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Monday, October 21, 2013

State Contractor: Federal Delays Hampered Rollout Of Health Exchanges

The Department of Health and Human Services says it’s bringing on a “tech surge” of people from inside and outside the federal government to help correct numerous glitches on HealthCare.gov, the new federal healthcare website.

The ongoing technical nightmare is clouding one of President Obama’s greatest domestic policy efforts since taking office.

Smaller contractors are saying that one of the causes for the issue is a delay in issuing technical requirements, forcing many to scramble.

Joe Marabito, the president of a company that has been helping private insurers connect with health care exchanges across the country, joins Here & Now’s Robin Young to explain.

Guest

  • Joe Marabito, president and CEO of ikaSystems, which has been helping private insurers connect with health care exchanges across the country.

Transcript

ROBIN YOUNG, HOST:

Well, today President Obama reminded people they weren't limited to online enrollment for healthcare.gov, the federal exchange. There's a phone number. But how are the states doing with their enrollment? Thirty-five state have exchanges run wholly or in part by the federal government, but 15 have their own. All of them vary. New Hampshire has one insurer, West Virginia 16. Seven plans are offered in Alabama, 106 in Arizona.

Let's check in with Joe Marabito, he's president and CEO of ikaSystems, they help insurance companies navigate technical issues. So he's working on the insurance company side. And Joe, what are CEOs telling you? What's their biggest concern?

JOE MARABITO: I think the biggest concern that insurers have, Robin, is that they are still trying to understand the requirements to connect with the state exchanges. First of all, we work with two health plans to connect to state exchanges in New York and in Minnesota. And both those states, like many others, have been scrambling to define how it is to connect to the exchanges. And so they're just concerned about getting up and running.

YOUNG: This is sort of a microcosm of what's happening nationally, you know, this idea of how do we connect into the system. From what you're seeing on your front line, why isn't this connection made?

MARABITO: Three challenges, I think, that all states are facing. One, the rules around how the program is to work were defined very late from a systems development perspective. Two, the rules are very complex. Thirdly, nobody really knows how much traffic, how much volume, these systems are going to have to take.

So as an example of the complexity, you know, the government wants more people to have coverage and wants to make it easier for them to have coverage, and so they've developed subsidies. There are two separate subsidies. There's a state subsidy, and there's a federal subsidy.

So from a system perspective, you actually have four different entities that have some fiscal responsibility: the member; a company that offers health coverage to its employees; the state, 'cause the state subsidizes some of the premium; as well as the federal government. So the systems now have to process a financial obligation for four different entities, and no system in the health care arena has ever had to do that before.

YOUNG: Well, we're reading analysts across the country, at least when it comes to the federal exchange as opposed to the state exchange, they say the login problems, although those are the most frustrating and the ones that you can really see, those are the easier to fix. The harder ones to fix are these deep system problems. They're talking on a federal level of perhaps having to rewrite 5 million lines of software code.

Staying with your expertise, the states, do you think that these software issues, these getting people interconnected questions can be fixed by the December 15th deadline?

MARABITO: I do think the interconnection problems can be fixed. However, I do think there's going to be potentially a second wave of issues. So if you think about it, the exchanges went live on October 1st, but the coverage isn't effective until January 1st. So as of January 1st, plans are going to have to start processing claims, they're going to have to start sending out invoices, and so the complexity in that part of the software won't actually be exposed until after the first of the year.

So I would see perhaps another wave of challenges coming forth then.

YOUNG: Why do you think, Joe, that some states are doing so well? The president has touted Kentucky. You have a Democratic governor there in a very red state who's very much behind the health care exchange in his state, and he's looking at 1,000 people signing up a day, a success according to observers.

Is a part of what's happening, just from your observation, that you really need to have a lot of people really behind this, as well, to make it work?

MARABITO: Exactly, Robin. You need commitment. It's a lot of work to set up an exchange. I mean, most plans have no experience setting up an exchange. They don't have very much experience hiring other contractors. And so the plans that did well, or are doing well now, are ones that started early.

