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Old 06-21-2013, 08:39 AM   #41
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Not sure about 5 years. Seems to me the Supreme Court Ruling on the PPACA was 51 weeks ago.
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Old 06-21-2013, 09:17 AM   #42
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Not sure about 5 years. Seems to me the Supreme Court Ruling on the PPACA was 51 weeks ago.
True, but those at point of service have already made the necessary changes to get into compliance. Adding electronic records, changing forms of employment, etc. Additionally, companies have made changes or are planning to implement changes in their business plans to accommodate the changes. From reducing hours, to lay offs, to opting for the fines over providing coverage. In other words, the private sector didn't wait for the Supreme Courts decision to begin making changes.
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Old 06-21-2013, 10:20 AM   #43
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True, but those at point of service have already made the necessary changes to get into compliance. Adding electronic records, changing forms of employment, etc. Additionally, companies have made changes or are planning to implement changes in their business plans to accommodate the changes. From reducing hours, to lay offs, to opting for the fines over providing coverage. In other words, the private sector didn't wait for the Supreme Courts decision to begin making changes.
By definition, the private sector need not wait. Gov't, however, needs not only law and regulation, it also needs funding. An agency cannot spent without specific authorization. Restraint on implementation has been imposed in two ways; first by subjecting the law to legal challenge and review, then by delaying and limiting budget. That's the way the system works and we should not be surprised at the outcome. This could explain the delay in SHOP implementation, because it would allow the budget to be concentrated on the FFE.
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Old 06-21-2013, 10:54 AM   #44
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......An agency cannot spent without specific authorization. Restraint on implementation has been imposed in two ways; first by subjecting the law to legal challenge and review, then by delaying and limiting budget. That's the way the system works and we should not be surprised at the outcome. This could explain the delay in SHOP implementation, because it would allow the budget to be concentrated on the FFE.
Exactly. With spending at $8000 per American per year, there is a lot of money in the political lobbying trough to extend the status quo for those that are doing very well under the current system. Expect delays.
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Old 06-21-2013, 11:23 AM   #45
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Exactly. With spending at $8000 per American per year, there is a lot of money in the political lobbying trough to extend the status quo for those that are doing very well under the current system. Expect delays.
If I was concerned about the ACA being overturned by special interests, I would be dropping the puck ASAP to get the game underway.
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Old 06-21-2013, 12:09 PM   #46
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If I was concerned about the ACA being overturned by special interests, I would be dropping the puck ASAP to get the game underway.
Follow the money.
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Old 06-21-2013, 12:23 PM   #47
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We'll have to. My spouse and I have worked for some of the largest software companies in the world, on some of the most complex systems, and from what we (mostly my spouse) can see
Just curious, since you seem to have some inside information

Do they not have provisions for a fallback plan. When I was involved in these things part of the software QA requirements was to have a manual process in place the event the software couldn't perform as expected. In this case, in the event the "online" part isn't ready, you could still fill out the paper application and take to your local CMS/SSA office.
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Old 06-21-2013, 01:29 PM   #48
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True, but those at point of service have already made the necessary changes to get into compliance.
Why are you switching from talking about the exchanges themselves to talking about point of service? We were talking about the exchanges.

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In other words, the private sector didn't wait for the Supreme Courts decision to begin making changes.
But the states did... I'm pretty sure that's what I mentioned earlier, that started this portion of the thread.
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Old 06-21-2013, 01:34 PM   #49
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Just curious, since you seem to have some inside information
I do, but that gravy train is arriving at the terminal. So while the information I have now is up-to-date and comprehensive, it'll start aging soon.

Starting next Thursday afternoon, to be exact.

nuf sed

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Do they not have provisions for a fallback plan.
Fallback plans cost money. American taxpayers do not want to pay more for fallback plans.

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When I was involved in these things part of the software QA requirements was to have a manual process in place the event the software couldn't perform as expected.
That's one of the big differences between the public sector and the private sector, I suppose. However, I do know that even in the private sector, cost-cutting has ripped out much of the inclination to have contingencies and backups. Get ready for a much more difficult way of things as every entity now economizes "reasonable caution" right out of existence.

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In this case, in the event the "online" part isn't ready, you could still fill out the paper application and take to your local CMS/SSA office.
I think this comment really helps outline one major source of confusion about why this is taking so long: The end-user user-interface is not the biggest part of the system ... It's the systems used by the exchanges themselves to verify eligibility. They have to do that whether the application is made online or on paper, and there is no way they can call or check paper records for all the various elements of eligibility. (See above, regarding "contingencies and backups".)
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Old 06-21-2013, 01:44 PM   #50
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I think this comment really helps outline one major source of confusion about why this is taking so long: The end-user user-interface is not the biggest part of the system ... It's the systems used by the exchanges themselves to verify eligibility. They have to do that whether the application is made online or on paper, and there is no way they can call or check paper records for all the various elements of eligibility. (See above, regarding "contingencies and backups".)
Good points. One other major task may be the need to interface with other legacy systems that sponsor or are involved in health care for the needy, such as CHIPS and Medicaid. That must be a nightmare.
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Old 06-21-2013, 02:04 PM   #51
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Luckily the entities which drafted this legislation and those charged with implementing it had 100% access to everything they needed to determine the complexity of the task ahead. All the private, state, and (especially) federal IT systems involved in health care insurance, payment, and delivery were known in advance. I am sure the administration will not gripe about states making late decisions about implementing various portions of the law when HHS itself has moved deadlines back to permit this very thing.

