health plans that are being offered to millions of the uninsured, in the most ambitious U.S. social program since Medicare was introduced in the 1960s.

Exchanges run by 14 states and the District of Columbia presented a mixed picture early on Tuesday. Some, like Massachusetts and New York, were able to accept consumer log-ins. New York said its site received 2 million hits in the first two hours.

The state-run exchange in Maryland delayed its opening by four hours and Minnesota said it would wait until the afternoon to check its connection with federal databases.

California and Washington state exchange officials said they were ready to open later in the morning as planned.

Obama was scheduled to promote his signature domestic policy achievement on Tuesday, including a meeting in the Oval Office with a group of Americans who stand to benefit from the program.

Vice President Joe Biden and first lady Michelle Obama will also promote the law in the media.

The marketplaces require health plans to provide a broad range of essential benefits that were not necessarily part of individual policies in the past, including mental health services, birth control and preventive care. The coverage is linked to other insurance market reforms and new consumer safeguards, including a ban on discrimination based on gender and health history.

The Affordable Care Act also mandates that Americans obtain insurance or pay a fine. Provisions that have taken effect since the law was passed three years ago have already prompted changes in the way insurance companies and hospitals do business, as they prepare for an influx of new insured members.

Shares in health insurers like UnitedHealth Group and Aetna Inc, as well as for hospital operator HCA Holdings Inc, outpaced rises on the broader U.S. stock market on Tuesday.

"For years, the financial, physical or mental health of millions of Americans suffered because they couldn't afford the care they or their family needed," Health and Human Services Secretary Kathleen Sebelius said in a statement on Tuesday. "But thanks to the health care law, all of that is changing. Today's launch begins a new day when health care coverage will be more accessible and affordable than ever before."

(Additional reporting by Lewis Krauskopf, Sharon Begley and Curits Skinner in New York; Editing by Michele Gershberg and Grant McCool)

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Eilat's corals stand better chance of resilience than other sites

Sep. 29, 2013 — Israel's southern Red Sea resort of Eilat, one of whose prime attractions is its colorful and multi-shaped underwater coral reefs, may have a clear advantage in the future over rival coral-viewing sites around the world, scientists at the Hebrew University of Jerusalem and Bar-Ilan University have found.

Coral reefs, earth's richest and most diverse ecosystem, are deteriorating rapidly. One of the most devastating causes for that deterioration is coral bleaching, which typically occurs when seawater temperatures exceed the local summer maximum by one-half to one and half degrees Celsius. At those higher temperatures, the coral's symbiotic algae are lost, leading to the coral's bleaching and eventually its death.

But, while the frequency of coral bleaching is globally increasing, no bleaching event has been observed in the Gulf of Eilat/Aqaba (Eilat sits at the northern end of the gulf), even when nominally bleaching conditions prevail.

The Israeli scientists explain the enigmatic lack of bleaching in the Gulf by the existence of a "warm-water barrier" at the southern Red Sea, allowing only heat-tolerant genotypes of corals to enter the Red Sea from the Gulf of Aden. This occurred following the disappearance of corals from the Red Sea during the last glacial period, some 15,000 years ago. The scientists predict that no bleaching is likely to occur in the Gulf of Eilat/Aqaba in the next 100 years, making it a unique refuge for coral reefs in the world's warming oceans.

The findings of the Israeli researchers, entitled "A Coral Reef Refuge in the Red Sea," was published on Sept. 23 in the journal Global Change Biology." The paper is the outcome of a joint study by Prof. Amatzia Genin of the Alexander Silberman Institute of Life Sciences at the Hebrew University; Dr. Hezi Gildor of the The Fredy & Nadine Herrmann Institute of Earth Sciences at the Hebrew University; and Dr. Maoz Fine of the Mina and Everard Goodman Faculty of Life Sciences at Bar-Ilan University. The work was carried out at the Interuniversity Institute for Marine Sciences in Eilat.

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The above story is based on materials provided by Hebrew University of Jerusalem, via AlphaGalileo.

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Journal Reference:

1. Maoz Fine, Hezi Gildor, Amatzia Genin. A coral reef refuge in the Red Sea. Global Change Biology, 2013; DOI: 10.1111/gcb.12356

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Largest, most accurate list of RNA editing sites

Sep. 29, 2013 — Researchers have compiled the largest and most rigorously validated list to date of genetic sites in fruit flies where the RNA transcribed from DNA is then edited by an enzyme to affect a wide variety of fundamental biological functions. The list yielded several biological insights and can aid further research on RNA transcription because flies are a common model in that work.

A research team centered at Brown University has compiled the largest and most stringently validated list of RNA editing sites in the fruit fly Drosophila melanogaster, a stalwart of biological research. Their research, which yielded several insights into the model organism's fundamental biology, appears Sept. 29 in Nature Structural & Molecular Biology.