And oddly enough, I believe the election had an impact on states' preparedness because I think a lot of states were waiting to see what happened in the election and were uncertain as to whether health exchanges would actually be a reality or would be pushed off. So I think as a result of that, many states got a late start.

YOUNG: But I'm presuming - well, you've been working on it. Would you say some of it's already working?

MARABITO: Some of it's working great. We actually started last year. We assigned someone to become an expert on health exchanges. We've anticipated the requirements and adapted as those requirements have shifted over time. So we're happy to report that our customers are ready to connect and, you know, waiting on the states.

YOUNG: Some of the things that we're hearing, the changes to the healthcare.gov - again this is the federal plan; they are going to let people know that you can apply both online and by phone. There's going to be simple language to find your coverage possibilities. And again, phone numbers, phone numbers, phone numbers.

We'd heard early on you can call directly to insurance companies. Is that kind of information getting lost because we're so fascinated by or aware of the fact that this is online?

MARABITO: I think it's getting lost for that reason but also because it depends on your state, right? So if your state has decided not to connect to the federal exchange, if it's decided, in other words, to build its own exchange, it may have its own rules. It may not let you call your local health plan and say I would like to sign up for the exchanges.

In fact, most of the exchanges want all of the membership to come through them.

YOUNG: Well, given that, one last question. On the federal level it's the Centers for Medicare and Medicaid Services, the federal agency that's in charge of the federal exchange. There's 55 contractors working together. What do you think of the idea of picking one or more company, as others have said - the New York Times writes - a quarterback for the information technology part?

MARABITO: I mean, there should be somebody who's responsibility for coordinating the activities of that many contractors across, you know, such a broad range of skills. It's essential.

YOUNG: Joe Marabito, president and CEO of ikaSystems. That's the software company helping private insurance companies in states connect to state health care exchanges. Joe, thanks so much.

MARABITO: Thank you, Robin.

JEREMY HOBSON, HOST:

A quick check now on some other stories we're following. The World Health Organization is investigating a possible polio outbreak in Syria. If that's confirmed, it would be a major setback for global efforts to eradicate the disease.

Also, it's estimated that sales of electronic cigarettes will reach $1.7 billion this year. Back in 2009, the Food and Drug Administration warned that e-cigarettes could pose health risks, and this October the agency is expected to release a set of proposed regulations on e-cigarettes.

And last year, the Mormon Church lowered the minimum age for female missionaries from 21 to 19. A year after that change, a quarter of all missionaries are women, up from 15 percent. These and other stories coming up later today on ALL THINGS CONSIDERED. You're listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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  • Jon

    Part of this is probably also millennials who are always weary of jumping in right away. Apple has trained us to always wait for the update. When all the bugs have been solved. We never buy the 1.0 version

  • BethaE

    I do not feel any sympathy for the CEOs of insurance companies. The guest just interviewed was explaining how hard the law is for them to understand and how challenging it is for them that there are so many different requirements and systems to coordinate and implement. Are we supposed to believe that insurance companies suddenly are not able to understand, design, and administer complex policies and processing systems? That is their forte, and we should not tolerate– much less solicit– generalized complaints about how hard their job is when suddenly it might not be as profitable or politically convenient as they prefer.

  • Justaguy

    I came in late. Did you mention how much the contractor is receiving from
    the states for the work he is doing? I’m sure Halliburton thought the Iraq war was going well, too.

  • http://profiles.google.com/barry.kort Barry Kort

    The silver lining here is that this rollout underscores the importance of having a high-functioning system of governance at the interface between the governed and the government.

    More importantly, behind that user interface, the machinery of the government needs to be high-functioning at the infrastructure level.

    Perhaps at some point in the 21st Century, Congress will delegate to competent technocrats (rather than to non-technical bureaucrats) the responsibility to translate national objectives into high-functioning systems.

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Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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