Obamacare official on exchanges: “Let’s just make sure it’s not a third-world experience.”

posted at 1:21 pm on March 22, 2013 by Mary Katharine Ham

A quick reminder about what I’ve been saying about the challenges of Obamacare exchange implementation, here and here.

Now, Obamacare feds are conceding the same. Gary Cohen, head of the Center for Consumer Information and Insurance Oversight, is the one charged with getting this bird off the ground, and has faced grilling from even Democratic lawmakers worried it will crash on take-off.

It seems now, there’s “some possibility” that exchanges might not be functional in October of this year. Expect a lot more backtracking before fall:

Federal officials are developing contingency plans in case the health insurance exchanges are not fully ready to begin enrolling people on Oct. 1, the head of the agency that’s building the massive 50-state marketplace structure said last week.

Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, also said there is “some possibility” that some states now conditionally approved to run their own marketplaces might not be able to launch them on Oct. 1. But he vowed that every state will have an exchange, which could mean the federal government might have to have more of a role than anticipated in states that can’t get to the finish line in time.

His remarks at a national policy meeting of America’s Health Insurance Plans (AHIP) marked the first time that Health and Human Services (HHS) leaders have veered even slightly from their insistence that exchanges will be totally functional by Oct. 1.

Now, here’s the guy in charge of developing the exchange technology, which as I’ve noted, is meant to marry seamlessly with archaic government systems in every state, innumerable private insurance systems, and a federal data hub that doesn’t yet exist by October:

Cohen appeared on an AHIP panel with Henry Chao, a CMS official who’s overseeing the technology for the exchange launch.

Chao was frank about the stress and tension of the compressed time frame involved in setting up the exchanges. “We are under 200 days from open enrollment, and I’m pretty nervous,’’ he said. “I don’t know about you,” he added, to murmurs from the insurance industry audience. Members peppered Chao and Cohen with many questions about the format for the health care policies they will submit to HHS for approval so the plans can be marketed in the exchanges.

Chao said the main objective is to get the exchanges up and running and signing up the uninsured. “The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” he said. “Let’s just make sure it’s not a third-world experience.”

He may have been being slightly tongue-in-cheek, but his comment encapsulates the serious challenges with building an exchange that works in all 50 states.

There is far too much taken for granted in health care reporting that asserts, “When the exchanges are built, they’ll be just like a Travelocity for health care.” That assumes a lot of complex tech work that would normally take many years and several pilot programs to complete, even in a private-sector environment. The poor guys building this stuff are faced with the natural problems of government bureaucracy, a federal government that still hasn’t filled in all the regulations in this bill, and a timeline of roughly seven months now. Even in Maryland, where bureaucrats have been preparing for Obamacare eagerly from the word “go,” the tech guys have been tugging at their collars nervously in meetings. It was always an ambitious project on a short timeline. The bill’s inattention to such details and lawmakers’ naive assumption that a “Travelocity for health care” would be a simple build have exacerbated the problem. The “murmurs” referenced above have been subtle but audible in every health care meeting I’ve attended in Maryland, where the industry crowd wants to show a good attitude but is very doubtful just millimeters below the surface smiles. Buckle in for a bumpy ride, people.

But there’s hope. Cohen says they totally have contingency plans….which they’re not yet ready to reveal:

Cohen would not be much more specific and said details of backup plans are not yet worked out. “But as we move closer to October, my hopes are the range of things that could go wrong gets narrower and narrower,” he said. “Then we will be in a position to know better which contingency plans we actually have to implement.”

Speaking with reporters afterward, Cohen said, “I’m absolutely confident every state will have an exchange that will be functioning and ready for enrollment” on Oct. 1. However, he added, “I think there is some possibility that the type of exchange may be different than what we’re looking at today.”

My ideological objections to Obamacare aside, this thing is and always was a beast for implementation and going to a burden on businesses, particularly small ones. It’s something critics pointed out during the bill’s debate and passage, and they were called charlatans for it. Now, the challenges are personified in the stories of Baked in the Sun bakery, which employs 95 people, but is looking at losing half its profit margin to insure them under the new law’s requirements.

Or, there’s Bittersweet Cafe, a local favorite in my area, which employs 45 people. Its owner Jody Manor is understandably hesitant to add another branch and new jobs, which would take him over the 50-employee mark, making him subject to far more regulation under the Affordable Care Act.

The helpful, heartfelt message of the Left for these hard-working small business people trying to stay above water, employ fellow citizens, and deliver good products in a down economy while trying desperately to anticipate the costly implications of a law the feds haven’t even bothered to finish writing after three years? Quit whining.

This thing has already broken every major promise made to pass it— it’ll save families money, it’ll save society money as a whole, it won’t add a dime to the deficit, and you can keep your plan if you like it. Come October, we’ll likely find out just how much more can break.

Hat tip to Phil Klein, who is always great and knowledgable on the health care bill.


Related Posts:

Breaking on Hot Air