The "master list" totals 3,581 sites in which the enzyme ADAR might swap an "A" nucleotide for a "G" in an RNA molecule. Such a seemingly small tweak means a lot because it changes how genetic instructions in DNA are put into action in the fly body, affecting many fundamental functions including proper neural and gender development. In humans, perturbed RNA editing has been strongly implicated in the diseases ALS and Acardi-Gutieres disease.

The new list of editing sites could therefore help thousands of researchers studying the RNA molecules that are transcribed from DNA, the so-called "transcriptome," by providing reliable information about the thousands of editing changes that can occur.

"Drosophila serves as a model for all the organisms where people are studying transcriptomes," said the paper's corresponding author Robert Reenan, professor of biology in the Department of Molecular Biology, Cell Biology, and Biochemistry at Brown. "But in the early days of RNA editing research, the catalog of these sites was determined completely by chance -- people working on genes of interest would discover a site. The number of sites grew slowly."

In fact, Reenan was co-author of a paper in Science 10 years ago that made a splash with only 56 new editing sites which at the time, more than doubled the number of known sites in the entire field.

Validation means accuracy

Several more recent attempts to catalog RNA editing sites have yielded larger catalogs, but those contained many errors (the paper provides a comparison between the new list and previous efforts such as ModENCODE).

To avoid such mistakes, Reenan and colleagues, including lead author and graduate student Georges St. Laurent, painstakingly validated 1,799 of the sites. They worked with Charles Lawrence, professor of applied mathematics and the paper's co-senior author, to predict another 1,782 sites and validated a statistically rigorous sampling of those.

In all, the team's methodology allowed them to estimate that the combined list of 3,581 directly observed and predicted sites is 87 percent accurate.

"The sites that we validated, for anyone who wants to do the same experiment under the same conditions, the sites should be there," said co-author and postdoctoral researcher Yiannis Savva. "In other papers, they just did sequencing to say there is an editing site there, but when you check, it's not there."

The researchers used the tried-and-true, decades-old Sanger method of sequencing to double-check all the candidate editing sites that they had found using the high-throughput technology called single molecule sequencing. They compared the sequenced RNA of a population of fruit flies to their sequenced DNA and to the RNA of another population of flies engineered to lack the ADAR editing enzyme. By comparing these three sequences they were able to see the A-to-G changes that could not be attributed to anomalies in DNA (i.e., mutations, or single-nucleotide polymorphisms) and that never occurred in flies incapable of editing.

As they conducted their validations, they fed the results back into their prediction algorithm. Over several iterations, that computer model "learned" to make better and better predictions. They ultimately found 77 different variables that helped them to distinguish real editing sites from nucleotides that were conclusively not editing sites.

Biological insights

The researchers then examined the implications of the patterns they saw in their data and gained several insights.

One was that a considerable amount of editing occurs in sections of RNA that do not code for making proteins. Editing is concentrated in a small number of RNAs, raising the question, Lawrence said, of what accounts for that selectivity.

"How does the cell go about choosing which ones are going to get edited and which aren't is an interesting question this opens," he said.

Where editing is found, the researchers discovered, there is usually more alternative splicing, which means the body is more often assembling a different recipe from its genetic instructions to make certain proteins.

The researchers also found that the RNAs that are most heavily edited tend to be expressed to a lesser extent, decreasing how often they are put into action in the body.

RNA editing helps explain why organisms are even more different from each other -- and from themselves at different times -- than DNA differences alone would suggest.

"RNA editing has emerged as a way to diversify not just the proteome but the transcriptome overall," Reenan said.

In addition to Reenan, Lawrence, Savva, and St. Laurent, who is also affiliated with the St. Laurent Institute in Cambridge, Mass., the paper's other authors are Michael Tackett, Sergey Nechkin, Dimitry Shtokalo, and Philipp Kapranov of the St. Lawernce Institute, Denis Antonets of the State Research Center of Virology and Biotechnology in Russia, and Rachael Maloney, a Brown graduate now at the University of Massachusetts Medical School.

Reenan received funding from the Ellison Medical Research Foundation.

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Race to get Obamacare online sites running goes to the wire

By Sharon Begley

NEW YORK (Reuters) - Just days before the launch of the new U.S. state health insurance exchanges that are the centerpiece of the Affordable Care Act, a nationwide push is still under way to test and patch the technology behind the online sites.

Officials working on the sites have acknowledged that information technology (IT) failures will prevent many of them from functioning fully for weeks, and perhaps longer. That will slow the government's drive to enroll millions of uninsured Americans under President Barack Obama's healthcare reform law starting Tuesday.

From a political standpoint, a successful opening day will shape perceptions of Obama's signature policy initiative. But the system's functioning is to a large extent beyond the control of politicians and policy experts, and instead sits in the hands of the battalions of coders working for IT sub-contractors.

Six months ago, people involved in setting up the exchanges were more hopeful that everything would be ready on time, said Cristine Vogel, an associate director at Navigant Consulting.

