Insurers: Where are the reconciliation and payment systems?

posted at 9:21 am on December 3, 2013 by Ed Morrissey

While the White House returns to “sales mode” on ObamaCare, insurers are more worried about their delivery mode. With less than a month before the individual mandate begins, the back-end systems for Healthcare.gov still don’t work — or don’t exist at all.  Given the track record at HHS of declaring victory while systems collapse, their partners in the private sector are not sanguine about the immediate future:

Insurance companies are still waiting for key parts of HealthCare.gov to be built—and still having trouble with the parts that are in place.

Important pieces of the Obamacare site are still glitchy, or missing altogether. And the site’s botched rollout is hardly boosting confidence in the vital components that still need to be built, including the systems for processing payments to insurers and squaring away the details of who has enrolled in which plans.

Both systems are crucial to the insurance industry, which needs to collect premiums so it can pay out claims. And carriers are still waiting for the delayed process of reconciling their enrollment information with the federal government’s data. As the rest of HealthCare.gov struggles to get off the ground, people in and near the insurance industry are nervous about the delays and about how well those systems will work once they’re in place.

Guess who’s in charge of building those pieces?

Another cause for insurers’ anxiety: CGI Federal—the contractor that has come under fire for its work building the bulk of HealthCare.gov—is also in charge of building the payment and reconciliation systems.

Yes, the same people who couldn’t turn out a functioning web portal with a year’s head start, and who still can’t make the front end function to meet the expected demand, are in charge of providing the crucial back end to complete enrollments.  So far, insurers aren’t seeing any sign that this will get done, not for reconciliation or for subsidy payments. Instead, HHS is telling customers to do the reconciliation themselves by flooding their insurers with the phone calls that Healthcare.gov was supposed to avoid.

The payment systems are an even bigger deal.  Insurers will have to start paying providers from the premiums they receive starting on January 1, and those subsidies are a large portion of those premiums.  If they don’t get paid on time, they’ll have to run at a loss until CGI figures out how to create a computer system that transfers funds accurately … a task that every financial institution figured out decades ago.  Heck, your local bank knows how to do that with Automated Bill Pay.  If it takes more than a month to get subsidy payments in place, insurers could be looking at some serious red ink, especially with the flood of demand expected to be created with the ObamaCare structure. Providers will end up getting stiffed, which is going to make them less than enthusiastic about remaining in these networks, too.

With all of these problems, why is Barack Obama trying to push more people into the system with a new sales pitch, Allahpundit asked this morning:

The White House needs to cheer up Democrats more than it needs to protect Americans from its disaster, that’s why.


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No vision, no leadership, no accountability, unworkable premise. This project is doomed.

Paul-Cincy on December 3, 2013 at 9:26 AM

The White House needs to cheer up Democrats more than it needs to protect Americans from its disaster, that’s why.

Gotta have priorities. Forward!

iurockhead on December 3, 2013 at 9:29 AM

This is big government at it’s ,er, finest. To many cronies and political payoffs, and it will always be this way. This is exactly why supporting big government means you’re stupid.

Flange on December 3, 2013 at 9:30 AM

I wonder if the awards ceremony / holiday party for the ACA project managers is scheduled for Vegas or Palm Springs? I guess we’ll find out when their comedy video is leaked on Youtube.

DarthBrooks on December 3, 2013 at 9:31 AM

Please do not forget the impact on State Insurance Commissioners and health insurance carriers. They can be sued for Bad Faith if a person “thinks” they signed up on ObamaCareFail but a policy was never issued.

This sh*tcan is about to explode. Mark my words.

Repeal it. NOW.

Key West Reader on December 3, 2013 at 9:35 AM

Please lower your expectations. Don’t forget, he’d no private experience before skyrocketing through the State Senate and US Senate on his way into the WH./s

socalcon on December 3, 2013 at 9:36 AM

While the White House returns to “sales mode”
=============================================

Good gawd, thats what Team Hopey/Changey has been doing since 07/08′
in a NeverEnding Sales Pitch Speechys!!!!!!!

canopfor on December 3, 2013 at 9:36 AM

canopfor on December 3, 2013 at 9:36 AM

I can’t wait for today’s speechifyin’ session. Can you?

