With the launch of the new health insurance exchanges — the centerpiece of the Affordable Care Act — just a day away, a nationwide push continued over the weekend to test and patch the technology behind the online sites.
Officials working on the sites have acknowledged that information technology (IT) failures will prevent many of them from functioning fully for weeks, and perhaps longer.
That will slow the government’s drive to enroll millions of uninsured Americans under President Barack Obama’s healthcare reform law starting Tuesday.
Florida declined to create its own health exchange, so it will be run in the state by the federal government.
From a political standpoint, a successful opening day will shape perceptions of Obama’s signature policy initiative. But the system’s functioning is, to a large extent, beyond the control of politicians and policy experts, and instead rests with the battalions of computer-coders working for IT subcontractors.
Six months ago, those involved in setting up the exchanges were more hopeful that everything would be ready on time, said Cristine Vogel, an associate director at Navigant Consulting.
“I don’t think there were enough hours in the day, or enough people with the skills,” she said. “When we look back, I think we’ll see that we missed an opportunity to share technology.”
Opponents of the law known as Obamacare say the computer problems bolster their view that the 2010 law is a “train wreck” and should be delayed or repealed.
The Obama administration insists the exchanges will be open for business Tuesday even if some uninsured Americans might not be able to buy coverage right away. More importantly, they say, the new health plans will begin to provide health coverage on Jan. 1, as planned.
“So long as the website is accessible and the plans and the plan information are displayed properly so a consumer can shop for coverage and compare the plans, they will claim victory,” said Chris Condeluci, an employee benefits attorney at Venable LLP and a former staffer with the Senate Finance Committee who helped draft the Affordable Care Act.
Last week, the Obama administration said its Spanish-language website would not be ready in time, and that it would be weeks before small businesses and their employees could sign up online for coverage on exchanges operated by the federal government.
The exchanges in Colorado and the District of Columbia, meanwhile, cannot calculate the amount of federal subsidies that customers might qualify for.
In New York, the exchange is not able to transfer data to some insurers instantaneously, as planned, one carrier told Reuters. Instead, the data will be sent in batches once a day or so. The glitch will not affect customers, but it raises questions that New York might have other IT problems.
Oregon had sufficient qualms about its online insurance marketplace that no one can enroll unless they use a trained, certified agent or other “community partner.”
Last week, Oregon also had trouble correctly displaying information about insurance plans on a test site. The problem could mislead customers about deductibles, prices and other details if it occurs on the live site Tuesday.
Ohio Lt. Gov. Mary Taylor, who opposes the healthcare law, said in a radio interview last week that her state’s online exchange, which like Florida’s is being run by the federal government, could crash on its first day.
In testing, she said, some plans filed by insurers “sat in a queue for the federal government for a week, so my concern is something similar is going to happen on Oct. 1 because of the amount of [online] traffic.”
In most cases, exchanges will offer workarounds that will take time to execute. In Washington, D.C., offline contractors will calculate federal subsidies and inform applicants what they qualify for in November, by which time the online calculator might be working.
Even before the exchanges open, the finger-pointing has begun, with states blaming contractors for problems and contractors blaming states or other contractors.
The system to calculate federal subsidies for the Washington, D.C., exchange was built by Curam Software, which IBM acquired in 2011. In tests of complex family situations, the software was getting subsidies wrong 15 percent of the time, said exchange spokesman Richard Sorian.
In a statement, IBM spokesman Mitchell Derman said the city “decided that a phased-in approach best meets the needs of its citizens.”
One of the most difficult IT jobs has been to integrate each health insurance exchange with its state Medicaid system. These legacy systems are typically decades old.
In Massachusetts, for instance, the system runs on the COBOL programming language, which is to today’s computer languages like a rotary telephone is to an iPhone 5.
“These legacy systems are old and difficult to configure and reconfigure,” said Tom Dehner, managing principal at Health Management Associates, a healthcare consultant, in Boston and former director of Massachusetts Medicaid.
“To change how eligibility is calculated,” as federal law now requires, he said, “you need to modify your Medicaid system, and that’s not something you can do by buying software off the shelf.”
The difficulty of interfacing with Medicaid will keep Colorado’s exchange from calculating subsidies online.
To determine eligibility for federal subsidies, explained Nathan Wilkes, a member of the board of Connect for Health Colorado, the system “first goes through Medicaid determination. That means connecting to a legacy system,” he said.
“Six or nine months ago we got an early warning that the way we wanted to integrate these systems wouldn’t work, and then time got away from us.”
Colorado’s exchange tested 100,000 scenarios to see how its software calculated subsidies, and got error after error.
“It’s an IT nightmare,” Wilkes said.