Washington Post article by Sarah Kliff and Sandhya Somashekhar, August 24, 2013
With a key deadline approaching, state officials across the country are scrambling to get the Affordable Care Act’s complex computer systems up and running, reviewing contingency plans and, in some places, preparing for delays.
Oct. 1 is the scheduled launch date for the health-care law’s insurance marketplaces — online sites where uninsured people will be able to shop for coverage, sometimes using a government subsidy to purchase a plan. An estimated 7 million people are expected to use these portals to purchase health coverage in 2014.
The task is unprecedented in its complexity, requiring state and federal data systems to transmit reams of information between one another. Some officials in charge of setting up the systems say that the tight deadlines have forced them to take shortcuts when it comes to testing and that some of the bells and whistles will not be ready.
“There’s a certain level of panic about how much needs to be accomplished but a general sense that the bare minimum to get the system functional will be done,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It will by no means be as smooth and as seamless as people expected.”
Oregon announced this month that it will delay consumers’ direct access to its marketplace, opening the Web site only to brokers and consumer-assistance agents in order to shield consumers from opening-day glitches.
“Even though we’re testing now, once you actually have the system up, you don’t know what the bugs will be,” said Amy Fauver, spokeswoman for Cover Oregon, the state agency implementing the law there.
In California, which has the nation’s largest uninsured population, health officials have begun hinting that they may have a similar problem.
“It’s a complex system, and there’s a lot of navigation that needs to happen,” said Oscar Hidalgo, a spokesman for Covered California. He said the agency will know by early September whether the system will be ready in time.
If not, he said, customers will still be able to log on to the Web site and peruse insurance plans and view prices. When they get to the final step, however, they will not be able to sign up. They will have to contact a customer service representative to complete the final enrollment step.
Officials with the District of Columbia’s Health Link decided to put off building a Spanish version of its Web site until later this year, giving its staff bandwidth to complete other tasks they see more critical to the launch.
Until then, the District will have bilingual call-center workers and in-person helpers who will be able to help Spanish speakers navigate the site.
The hiccups are troubling to advocates, who worry that there will be mistakes that result in people being erroneously rejected by Medicaid or denied subsidies to which they are entitled. They are concerned that impediments will discourage the uninsured from signing up for coverage.
“There will be something up and running, but there will be serious, serious difficulties with it” that could result in delays and errors initially, said Robert H. Bonthius Jr., a lawyer at the Legal Aid Society of Cleveland. “It’s an extremely ambitious program, well-intentioned, that is going to be very difficult to accomplish, and it’s going to be months and maybe years before it really gets sorted out.”
Much of the difficulty stems from the information the federal government needs to determine who qualifies for which health-law program, including data on citizenship, income, residence and employment. State systems will need to communicate seamlessly with a federal data hub that pulls in information from the Department of Homeland Security and the Internal Revenue Service, among others.
President Obama has predicted “bumps” and “glitches” in the initial launch of the exchanges. Health and Human Services Secretary Kathleen Sebelius has acknowledged a very tight time frame that has required the government to test the hub in imperfect conditions, but she has said it will still launch on time.
“Ideally what you would do if you were building a data hub that needs this kind of information, you’d put a piece together and test that. You test it, if you will, sequentially,” she said in an interview. “We have to build and test simultaneously. . . . It’s a big operational issue, but all systems are a go for the first of October.”
Sixteen states decided to build their own health-insurance marketplaces, with the rest leaving all or much of the task to the federal government. Those states are now in the process of, or have completed, testing to share data back and forth with the data hub.
“There were times when the hub had to be taken offline. . . . So we couldn’t test until they got it back online,” said Jon Hager, executive director of Nevada’s Silver State Health Insurance Exchange. “But I think the end result, and everything I’ve seen, says it will be ready.”
Hager has invested significant time preparing contingency plans for his state, including one for a situation in which the federal data hub does not work, though he said he believes that to be a relatively unlikely scenario.
“If there’s a new rule, that could throw us into a quandary,” Hager said. “You could have, I don’t know, a disaster or a fire. I think we’ve got backup and contingency plans for everything.”
The federal government handles all testing of these connections for states that did not build a portal and chose instead to rely on the federally facilitated marketplace.
State Medicaid programs, which typically serve low-income individuals, are also undergoing testing with the federal data hub. At least one state, Arizona, has not begun that work. It will start testing in September, a late start that worries the executive director of the state’s marketplace.
“It’s a concern that we’re testing this late,” said Tom Betlach, who runs the Arizona Health Care Cost Containment System. “Usually when you do testing, you have to go ahead and address any changes. Given the October 1st start date, I don’t know much of it will be an iterative process.”