/Bleh.

Key West Reader on December 3, 2013 at 9:38 AM

The number one objective of Obamacare has been, from the start, to put insurance companies out of business or at least to anger the populace enough at the companies, either or both being a way to get to single payer. What better way to do it than to NOT build a reconciliation and payment system, which will ensure that most applicants won’t have insurance on day one.

TXUS on December 3, 2013 at 9:38 AM

Dog Eater will get mad and things will get fixed so settle down, you KKK’ers.

Everything doesn’t need to be racism 24/7 with you people, does it?

Bishop on December 3, 2013 at 9:38 AM

So insurance companies go to bed with the Devil and are now surprised when they wake up with pitchforks in their backs? Ok, got it.

hillsoftx on December 3, 2013 at 9:41 AM

We have to spend another 600M “to find out what’s in it”.Spiking the football and declaring victory is a real hoot if it weren’t so sad.This turd is beyond polishing, abolish it now!

jeffinsjvca on December 3, 2013 at 9:42 AM

On 1210 AM Philly I just tuned in and heard a woman representing the Cleveland Clinic touting the wonders of group doctor visits, and how it builds community.

Akzed on December 3, 2013 at 9:42 AM

You don’t need no stinkin insurance when you’re a perfect physical specimen.

bsinc1962 on December 3, 2013 at 9:43 AM

The number one objective of Obamacare has been, from the start, to put insurance companies out of business or at least to anger the populace enough at the companies, either or both being a way to get to single payer. What better way to do it than to NOT build a reconciliation and payment system, which will ensure that most applicants won’t have insurance on day one.

TXUS on December 3, 2013 at 9:38 AM

I guess they mis-calculated their expedient velocity in their quest to level out the playing field to make insurance fair for the quantifiable public at large, whilst investing SIX HUNNIT MILLION DOLLAH’s in a website created by a well respected crony of Obama’s White House and the dog is doing fabulous! Oh and Sandra Fluck.

/Talking points ointment.

Key West Reader on December 3, 2013 at 9:44 AM

Nancy Sniderman was the gal on 1210 AM, who also said women don’t need mammograms.

Akzed on December 3, 2013 at 9:46 AM

Anyone have the link for the front-end cartoon? Look hilarious.

itsspideyman on December 3, 2013 at 9:47 AM

obama is going to be so very angry when he finds out his website still isn’t working.

HumpBot Salvation on December 3, 2013 at 9:49 AM

“Get Covered”!

Hah, no you ain’t covered~ You’re screwed. Now bend over so your DMV agent can check your butt hole.

/What a fiasco this is.

Key West Reader on December 3, 2013 at 9:50 AM

Those gop won’t help us…what is their plan?
-wh talking point

cmsinaz on December 3, 2013 at 9:51 AM

The only plan Barky had was to fail, blame it on the insurance companies and the GOP, and force the country into single-payer. Things are going right on schedule as planned.

Philly on December 3, 2013 at 9:51 AM

What’s the over/under on when the first lawsuit is filed when someone incurs major medical expenses and discovers that they don’t have health insurance after all?

Lawyers must be drooling in anticipation.

HumpBot Salvation on December 3, 2013 at 9:52 AM

canopfor on December 3, 2013 at 9:36 AM

I can’t wait for today’s speechifyin’ session. Can you?

/Bleh.

Key West Reader on December 3, 2013 at 9:38 AM

Key West Reader:Lol,….

….everyday, I get goose-stepping pimples in anticipationg of
herr’ Obama’s daily speechifications, haha:0

Oh you mean dis one:
====================

Mark Knoller ‏@markknoller 1h

In remarks today at 230pm, Pres Obama with emphasize the ObamaCare benefits that have already kicked in for millions who have insurance.

https://twitter.com/markknoller

canopfor on December 3, 2013 at 9:53 AM

What’s the over/under on when the first lawsuit is filed when someone incurs major medical expenses and discovers that they don’t have health insurance after all?

Lawyers must be drooling in anticipation.

