Obamacare on track despite IT hiccups

Federally run exchanges set to begin offering insurance under the 2010 health care overhaul are miscalculating the prices shoppers will be required to pay for premiums, according to a recent report in the Wall Street Journal. The problem, attributed to software errors in a calculator program, affects would-be insurance buyers in the 36 states using the federal exchange.

"Our tech and operations people are very concerned about the problems they're seeing and the potential of them to stick around," an insurance company executive told the newspaper.

The pricing inaccuracies come amid other IT problems surrounding the Oct. 1 launch of open enrollment, including delays in obtaining security authorizations for the data hub, which collects eligibility information about insurance applicants from a variety of government sources. However, IT hangups aren't expected to delay the Oct. 1 rollout of the exchanges. "We continue working with [insurers] and we are confident that on Oct. 1, consumers will see accurate premium costs, including tax credits," said Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services.

Even if the exchanges don't offer instant pricing and eligibility information on Oct, 1, they will be able to collect enrollment information. People who use the exchanges early in the process could find some delays in getting signed up. However, those customers are likely to be among the biggest fans of the new insurance offering, according to Dan Diamond of the Advisory Board. "They likely won't be deterred by a few software glitches," he wrote in a Sept. 19 blog post. Coverage under the law doesn't take effect until Jan 1, 2014, and open enrollment extends to March 31, 2014, giving developers more time to work out the problems.

"I think there's going to be hiccups no matter what. It really depends on how fast they recover," insurance and health IT expert Stephen Parente told FCW. Parente, who advised Sen. John McCain (R-Ariz.) on health care issues during the 2008 campaign, said that if technology problems continue into 2014, there could be more long-term consequences. For example, if the exchange mistakenly offers a health insurance customer a high level of premium support for which he or she does not qualify, it could be up to the IRS to claw back the difference.

The latest effort to delay the law legislatively appears destined to fail as well. Republican opponents of the health care law are hoping to stop implementation by pulling financial support. A stopgap spending bill passed Sept. 20 would strip funding for Obamacare as a condition of keeping the government open through Dec. 15, while Congress negotiates spending bills or a full-year continuing resolution. However, the provision defunding the health care law has been declared "dead on arrival," by Senate Majority Leader Harry Reid (D-Nev.) and President Barack Obama has said he would not sign it into law, setting the stage for a potential government shutdown.

However, a shutdown won't derail implementation of the health care law, according to a Congressional Research Service report from July that was recently made public by Sen. Tom Coburn (R-Okla.). The government will be able to tap funds outside of annual appropriations for the law's implementation, including paying for the IT components such as the online exchanges and the data hub which connects information from a variety of government databases to determine the eligibility of potential enrollees.

The data hub requires connections between key government databases, at agencies including the IRS, the Defense Department, the Department of Homeland Security, the Social Security Administration and elsewhere. But it's unlikely that a shutdown affecting other agencies would prevent the operation of the hub. "None of these agencies will in their entirety shut down, and their computer infrastructure is a pretty essential thing," former Congressional Budget Office Director Doug Holtz-Eakin told Bloomberg.

The Department of Health and Human Services is spending an estimated $1.5 billion on implementing the health care law in fiscal 2013, with most of that going toward the construction of the exchanges and the data hub. The Obama administration sought $1.4 billion for implementation and program management for fiscal 2014.

"In the event that congressional appropriators do not provide [requested] funds, or in the event of a temporary lapse in discretionary appropriations, it seems likely that the Administration will continue to rely on alternative sources of funding to support [Affordable Care Act] implementation activities," according to the Congressional Research Service. Alternative sources include unobligated funds from the Health Insurance Reform Implementation Fund, the $450 million non-recurring expenses fund at HHS, the secretary's authority to move money between HHS accounts, and the $454 million permanent appropriation for the Prevention and Public Health Fund.

The report also found that federal and state exchanges would be able to continue operations in the event of a government shutdown. Planning for the exchanges and grants to states for fiscal 2014 are covered by mandatory appropriations, and beginning in fiscal 2015, fees from insurance companies are required to make the exchange operations self-sustaining.