Health-industry consultant: " is in de facto shutdown"

That’s the highlight of a devastating, click-now-and-read-it-all interview between Ezra Klein and Bob Laszewski, who’s become a mainstay of reporting on due to his contacts in the insurance industry. Laszewski’s point is simple: Although the site is still online, HHS is basically frozen in repairing it until they figure out how to get the back-end part running smoothly first. Unless and until the site’s database starts transmitting accurate information about enrollees to the insurance companies, they don’t dare fix the front-end part to make it easier for people to enroll. If they do, enrollees will start flooding in and insurers will end up buried under an avalanche of garbled registration paperwork. Result: Total chaos next year when coverage takes effect and people start filing claims. As things stand right now, the disaster on the front-end is actually preventing the disaster on the back-end from being even more disastrous. That’s the degree of incompetence we’re dealing with here.

And why is there a disaster on the back-end? Nobody knows. For ease of reference below, “834” is a type of form that’s routinely transmitted to an insurance company whenever someone enrolls in a plan. It’s an industry standard — and yet there are errors scattered throughout the 834s being sent from to insurers:

EK: Let’s go back to the 834s for a minute. This sounds like it should be an easy problem to solve. The 834 standard is widely used. It’s not particularly complicated. What’s going wrong?

BL: I don’t know. This process is decades old. Every union and every self-insured employer who contracts with an insurance company uses it. It’s like a 74 Ford pick-up truck. There’s nothing complicated about it. People in the industry are shaking their heads over the errors they’re getting. They’ve been using this process for many years. No one has ever seen these kinds of errors before. No one has any idea where they’re coming from.

EK: The White House says it’s working very closely with insurers to resolve this issue. Are you hearing from insurers working closely with the White House?

BL: No, I can’t confirm or deny that other than to say I talk to a lot of people in the industry, and no one knows of anybody doing that. I’m not saying the White House is lying. If they say they’re doing this, they probably are. It’s possible they have found three or four key people in big insurance companies, and that’s who they’re talking to. But I’ve got a pretty good net, and I don’t know of anybody.

No one knows why HHS couldn’t replicate a standard form of data transmission and no one’s aware of anyone in the industry huddling with the White House to fix this. Solid. The White House’s fallback options don’t work either. The 1-800 number Obama gave out the other day is next to useless, not only by Laszewski’s reckoning (how do you comparison shop among dozens of plans over the phone?) but by that of others who’ve tried it out. Private insurance companies could, in theory, fill the gap if they had a way of telling enrollees what their subsidies will be before they purchase a plan, but the subsidies calculator on … doesn’t work either. If HHS can get that up and running, at least, maybe users could be redirected to private sites like But then that simply raises the question of why HHS didn’t focus on fixing that part of the site in the home stretch before launch day. Laszewski doesn’t know. As a gloss on all this, go look at the infographic HHS posted today on its website to show the alleged progress they’ve made on a site that’s now in “de facto shutdown.” Infographics should, in theory, be light on text and easy to scan, to allow the info to be absorbed as efficiently as possible. Emphasis on “in theory.”

And yet, and yet, Gallup confirms the trends in other recent polls by finding a slight uptick in support for ObamaCare, from 41/49 in August to 45/50. No surprise as to why if you read my post last night:


Republicans are almost static, indies have inched up a bit but remain firmly underwater in their views of the law — and Democrats have bounced up double-digits in favor. No amount of “glitches” is going to sour them on this project now, especially not after those dastardly tea partiers forced a shutdown to defund the law. They’re in circle-the-wagons mode and ObamaCare’s numbers are benefiting from it — for now. We’ll see what happens next month when this thing still isn’t fixed and Democratic recriminations on the Hill begin in earnest. Exit quotation: “A Washington Post–ABC News poll conducted Oct 17 to 20 and released Oct. 21 found that 56% of those surveyed believed the ‘website glitches’ are ‘part of a broader problem with the health care law.'”