This looks like it’s going to be a problem. We have a deadline of 1 January 2014 and we are nowhere close to meeting this goal. To make matters worse, that is not really the due date, but the drop-dead date, since the states will have to connect by the Fall of 2013 to insure this required start date. What am I talking about? The insurance exchanges (part of Patient Protection and Affordable Care Act-PPACA [Obamacare] )that are to be operational in each state. And, that means that the Federal exchange that coordinates these state systems must also be operational.
There are two major problems. First, the Republicans keep finding ways to not authorize money to fund the program. (The recent – as of this writing- disagreement to fund the 2% social security holiday included a provision to unfund this requirement as a means to pay for the holiday.)
These exchanges are supposed to be provided via a fully operational website- one where an individual or a representative from a small company would be able to examine various insurance policy offerings. The data would afford the user a comparison based upon price, coverage, and quality. These sites will notify the inquirer if there are federal subsidies, tax credits, or Medicaid funds to offset the price of the premiums listed (based upon their social security or Federal Employer Identification Number [FEIN]).
As you can see, this means the websites must have access to and include data from Federal and State income taxes, employment data, and the domicile (residency) for each entity. That means a whole bunch of data from federal agencies will need to be collated- and then linked with data from each of the 50 states and the District of Columbia. Given how long it took the IRS and the FBI to redo their computer systems, there is a reluctance (and that is an understatement) to assume this will be completed by the due date. And, this doesn’t even factor in the uncertainty of what the Supreme Court ruling will be come next June (2012).
Right now, we (the US government) are funding private contractors, to the tune of $ 150 million, to enable them to develop this federal exchange system. This HHS (Health and Human Services) effort is being directed by Teresa Miller, who was snatched from the state of Oregon (where she was the head of insurance regulation). (If you want to know why Oregon is a good place to mine such talent, check my index for “Oregon”; a good starting place is right here.)
The first phase in this design project is to develop a “hub”, one that will coalesce data from the Social Security Administration and the Internal Revenue Service. This system will have to afford the states access- since they are expected to build their own exchanges. (The link has been removed. Quality Software Services of Maryland has been acquired by Optum and it has removed the reference. The program involved developing this hub with funding of about $ 69 million.)
CGI (Federal) is building the exchange itself. For this portion of the effort, it’s getting $ 94 million of our money. It’s also ramping up the data handling capabilities of healthcare.gov so that more information on the health insurance laws and insurance companies can be included on this fairly comprehensive site.
It’s unclear what standards the federal government will require for state access to these hubs. And, the states are supposed to submit their capabilities by 1 January 2013 to determine if they can interconnect! (Note that Massachusetts managed to get their individual exchange running within a 6 month timeframe- so if there is a will, there is a way.) Moreover, the federal government has yet to define “essential benefits”- the services that the government will specify for inclusion in all approved insurance packages. Given these data- and no one is willing to provide any updates as to the progress achieved to date- 1 January 2014 is going to present a very interesting deadline.
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