Filed Under:Health Insurance, Individual Health

Shock and flaw

To your good health

So much for her marketplace... (HHS image)
So much for her marketplace... (HHS image)

Hanlon’s Razor dictates, “Never attribute to malice that which is adequately explained by stupidity.” 

The first 30 days of the PPACA marketplace implementation have left Americans divided as to the appropriate Hanlon choice. Regardless of your viewpoint, one thing on which nearly everyone has agreed is that, thus far, the user experience has been pretty dreadful.

“That means,” he continued, “that before I even get any benefit (other than having a card in my pocket) my household outlay will be, after taxes, approximately $33,000 a year ($21,167.78 plus $11,000). After that, I get to contribute another 30 percent to any services rendered under my new plan. This will be the single largest monthly outlay in my household. It will be more than my house payment, more than all my utilities combined, more than my food bills and more than what it costs me to send my son to a state-run university!”

My friend’s total plan cost is in the middle of the pack of increases some are finding. Remember that these are just premium and out-of-pocket costs. For even more disappointment, we need only wait until people start to utilize these plans and realize that their networks and providers are so thin that they are unable to access the facility or provider they want, and that waiting times for non-emergent appointments have skyrocketed.

I have a somewhat unique perspective on this Rube Goldberg type of software. As part of the executive team some years ago, our company administered an indigent care plan for a large county. One of the tasks the system had to accomplish was to retroactively check to determine that participants were not eligible for Medicaid. It took months upon months and specially crafted software to reliably accomplish that goal; a goal which, when viewed against the monstrous complexity of the marketplaces, seems minuscule. Once the architecture was in place, additional months of checking and cross-checking took place. Only then did we go live.

By comparison, and by any objective measure, the marketplaces were cobbled together at warp speed. The system deals with nearly 50 statutory provisions. L. Gordon Crovitz, columnist for the Wall Street Journal, captured just the tip of the iceberg in his Oct. 13 column. “Signing up uses a Byzantine process to check if a family is entitled to a subsidy, requiring data from dozens of federal and state agencies using databases built on different technology platforms.” These include Medicaid, the IRS, the VA, the OPM and various state Medicaid and CHIP programs. Once the calculations and verifications are done, the information has to be transferred to an insurance company. The insurers are already getting incomplete, incorrect and erroneous information, and they are beginning to question the long-term viability of the current system.

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Nichole Morford

Nichole Morford
Managing Editor

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