HumpBot Salvation on December 3, 2013 at 9:52 AM

Hmmm. The Plaintiff’s Bar love’s it… they are Obama’s biggest donors. Including Charlie Crist who works for Morgan & Morgan. FOR the People.

Uh huh

Key West Reader on December 3, 2013 at 9:53 AM

squaring away the details of who has enrolled in which plans.

Minor details to be squared away. Who bought this? What did they buy?

Who cares. Healthcare.gov wasn’t designed for that. It was always just a way to collect as much private data as possibe for use by the IRS, OFA, and Chinese Identity Thieves.

notropis on December 3, 2013 at 9:56 AM

OT-

Does this sound like a certain HA troll? Three white students in the class singled out for being white. Racist professor who dared them to file a complaint. They did and now she is suing because the college “undermined” her authority by siding with the whites.

A faculty member at Minneapolis Community and Technical College, Shannon Gibney, received a formal reprimand for her handling of a discussion about structural racism in her Introduction to Mass Communication course.

According to Gibney in an interview with City College News, a white male student asked her, “Why do we have to talk about this in every class? Why do we have to talk about this?”

She claims she was shocked, because “[h]is whole demeanor was very defensive. He was taking it personally. I tried to explain, of course, in a reasonable manner — as reasonable as I could given the fact that I was being interrupted and put on the spot in the middle of class — that this is unfortunately the context of 21st century America.”

Happy Nomad on December 3, 2013 at 9:57 AM

Oh, you expect to be paid?

This goes beyond big government v. small government. The push (ram) toward marxism is so ingrained in their mindset that they cannot imagine that the common man does not think the same way, and they think that the people will accept shoddy workmanship because we simply accept the fact that they are in charge and are our betters.

This is serious stuff, folks. They want to turn the USoA into a socialist country. This goes way beyond Social Security, Medicaid/care, and obamaphones. Way beyond.

davidk on December 3, 2013 at 9:57 AM

What’s the over/under on when the first lawsuit is filed when someone incurs major medical expenses and discovers that they don’t have health insurance after all?

Lawyers must be drooling in anticipation.

HumpBot Salvation on December 3, 2013 at 9:52 AM

What’s the over/under that the administration will announce that people might want to call their insurer directly and make sure they actually have coverage? It’s an admission that the fixed system is anything but. I’m guessing they won’t because it will detract from the PR campaign this month where every day features a slut or parasite who are the few winners among the many losers with Obamacare.

Happy Nomad on December 3, 2013 at 10:00 AM

You stupid insurance companies – you sold your souls long ago when you went along with this administration.

I have no sympathy for you now.

stenwin77 on December 3, 2013 at 10:04 AM

Those huge deductibles cut the insurance company’s some slack right off of the bat.They won’t be paying much above those in most cases.

docflash on December 3, 2013 at 10:10 AM

Happy Nomad on December 3, 2013 at 9:57 AM

MCTC?

ROFL, you have to see that place to believe it, like UC Berkeley was cloned and dropped in the middle of Minneapolis. Whenever Kwanzaa is, these giant banners appear while students and faculty alike start wearing “traditional” African clothing such as those long dishdasha-type shirts and the pillbox skullcaps, even the white kids do it.

I did some work out there years ago and let me tell you, the campus is a hoot, the whole place looks like this at Kwanzaa:
http://www.worldofstock.com/slides/TAF2098.jpg

Bishop on December 3, 2013 at 10:10 AM

Obama health care law
33m
=====
Between today and Dec. 23, the deadline to enroll for coverage starting Jan. 1, White House will hold 1 event daily on health care – @mmurraypolitics
read more on twitter.com
=========================

https://twitter.com/mmurraypolitics

canopfor on December 3, 2013 at 10:15 AM

You stupid insurance companies – you sold your souls long ago when you went along with this administration.

I have no sympathy for you now.

stenwin77 on December 3, 2013 at 10:04 AM

What they saw was that all the money coming to them from the government forcing people to buy their product. What they didn’t see what the government intending to kill their business. Greed clouded their judgment. Suck it up insurance companies, you bought into it.

