Will the Affordable Care Act’s Health Insurance Exchanges Be Ready On Time? The Obama Administration’s Top Secret Enterprise

Last week, I received my weekly email update from the Maryland health insurance exchange:

Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.

This report tells us a few things.

First, the Maryland health insurance exchange is on track to launch on time and ready to serve all comers. I continue to be impressed by how well this state-run health insurance exchange is working toward implementing the Affordable Care Act (“ObamaCare”) on October 1, 2013.

Second, apparently the Federal Data Hub is up and running. While that is what the Obama administration has been telling us, it has been hard to find anyone who has actually seen it or used it.

Third, Maryland has its system ready to exchange eligibility and premium information with the health insurance plans––perhaps the biggest challenge the new exchanges, state or federal, face.

Across the country, I am not so worried that consumers will have a website to go to on October 1 in order to shop for the new health plans as I am concerned with how things will go on January 1, 2014 when patients show up in a doctors office. If we don’t have a clean exchange of eligibility and payment information there are going to be lots of people who will have their doctor or hospital telling them they don’t know anything about their coverage.

Separately, the Government Accountability Office (GAO) recently conducted interviews with six states building their own exchanges––Iowa, Minnesota, Nevada, New York, Oregon, and Rhode Island––as well as DC.

While they only conducted interviews––they did not do a detailed audit––and did so in April, the GAO concluded these states were on track to also be ready on October 1 to begin enrolling people in the new health insurance exchanges.

All  states  are  in  various  stages  of  developing  an  information  technology   (IT) infrastructure, including  redesigning, upgrading, or replacing their outdated Medicaid and  Children’s  Health  Insurance  Program eligibility and enrollment systems. Six states are also building the exchange IT infrastructure needed to integrate systems and allow consumers to navigate among health programs, but identified challenges with the complexity and magnitude of the IT projects, time constraints, and guidance for developing their systems.

You will also note that the GAO reported these states are not home free––”but identified challenges with the complexity of IT projects.”

I continue to be puzzled by the way the Obama administration is developing the federally run exchanges in the 35 states in which they will have to run them.

We don’t know any details on just where they are and if they are on track. They continue to tell us they will be ready on October 1 to begin enrollment and on January 1 to exchange billing and eligibility information with the health plans––by far the toughest challenge.

But why all of the secrecy? Why aren’t we getting the same reports from the Obama administration we are getting from Maryland? Why isn’t the GAO doing a report on just where the administration is in the 35 states’ exchanges they will now manage?

Even more, all of the health plans intending to do business on the new federal health insurance exchanges had to submit their plan and rate data to the Obama administration weeks ago.

Will we have rate shock in the federal exchanges? The Obama administration has all of the rate data. They know if we will or won’t. True, all the rates are preliminary but they are preliminary in California and Ohio and all of the other states that have released that data.

Why won’t the Obama administration release the detailed information on which health plans are participating in which states and what they are charging?

Last week Washington was abuzz with detailed reports in the Washington Post about how people’s phone and computer records are being monitored by the federal government. It’s notable that more is now known about that national security enterprise than exactly where HHS is on “ObamaCare” implementation!

Why is the implementation of “ObamaCare” by the Obama administration a top-secret enterprise?

Robert Laszewski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

4 replies »

  1. JD, of the 55 million uninsured Americans, I heard that only ten million will be covered on January 1, 2014. In three years the ten million will be reduced to four million people covered with ACA. Is this true? President Obama and the democarts promised 24 million citizens of the 55 million uninsured would be covered. What gives someone who has zero insurance the right to get insurance over another uninsured person? One more question, On Janaury 1, 2014, you are not one of the ones selected to participate in ACA, can you get treatments in the ER? Would you not lose the right to be treated, without ACA? How is getting ACA insurance helping you out? How can you fine someone who has no money and no health insurance. What if you are not selected? then what? Do you to attempt to pay the premium of private insurance?

  2. I’d like to remain anonymous so I won’t reveal the state or my role, but I’ve been involved with building one of the state exchanges and I can say that health plan billing is not near the top of the list of challenges in my state. If I were to list the top three challenges they would be: eligibility, eligibility, enrollment. These are things that need to be worked out by October 1, so that is the harder deadline to meet. January 1 will be easy in comparison.

  3. I can assure you the providers are not ready. Lots of work to be done. Challenged with collaboration, developing high performing teams and even basic understanding of managed care. Why is it so challenging for healthcare to change? Is it related to payment structures & lack of alignment? Innovation seems in short supply as is ability to operationalize.