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.