TulsAmerican on December 3, 2013 at 10:16 AM

With all the success of Obamacare, why are we letting this Bozo administration negotiate with Iran?

Deafdog on December 3, 2013 at 10:16 AM

Anyone have the link for the front-end cartoon? Look hilarious.

itsspideyman on December 3, 2013 at 9:47 AM

The cartoonist is Nate Beeler: http://www.cagle.com/author/nate-beeler/

I don’t know the date; you’ll have to dig to find it.

davidk on December 3, 2013 at 10:17 AM

you have to see that place to believe it, like UC Berkeley was cloned and dropped in the middle of Minneapolis. Whenever Kwanzaa is, these giant banners appear while students and faculty alike start wearing “traditional” African clothing such as those long dishdasha-type shirts and the pillbox skullcaps, even the white kids do it.

Bishop on December 3, 2013 at 10:10 AM

That explains a lot. It also means that this racist professor really was out of line if the administration found cause to reprimand her. I take it from the article that essentially this class on Mass Communication was a lecture on the evils of white people.

I was in a similar experience during my Master’s work. The class was supposed to be about ethics in the workplace. One of the presentations was about sexual harassment. There were two males in this class and in every single instance the harasser was “he” while the victim was always “she.”

Happy Nomad on December 3, 2013 at 10:20 AM

With all the success of Obamacare, why are we letting this Bozo administration negotiate with Iran?

Deafdog on December 3, 2013 at 10:16 AM

He’s been secretly negotiating with them for over a year. Secret, I am sure, because he didn’t want the public to get in the way of selling out to the Muslin terrorists that run the country.

Happy Nomad on December 3, 2013 at 10:22 AM

Between today and Dec. 23, the deadline to enroll for coverage starting Jan. 1, White House will hold 1 event daily on health care

canopfor on December 3, 2013 at 10:15 AM

I intend to refer to it as the “Parasite of the Day” campaign. Because they intend to feature the few winners who benefit from this wealth redistribution. Sluts who finally don’t have to pay for birth control. Poor people who now have somebody else paying for their breeding options (maternity or abortions). And so forth.

Happy Nomad on December 3, 2013 at 10:24 AM

Anyone have the link for the front-end cartoon? Look hilarious.

itsspideyman on December 3, 2013 at 9:47 AM

The cartoonist is Nate Beeler: http://www.cagle.com/author/nate-beeler/

I don’t know the date; you’ll have to dig to find it.

davidk on December 3, 2013 at 10:17 AM

Thanks davidk.

Here’s the cartoon. :)

http://blogs.denverpost.com/opinion/2013/10/22/cartoons-of-the-day-fixing-obamacare-website-glitches/41875/3/

itsspideyman on December 3, 2013 at 10:27 AM

“Both systems are crucial to the insurance industry, which needs to collect premiums so it can pay out claims. “

Oh. There’s the problem. Apparently, nobody ever explained this phenomenon to Obama.

Tsar of Earth on December 3, 2013 at 10:29 AM

Boy, when Obama learns about this from the morning newspaper, will he ever be p***ed!!!

PackerBronco on December 3, 2013 at 10:30 AM

Boy, when Obama learns about this from the morning newspaper, will he ever be p***ed!!!

PackerBronco on December 3, 2013 at 10:30 AM

Nobody is madder than Obama.

Happy Nomad on December 3, 2013 at 10:34 AM

People who didn’t vote for Obama don’t deserve this, but insurance companies that got in bed with Obama do.

David Blue on December 3, 2013 at 10:43 AM

Will the insurance companies recognize the policies as active, if the premiums–in this case the subsidy portion–haven’t been paid? Are they required by the law to honor the policies, even if the government hasn’t given them the money yet?

In a private contract with an insurance company, there is no way the policy would go active, until you have paid the premiums in full.

HakerA on December 3, 2013 at 10:43 AM

This is big government at it’s ,er, finest. To many cronies and political payoffs, and it will always be this way. This is exactly why supporting big government means you’re stupid.

