ACA Federal Marketplace updates

[pb4uski]

I cannot get into details, but let me just say that recent info I have overheard gives me further reason to believe the watchdog's report.

I am beginning to think we're going to see what will become the next "textbook case" of the damaging impact of under-funding.

Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.

 

[Mulligan]

Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.

Must be a lot of rules, regs, and procedures that have to be all followed before the numbers can be posted on exchange. I am as anxious as anyone to see what I am going to have to pay, but if they got so far behind they delayed it a year, my wallet would not fall into a great depression that is for sure.

 

[Htown Harry]

Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.

I suspect you may be overestimating the similarity to other marketplaces. There is no COTS systems out there that does all of the things exchange software must do. None of us could even spell MAGI until recently.

Another example. Each and every state system must rework its Medicaid systems to allow on-line sign-ups using the new MAGI-based eligibility criteria. Some state's legacy systems that need to be overhauled use COBOL.

This is a pretty good summary of the software / system requirements and challenges, mostly written in non-technical terms.

http://www.nasi.org/sites/default/f...astructure_for_Health_Insurance_Exchanges.pdf

Reading through it gave me flashbacks to an unpleasant detour in my career. I managed a government software project that handled real-time and near-real-time data among several agencies. Rocket science? Probably not, but it sure wasn't easy to accomplish on a tight schedule.

I feel for the IT folks grinding away.

 

[bUU]

Or underperformance. I'm struggling to see how creating an online marketplace for health insurance is rocket science given the numerous similar online marketplaces already in existence.

After you've spent a year working on the systems development, you'll have gained some significant insights on the challenges.

It is not uncommon for folks to grossly underestimate what it takes to do something they want done, but aren't responsible for doing themselves.

Must be a lot of rules, regs, and procedures that have to be all followed before the numbers can be posted on exchange.

The biggest challenges involve linking together myriad systems, such as for verifying eligibility - IRS, SSA, INS, HHS, etc., and then all the linkages into the states' various systems. Their systems have to all talk to each other for this. Also, the requirements on the software itself are more stringent than ever before - such as with regard to accessibility.

I feel for the IT folks grinding away.

I'll relay your sentiments to at least one of them.

 

[sheehs1]

It pains me to say this Sam, but I think as a whole you give the masses too much credit... Almost half of Americans still don't even know the Act exists as law.
Three quarters of the other half probably won't understand what they signed up for until after they need the benefits, anyways.

Along those lines, makes me wonder if there won't be sign up avenues at every ER and doctor's office. "You don't have health care?, Sign up now."

 

[Gatordoc50]

Along those lines, makes me wonder if there won't be sign up avenues at every ER and doctor's office. "You don't have health care?, Sign up now."

The hospitals and docs currently are responsible for handling the health insurance of patients and determining benefits and billing/collecting copays. They might as well sign folks up and collect premiums while they're at it. Doesn't seem like the business and computer majors are up to the task.

 

[bUU]

Business and computer majors aren't in the business of "signing folks up and collecting premiums". They're in the business of developing software systems to do such things. It's a bit like the difference between the medical technician who operates the X-ray machine and the people who design the X-ray machine.

 

[Gatordoc50]

Business and computer majors aren't in the business of "signing folks up and collecting premiums". They're in the business of developing software systems to do such things. It's a bit like the difference between the medical technician who operates the X-ray machine and the people who design the X-ray machine.

Chop Chop.

 

[travelover]

...........

The biggest challenges involve linking together myriad systems, such as for verifying eligibility - IRS, SSA, INS, HHS, etc., and then all the linkages into the states' various systems. Their systems have to all talk to each other for this. Also, the requirements on the software itself are more stringent than ever before - such as with regard to accessibility.
............

I recently posted that the SS administration had just now "connected" with the IRS such that they could dun me for an overpayment that occurred in 1971. This kinda put it all into perspective for me.

 

[youbet]

My wife works on a health exchange project (though she's actually leaving that project in a couple of weeks) and what she's heard is that some of the health exchange projects have been so badly underfunded by Congress...........

Or the states are inept and/or corrupt at getting the job done..........

 

[ERhoosier]

Or the states are inept and/or corrupt at getting the job done..........

Irrelevant to states who always intended to use the Federal Marketplace, which (by definition) is to be done by Feds/HHS. But I agree that certain states have messed with the process. For example I don't see how California adding voter registration to its Health Exchange helps speed up ACA implementation.
California's health exchange to serve as voter registration hub - Health and Medicine - The Sacramento Bee

FWIW- Another take on HHS progress and past misstatements- even to even to Sen Baucus who was deeply involved in drafting & passing ACA. Does not give one a warm fuzzy feeling that individual Exchanges will be functional on Oct 1-

Audit Finds ObamaCare Exchanges Are Well Behind Schedule - Investors.com

 

[pb4uski]

After you've spent a year working on the systems development, you'll have gained some significant insights on the challenges.

It is not uncommon for folks to grossly underestimate what it takes to do something they want done, but aren't responsible for doing themselves.....

I actually was responsible for financial systems of a company with over a billion of revenue during one of my jobs so the challenges of systems development and implementation are not new to me. My only point is that they are spending tens or even hundreds of millions on this effort and it still seems to be woefully behind being ready for prime time. Given the amounts they are spending it is hard to see underfunding as the issue. But we can agree to disagree on that I guess.

 

[bUU]

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, the level of under-funding of the health insurance exchanges is remarkable. Read over the PDF that Htown Harry posted - it describes a system that would necessarily have to be one of the most complex of its class ever undertaken, simply on the basis of the number and variety of external interfaces. Interfacing with INS, itself, is a large undertaking, and that's just one of many external interfaces.

To be fair, this kind of short-changing has been common in large government projects, at times in the past, and that cheapness is now leeching into non-government projects, from what I can see.

 

[Gatordoc50]

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, the level of under-funding of the health insurance exchanges is remarkable. Read over the PDF that Htown Harry posted - it describes a system that would necessarily have to be one of the most complex of its class ever undertaken, simply on the basis of the number and variety of external interfaces. Interfacing with INS, itself, is a large undertaking, and that's just one of many external interfaces.

To be fair, this kind of short-changing has been common in large government projects, at times in the past, and that cheapness is now leeching into non-government projects, from what I can see.

We were told that all this had already been done in Massachusetts. Now we are five years in and you're telling me it's too complex and expensive to implement? Thats incredible.

 

[bUU]

We were told that all this had already been done in Massachusetts. Now we are five years in and you're telling me it's too complex and expensive to implement? Thats incredible.

I'm telling you that the Massachusetts legacy system didn't interface with INS or with other federal systems for which the linkages were mandated by ACA as a compromise with those who wanted to more strongly ensure that illegal immigrants wouldn't gain subsidies.

Also, I'm telling you that the Massachusetts legacy system was not accessible by the vision- or hearing-impaired as per WCAG 2.0.

Just two of many complicating differences, for-instance.

 

[MichaelB]

Not sure about 5 years. Seems to me the Supreme Court Ruling on the PPACA was 51 weeks ago.

 

[Gatordoc50]

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.

 

[MichaelB]

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.

 

[travelover]

......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.

 

[Gatordoc50]

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.

 

[travelover]

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.

 

[rbmrtn]

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.

 

[bUU]

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.

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.

 

[bUU]

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

Do they not have provisions for a fallback plan.

Fallback plans cost money. American taxpayers do not want to pay more for fallback plans.

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.

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".)

 

[MichaelB]

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.