Opponents of the legislation raised many of the same issues concerning complexity and the inherent difficulties that are now being raised by those who favor the ACA. In that sense, I suppose we can say that the ACA has helped to build a bipartisan concensus, which is a good thing, right? Now, let's trust those who fought for the job of establishing this new system. The legislation has not enjoyed majority support, so those implementing it have a golden opportunity to change some minds.
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Old 06-21-2013, 02:35 PM   #52
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Why are you switching from talking about the exchanges themselves to talking about point of service? We were talking about the exchanges.

But the states did... I'm pretty sure that's what I mentioned earlier, that started this portion of the thread.
Sorry, didn't mean to hijack the thread. It doesn't really matter if we are a few months late. What matters is that we are going to get universal care at higher quality and with less cost.
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Old 06-21-2013, 05:32 PM   #53
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Good points. One other major task may be the need to interface with other legacy systems that sponsor or are involved in health care for the needy, such as CHIPS and Medicaid. That must be a nightmare.
I was reading an article from USVI, and setting these things up are expensive, way beyond what I could conceive. Article said each state exchange alone will cost between
30-50 million dollars. On a side note, if you are hell bent on avoiding Obamacare and still want to live in the US, you can move to a US territory including USVI and avoid it. I am sure they have top notch medical facilities. St. John doesn't even have a hospital.

States can opt to use an exchange set up by the federal government, but territories like the U.S. Virgin Islands do not have that option, she said. Building an exchange from scratch is typically costing states between $30 and $50 million, Phillips-Dorsett said. "That cost is why several states have opted to have the federally run exchange."
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Old 06-21-2013, 05:51 PM   #54
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"That cost is why several states have opted to have the federally run exchange."
Yes, and some states reported they couldn't get answers from the federal government that would allow them to establish a compliant exchange. Some state leaders remarked that the lack of flexibility allowed under the law resulted in little perceived benefit to setting up a state exchange--if the federal government will be making the important decisions and determinations anyway, some governors saw no advantage to spending their state resources in this area.
The reluctant states can hop in later, after the federal government offers more clarity on how these exchanges will be run, and after some of the lead states have made their mistakes. And if things end up changing >a lot<, the states that waited could look pretty smart. It would be especially interesting if some of the contiguous smaller (population) states set up pooled exchanges--voluntarily harmonizing their insurance laws and regulations so more companies will participate in these markets. That's something the federal government can't do for them, and which might make a big difference in costs and quality of service.
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Old 06-22-2013, 04:32 AM   #55
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Luckily the entities which drafted this legislation and those charged with implementing it had 100% access to everything they needed to determine the complexity of the task ahead.
And still the states that didn't like the law dragged their feet, and did whatever they could, really, to try to make what they were legally-obligated to do into a failure.

Isn't politics grand?

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Opponents of the legislation raised many of the same issues concerning complexity and the inherent difficulties that are now being raised by those who favor the ACA.
So you're saying that they had a vested interest in dragging their feet and otherwise interfering with the success of the program through political sabotage, so that their earlier claims, which they presented because their politics didn't want the goals of ACA to see the light of day, wouldn't be proven wrong. So you're saying that this was all just a matter of critics of ACA trying to save face?

Sam: Seriously: This isn't the right forum for such political debate, even if hidden in sarcasm. If you have something constructive to say about ACA, then please share. Otherwise, let's stop with the criticizing and so we can stop with the defending.

Deal?
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Old 06-22-2013, 08:16 AM   #56
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If the PPACA is a national law, why have 50 monkeys each building similar houses at $30-50 million a pop. Why not have the big gorilla build a 50 unit apartment building that the 50 monkeys can use?

I can see that each monkey may decorate their apartment differently to meet their unique needs, but the basic apartment would be the same for each.

Sort of like how a commercial software vendor designs and maintains software that it sells to companies and each company can modify it as they need to but are responsible for the mods when new releases are made.
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Old 06-22-2013, 08:51 AM   #57
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If the PPACA is a national law, why have 50 monkeys each building similar houses at $30-50 million a pop. Why not have the big gorilla build a 50 unit apartment building that the 50 monkeys can use?

I can see that each monkey may decorate their apartment differently to meet their unique needs, but the basic apartment would be the same for each.

Sort of like how a commercial software vendor designs and maintains software that it sells to companies and each company can modify it as they need to but are responsible for the mods when new releases are made.
Because the opponents of the ACA painted it as "big government taking over your healthcare decisions". Allowing everyone to build their own monkey house was a sop to these concerns. All part of the sausage making process.
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Old 06-22-2013, 11:43 PM   #58
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The smell of bacon increases as the political comments move farther OT.
I still think a thread like this could be good for sharing reliable info on actual updates re ACA Fed Marketplace system. IMHO- at this point speculation regarding why more progress has/has not been made is not useful to those who will may need to get their HI via this system (warts and all) in just a few short months. I expect (& hope for!) increasing volume of info to become available as Oct 1 approaches.
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Old 06-23-2013, 07:35 AM   #59
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http://www.miamiherald.com/2013/06/1...-later-florida


An update on Florida. Florida is one of the states that has opted not to form a state exchange but rather use the federal exchange. Florida is in the process of overhauling it's Medicaid but not expanding it to the point of covering everyone who doesn't qualify for the exchange.
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Old 06-23-2013, 07:36 AM   #60
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http://www.miamiherald.com/2013/06/1...-later-florida

An update on Florida. Florida is one of the states that has opted not to form a state exchange but rather use the federal exchange. Florida is in the process of overhauling it's Medicaid but not expanding it to the point of covering everyone who doesn't qualify for the exchange.
The article didn't come up! Dang!
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