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View Diary: Technical problems extend to state health insurance exchanges (68 comments)

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  •  The insurance carriers (0+ / 0-)

    ...have no incentive to make this work.  Well, let me clarify that.  Some insurance carriers have no incentive to make this work.

    And the complexity of what they have to do with the communications routines depends on how they interface their own internal systems that require copies of the enrollment data.

    First of all, in 2010 there was little expectation that the federal exchange would have to handle the majority of the transactions at roll-out.  The whole point of implementing it through state exchanges as sold was to facilitate the roll-out.  And the last state to dump their exchange and the relations with their insurers on the federal exchange was North Carolina in July 2013.

    Second of all, the insurers got federal permission during the Bush administration to "customize" the HIPAA 834 data transaction.  Reconciling that took long negotiations with AHIP, BCBS Association, and other stakeholders--some of which were and still are opposed to the ACA.  So take their complaining with a huge grain of salt.

    Things started going bad right from the start apparently.  The HIPAA 834 issue supposedly caught the contractor (an experience HHS contractor) by surprise.  Take that with a grain of salt too.

    And yes, federal project managers are more than capable of screwing up stuff.  But I think that some of the more important players in the screw-up are being let off the hook.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Thu Jan 09, 2014 at 03:07:00 PM PST

    [ Parent ]

    •  This is not the case (0+ / 0-)

      Your version of reality is that insurance companies have some kind of interest in turning down real money by making sure that they can't enroll new policyholders and take their money for premium payments.

      Unless you have smoking gun memos from management, of course, in which case criminal prosecutions or at least shareholder lawsuits would be in the offing.

      Ceterem censeo, gerrymandra delenda est

      by Mokurai on Thu Jan 09, 2014 at 07:38:33 PM PST

      [ Parent ]

    •  I believe our state had some trouble with the (0+ / 0-)

      HIPAA data transaction at least with some carriers, but that was just one of the problems.  I spent a few years in HRIT hell with large corporation open enrollment so I know the issues with small carriers and feeds and large carriers with inflexibility but I think the biggest problem was not understanding the scope of the project even in one state.  And when they designed this so every state could do it's own thing the feds were enormously complicating something that was already going to be a challenge.  

      But I don't blame tech.  I don't blame IT.  I worked too many projects with inadequate senior management to know how dazzled they get with the idea that some whiz kid from an IT contractor is going to wow them with a web site and they can just sit back and let it happen.  It's always the operations folks who wind up holding the bag and in this situation with a new program there wasn't even the operational expertise in place to catch the problems as they arose.

      And that's even best case because I'm seeing this from a true blue state where healthcare is valued even by Republicans so adding the obstruction and corruption to the mix from the red states and I guess maybe it really is a miracle that this is working at all.  

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