"I don't think there were enough hours in the day, or enough people with the skills," she said. "When we look back, I think we'll see that we missed an opportunity to share technology."

Opponents of the healthcare reform known as Obamacare say the computer problems bolster their view that the 2010 law is a "train wreck" and should be delayed or repealed. The Obama administration insists the exchanges will be open for business on October 1, even if some uninsured Americans may not be able to buy coverage right away. More importantly, they say, the new health plans will begin to provide health coverage on January 1, as planned.

"So long as the website is accessible and the plans and the plan information are displayed properly so a consumer can shop for coverage and compare the plans, they will claim victory," said Chris C1ondeluci, an employee benefits attorney at Venable LLP and a former staffer at the Senate Finance Committee who helped draft the Affordable Care Act.

FIRST-DAY CRASH?

This week, the Obama administration said its Spanish-language website would not be ready in time, and that it would be weeks before small businesses and their employees could sign up online for coverage on exchanges operated by the federal government.

The exchanges in Colorado and the District of Columbia, meanwhile, cannot calculate the amount of federal subsidies customers qualify for.

In New York, the exchange is not able to transfer data to some insurers instantaneously, as planned, one carrier told Reuters. Instead, the data will be sent in batches once a day or so. The glitch will not affect customers, but it raises questions that New York might have other IT problems.

Oregon had sufficient qualms about its online insurance marketplace that no one can enroll unless they use a trained, certified agent or other "community partner."

As late as this week, Oregon also had trouble correctly displaying information about insurance plans on a test site. The problem could mislead customers about deductibles, prices and other details if it occurs on the live site Tuesday.

In Ohio, Lieutenant Governor Mary Taylor, a fierce opponent of the healthcare law, said in a radio interview this week that her state's online exchange, which is being run by the federal government, could well crash on its first day.

In testing, she said, some plans filed by insurers "sat in a queue for the federal government for a week, so my concern is something similar is going to happen on October 1 because of the amount of (online) traffic."

WORKAROUNDS OFFERED, TAKE TIME

In most cases, exchanges will offer workarounds that will take time to execute. In Washington, D.C., off-line contractors will calculate federal subsidies and inform applicants what they qualify for in November, by which time the online calculator might be working.

In Colorado, until at least November, customers will have to call phone service centers, where representatives will manually take them through the calculations to determine what subsidies they qualify for.

Even before the exchanges open, the finger-pointing has begun, with states blaming contractors for glitches and contractors blaming states or other contractors.

The system to calculate federal subsidies for the D.C. exchange was built by Curam Software, which IBM acquired in 2011. In tests of complex family situations, the software was getting subsidies wrong 15 percent of the time, said exchange spokesman Richard Sorian.

In a statement, IBM spokesman Mitchell Derman said the city "decided that a phased-in approach best meets the needs of its citizens." He pointed out that Curam also built the eligibility software in Maryland and Minnesota, "two states that plan to have full functionality on October 1."

In other words, a company that achieved its goal on time in two states fell short in a third. The reasons, said outside experts, include relationships among contractors and the specifics of existing computer systems in a state.

In Washington, Infosys, the giant Bangalore, India,-based technology company, is the system integrator - the contractor that takes software from sub-contractors like Curam and puts it all together. The fact that Curam's calculation software is working on other exchanges suggests the glitch may not lie in its integration with the D.C. exchange's other IT.

"A software package like Curam's is put into the system by the system implementer, not the software provider," said an IT expert not involved in the D.C. exchange. A spokesman for Infosys was not able to comment on its D.C. work.

MEDICAID SYSTEMS POSE HUGE HURDLE

One of the most difficult IT jobs has been to integrate each health insurance exchange with its state Medicaid system. These legacy systems are typically decades old. In Massachusetts, for instance, the system runs on the COBOL programming language, which is to today's languages like a rotary phone is to an iPhone-5.

"These legacy systems are old and difficult to configure and re-configure," said Tom Dehner, managing principal at Health Management Associates, a healthcare consultant, in Boston and former director of Massachusetts Medicaid.

"To change how eligibility is calculated," as federal law now requires, he said, "you need to modify your Medicaid system, and that's not something you can do by buying software off the shelf."

The difficulty of interfacing with Medicaid will keep Colorado's exchange from calculating subsidies online.

To determine eligibility for federal subsidies, explained Nathan Wilkes, a member of the board of Connect for Health Colorado, the system "first goes through Medicaid determination. That means connecting to a legacy system," he said.

"Six or nine months ago we got an early warning that the way we wanted to integrate these systems wouldn't work, and then time got away from us."

Colorado's exchange tested 100,000 scenarios to see how its software calculated subsidies, and got error after error.

"It's an IT nightmare," Wilkes said.

(Additional reporting by Lewis Krauskopf and Caroline Humer; Editing by Michele Gershberg and Doina Chiacu)

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