Flange on December 3, 2013 at 9:30 AM

The rot goes way deeper than that. Government cannot do ANYTHING right anymore. Had the Democrats of the FDR or Kennedy eras been running this thing it would have at least been successfully implemented. It still would have done massive harm to the American people but at least the website would have worked.

The government is, just barely, able to maintain existing legacy programs, but any new government programs basically are nonfunctional from the get-go now. They are unable to even hire people from the private sector to do it for them successfully.

Doomberg on December 3, 2013 at 10:44 AM

Nancy Sniderman was the gal on 1210 AM, who also said women don’t need mammograms.

Akzed on December 3, 2013 at 9:46 AM

Let’s all feel sorry for her if she gets breast cancer.

My mother was diagnosed with breast cancer at age 45, and lived to the age of 77. A mammogram gave her an extra 32 years, for which she was very thankful.

Steve Z on December 3, 2013 at 10:44 AM

What they saw was that all the money coming to them from the government forcing people to buy their product.

TulsAmerican on December 3, 2013 at 10:16 AM

That’s when they got out of the business of delivering a product worth buying and got into the business of getting money off people by force.

David Blue on December 3, 2013 at 10:45 AM

Greed clouded their judgment. Suck it up insurance companies, you bought into it.

TulsAmerican on December 3, 2013 at 10:16 AM

Excellent distillate. Broad applications.

Tsar of Earth on December 3, 2013 at 10:46 AM

Tsar of Earth on December 3, 2013 at 10:29 AM

Can’t they just raise their debt limit the way Obama does?

myiq2xu on December 3, 2013 at 10:47 AM

Doomberg on December 3, 2013 at 10:44 AM

That’s the problem with a big and growing government. The problems grow exponentially. Old laws, regulations and programs rarely go away, just new one getting added. Very few are held accountable. And it just keeps getting worse. It’s why only criminals, idiots and the deranged support it.

Flange on December 3, 2013 at 10:58 AM

What they saw was that all the money coming to them from the government forcing people to buy their product. What they didn’t see what the government intending to kill their business. Greed clouded their judgment. Suck it up insurance companies, you bought into it.

TulsAmerican on December 3, 2013 at 10:16 AM

Most of the major insurance companies declined or dropped out of Obamacare. They knew what was coming.

TerryW on December 3, 2013 at 11:12 AM

What they saw was that all the money coming to them from the government forcing people to buy their product. What they didn’t see what the government intending to kill their business. Greed clouded their judgment. Suck it up insurance companies, you bought into it.

TulsAmerican on December 3, 2013 at 10:16 AM

Most of the major insurance companies declined or dropped out of Obamacare. They knew what was coming.

TerryW on December 3, 2013 at 11:12 AM

If you pay your income taxes on time it doesn’t mean you love the IRS, or approve of progressive income taxes, or are not a good conservative.

Insurance companies deserve equal consideration. Under the boot of a fascist dictatorship, precious few entrepreneurs would shut down a business and walk away.

slickwillie2001 on December 3, 2013 at 12:18 PM

slickwillie2001 on December 3, 2013 at 12:18 PM

A very poor analogy. The insurance industry lobbied FOR the ACA. They weren’t just playing by the rules; they were fighting to change the law to make buying their products mandatory.

Al in St. Lou on December 3, 2013 at 1:18 PM

“Gee, if I didnt know better, I’d start to wonder if maybe the total collapse and destruction of the private insurance market and healthcare system across the whole country wasnt the President’s exact, if deceptively unstated, goal all along”, said every American not wearing Obama kneepads.

Sacramento on December 3, 2013 at 2:07 PM

Time to eat your peas Make that worms.

Kuffar on December 3, 2013 at 2:33 PM

Get used to late payments. BO comes from a state that is about a year behind on Medicaid, school, and LGU tax payments. Obamacare paying a year late will be the norm.

Add that onto normal insurance foot-dragging and you end up with health systems and doctor/hospital networks carving out their own business to those that can afford it. Socialized medicine a la UK: one system for those that have, and one system for those that don’t.

MarkT on December 3, 2013 at 2:59 PM

I’m sure doctors and hospitals will work for free until this can all be fixed.
/sarc

virgo on December 3, 2013 at 10:57 PM