When the Obama administration said it would delay the health reform law’s requirement that employers insure their workers or face a fine, its critics began to wonder what else might get delayed. The law’s big new piece of infrastructure—the online insurance marketplaces scheduled to go live Oct. 1—involves coordinating a massive trove of information technology and a ton of personnel training. So the doubters, reveling in the recent bad news, have begun casting doubt on the whole enterprise.
Not so fast. The employer mandate was one of many ancillary provisions—not critical to Obamacare’s central mission—that the administration has jettisoned in its race to build the exchanges in time. But signing people up for new insurance plans and giving them tax credits to do so is the main idea. It will take a major calamity for the administration to delay this crucial piece of the law. The exchanges may not work smoothly in the early months, but the administration will hit the deadline, says Dan Schuyler, a director at Leavitt Partners, a consultancy helping states build their exchanges. “Worst-case scenario: October 1, all exchanges open up.”
Administration officials are repeating earlier promises of an on-time launch. “The marketplaces will be ready,” Health and Human Services spokeswoman Joanne Peters said Thursday in a typical statement. “We are on schedule with the testing that began in October 2012. Any discussion to the contrary is pure speculation.” And while administration officials didn’t hint at problems with the employer system until the surprise delay, the marketplaces are different. The core goal of the Affordable Care Act is to bring health insurance to those who don’t have it, and the law’s long-term success will be judged on how many new people get covered. That’s a reality with both practical and political consequences, and the people setting it up know that. “There will be a Web portal, and there will be call centers, and they will enroll people in products and put them on tax credits,” says Cindy Gillespie, senior managing director at McKenna Long & Aldridge. “That’s going to happen. How smoothly the eligibility process works? Who knows. But it will be made to work.”
Building the exchanges has proven a heavy lift. To make them work, the federal government needs not only a consumer-facing website and call centers stocked with customer-service representatives in 34 states but also a brand-new, complex IT structure to make the system work across the country. The law says that when an applicant enters her information online, various federal agencies must validate her income, citizenship status, residency, and eligibility for Medicaid. The portal must also connect to the Veterans Administration, the Defense Department, the Office of Personnel Management, and the Peace Corps. Plus, it needs to communicate with every health plan selling insurance in each state.
It’s still unclear just how ready these digital systems will be on Day One and how much is already being done to mitigate the inevitable glitches. The administration has remained tight-lipped about the operational details. That has frustrated states and insurers, both of which need to connect to the new under-construction system. “From where I sit, it’s hard to monitor their progress on the data hub, because it is a black box until it either works or doesn’t work,” says Dan Mendelson, CEO of Avalere Health and a former official at the Office of Management and Budget.
Indeed, a Government Accountability Office report last month said that while HHS had been hitting internal IT milestones, the volume of work to be completed was too large for GAO to assess the likelihood that systems would work in time. “Whether ... contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” according to the report. States and health plans have begun testing some data exchange with the federal hub. But states have been testing “clean” data, meaning that every name is spelled perfectly and every Social Security number is entered correctly. Ultimately, the data hub will need to identify people and their information even with typos and errors.
Still, while the public deadline is Oct. 1, HHS and its contractors will realistically have a little extra time to fix IT problems. The insurance plans won’t go live until January, leaving a cushion if parts of the system have to default to paper, or if delays arise in processing applications. Cheryl Smith, a senior practitioner at Deloitte, worked on the Utah small-business health exchange, which launched in 2009. Before the open-enrollment deadline, “I had holes in my stomach,” she says. “We got to that day and I realized, this is not really the launch.” As long as the website goes live in October and people have new insurance plans in January, the administration will have kept its key promises.
In the meantime, administration officials and their allies are working to get the word out about the new systems. HHS Secretary Kathleen Sebelius told reporters this week she would be in a new city nearly every week this summer explaining the exchanges. Television ads are running, and smaller, targeted outreach efforts have launched. That’s a big job, too, because most people without insurance don’t know what Obamacare offers them. The better these outreach efforts work, the greater the imperative to launch on time.