When you stop and think about it, what the federal government is proposing to do in implementing Obamacare is absolutely breathtaking. The government is proposing to basically take over 17% of the American economy, create a massive database — yet to be built — so that insurance exchanges — yet to be designed — can give up to 62 million Americans access to individually tailored insurance plans, while coordinating among three federal agencies millions of requests for federal subsidies.
We are 149 days away from the October 1 deadline for state insurance exchanges to be up and running so that citizens can purchase plans and find out how much of a subsidy they are eligible for. The IT requirements to connect everything, have all the interfaces in place, not to mention securing the system from hackers looking to steal your personal information, are incredibly complex.
How complicated is it? Here’s a chart by Xerox (via WaPo) that should pop your eyes a bit:
Michael Barone published a letter from one of his readers, an IT professional with 35 years of experience, that lists just a few of the massive challenges facing the government:
“Wow, what can go wrong here? Let me assess this based on my years of experience in this industry. The federal government is going to build 50 exchanges, using a data hub that doesn’t exist physically and in fact, the design hasn’t been solidified, and must be accessible to a variety of data processing technologies that range from archaic to old.
Each of the 50 states have different eligibility rules, and with a significant number of states opting out, the federal government now has to learn the intricacies of each state’s Medicaid eligibility models which then scale to different applicability rules for different members of a given family. The thousands of pages of bureaucratic rules that will drive requirements haven’t been completed yet, and those requirements are needed to drive design not only for the application programs, but for the entire processing architecture. The issue of network, processor, and storage performance has to be decided, modeled and tested.
To complicate matters, the convoluted federal procurement rules for hardware and software have to be adhered to, which require mixing different hardware brands, software packages and service providers. Add to this compliance analysis to validate and re-validate trusted sources of data. All legal requirements at the local, state, and federal level have to be met by the design. And last but not least, staffing up for customer support which requires hiring, training on applications not yet designed and real world tested, the creation of support documentation, building or retrofitting facilities for these folks, setting up backup sites for the required redundancies, plus hardening the sites for natural disaster power failures.
Additionally, the people hired must meet the Equal Opportunity criteria, and all GUIs must be handicapped usable, as well as the facilities themselves. I could be here all evening defining additional work to be done. Oh, did I mention this will be done by next year?
Another Barone reader lists some of the resource requirements:
o System Analyst
Strong ability to work with subject matter specialist to develop systems requirements and document for the programmers.
o Technical and Subject Matter Specialists
Writers to develop Standard Operating Procedures (SOP) for the end users (How many will that be???) and SOP’s for operations.
Computers
o Will we need various types of computer equipment in order to test and migrate to production? Problem is we must likely don’t have that computer capacity in order to test followed by migration to production
o Mainframes, Desktops and other devices that I am unaware of
o Will vendors have to get involved with hardware/software packages, etc?
o LANs
Interfaces (based on the GAO report-as follows)
o IRS
o HHS
o TREASURY
o INSURANCE COMPANIES
o SSA
o STATE EXCHANGES
o CORPORATIONS
o SMALL BUSINESS
o MEDICARE
Given my chimp-like abilities with the computer, do you think they’re going to have someone you can talk to for help if you get stuck? (“Your call is valuable to us. Estimated wait time to speak to a representative is three days.”)
No one expected the implementation of Obamacare to be smooth. But this promises to be beyond disaster, a clusterfark of epic and unforgettable proportions.
If the government goes ahead and tries to maintain the October 1 deadline for the exchanges to go live, it will probably be as bad as it appears. They need to create 26 complete exchanges (the feds are partnering with 7 other states to build the systems). They need to sync up all those interfaces, including those connected to the IRS and HHS so that the consumer can get approved for subsidies. How many millions of lines of code? How complex will the applications be? We’re not even thinking about the complexity of the Medicaid expansion.
Why is the government so far behind the curve in prepping for Obamacare’s rollout? One big reason is that the 13,000 pages of regulations that are supposed to tell insurance companies what kinds of policies they can offer were just released after the election. Apparently, most of them were ready last May but the president chose not to release the bad news before he was safely re-elected.
The insurance companies couldn’t design the policies without the regulations and the IT people couldn’t create the platform without the policies. So instead of spending almost a year designing and tweaking the exchanges’ computer systems, the feds now have 149 days to get things up and running.
It’s not going to happen. Henry Chao’s famous quote about problems setting up the exchanges — “Let’s just make sure it’s not a third-world experience” — reflects the nervousness of the administration. It also points the way to some kind of delay as the kinks are worked out of the system.
Six months isn’t going to make the policies offered on the exchanges any cheaper. Nor is a delay going to make the process any easier. What was once promised to be an online experience similar to buying a plane ticket on Expedia is no doubt going to turn into something akin to Chinese water torture.
But for the present, we are stuck with it. For how long a time may very well depend on how patient the American public is with the incompetence of the government and the bewildering complexity of the exchanges.
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