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ObamaCare Clusterfuck: Federal exchanges must move from pre-alpha to release in four months

Corrente readers already know this, of course; our hair has been on fire about exchange implementation for months; favorite quote: "Let's just make sure it's not a third-world experience." So, this story has now bubbled up to the mainstream. AP:

[T]he administration had spent nearly $400 million as of March to set up the infrastructure of a sprawling system involving major federal agencies, every state, hundreds of insurance companies, and millions of citizens, among them many individuals seeking coverage for the first time.

"Whether (the administration's) contingency planning will assure the timely and smooth implementation of the exchanges by Oct. 2013 cannot yet be determined," the report concluded. A copy was provided to The Associated Press.

The administration is taking the lead in setting up the markets in 34 states, the report said — a heavy lift [note Beltway-ese] unforeseen when the law was passed [so, in the four years from 2009 to 2013 nobody figured this out?]. The computerized clearinghouse for the entire system — a federal "data hub" designed to deliver real-time eligibility rulings — has only undergone initial testing. And states have yet to complete many of their assignments.

"Much progress has been made in establishing the regulatory framework and guidance required for this undertaking, and (the administration) is currently taking steps to implement key activities of the (exchanges)," the report said. "Nevertheless, much remains to be accomplished within a relatively short period of time."

Translation: Most of the specs have been written, but the all wiring hasn't been laid, and what will happen when they flip the switch nobody really knows. And remember, Oct. 1 is less than four months away.

This is why Sibelius's statement back in April that “The hub is basically built and paid for" was so deceptive; the real issue was not building the hub; the issue was and is systems integration between the Feds, the states, the insurance companies, DHS, the IRS, and (Corrente and NC readers know but nobody else seems to have noticed) credit consumer reporting agencies. Here are the contractors:

As of March, the administration had spent almost $394 million, mostly through payments to 55 different contractors. That figure does not include the salaries of hundreds of government officials dedicated to the massive project. That project is forever linked to Obama's legacy.

The largest single ledger item: $84 million for the federal exchange computer infrastructure, being designed and built by CGI Federal, Inc., a Virginia-based government contractor.

The contractor building the data hub, Maryland-based Quality Software Services, Inc., received $55 million.

Third on the contracting totem pole was Booz Allen Hamilton, which received nearly $38 million to provide technical assistance for enrollment and eligibility.

Well, Booz Allen certainly has experience with that. MEMO TO BOOZ ALLEN DEVELOPERS: Corrente is ready to receive any PowerPoints you may have on your thumb drives. The Contact form is above.)

The Wall Street Journal points out the State exchanges are behind too:

It said that the 17 states running their own exchanges were late on an average of 44% of key activities that were originally scheduled to be completed by the end of March. "While interim deadlines missed thus far may not impact the establishment of exchanges, any additional missed deadlines closer to the start of enrollment could do so," the [GAO] report said.

And Reuters points out that right now, we're pre-alpha:

The report by the nonpartisan Government Accountability Office (GAO) said key parts of the framework of the exchanges, including those that addressed consumers' eligibility for federal subsidies, management and monitoring of insurance plans and consumer assistance, had not been completed.

The report found that states had not completed many of the tasks assigned for implementation, while U.S. officials have conducted only initial testing of the computerized system that will link the exchanges, states and the federal government.

Can a huge systems integration project with 55 vendors and 50 million potential users move from pre-alpha to release status in four months? Na ga happen. I doubt very much they'll slip the October 1 deadline, because that would be a public relations disaster, so I would bet they'll try to triage functionality, the way the CO exchange did. Then again, the logic of the eligibility engine -- the key functionality -- could be such a hairball that they can't triage anything. Pass the popcorn.

Finally, implementation delays ripple out to documentation and training delays, says Bloomberg:

The Centers for Medicare and Medicaid Services is still developing and testing computer systems meant to determine consumers’ eligibility for government subsidies, the U.S. Government Accountability Office said today. Plans to train “navigators” to assist people in finding new insurance plans have been delayed by about two months past a June deadline, the GAO found. The exchanges are set to open Oct. 1.

“Factors such as the still-evolving scope of CMS’s required activities in each state and the many activities yet to be performed -- some close to the start of enrollment -- suggest a potential for challenges going forward,” the GAO said in its report. “Much progress has been made, but much remains to be accomplished within a relatively short amount of time.”

In Beltway-ese, "challenges going forward" is "hair on fire"-type language; the Pentagon uses it when talking about Afghanistan, for example. Oh, and Obama's keeping everything about the Federal exchanges a secret:

I continue to be puzzled by the way the Obama administration is developing the federally run exchanges in the 35 states in which they will have to run them.

We don't know any details on just where they are and if they are on track. They continue to tell us they will be ready on October 1 to begin enrollment and on January 1 to exchange billing and eligibility information with the health plans––by far the toughest challenge.

But why all of the secrecy? Why aren't we getting the same reports from the Obama administration we are getting from Maryland? Why isn't the GAO doing a report on just where the administration is in the 35 states' exchanges they will now manage?...

Why is the implementation of "ObamaCare" by the Obama administration a top-secret enterprise?

Let me guess: ObamaCare is a clusterfuck that Obama needs to keep under wraps as long as possible, partly out of hope that things will magically change for the better, partly to manage the public relations fallout, and partly because a ton of money is going to contractors and slush fund hacks, and who wants that to stop?

So, super. We're going to launch a buggy* system that nobody understands, with multiple and potentially conflicting sources of support with staff that aren't trained to offer real help, to people who are filling out forms online under penalty of perjury, with their health and their family's health at stake. What could go wrong?

The ObamaCare clusterfuck is not, in the end, a technical story; it's a story about bad policy choices demanding a system architecture that can't be delivered on time with the resources available; but eligibility determination wouldn't even be an issue if Obama and the Democrats had not made the policy choice to preserve the private health insurance industry at all costs.

And just think: All of this could have been avoided with a simple change in statutory language: Reducing the age of Medicare eligibility to zero. And if that's too extreme, reduce it every year by five years until everyone's covered, like Kennedy wanted.

NOTE * Testing can show the presence of bugs, but never their absence. Nothing I'm hearing in the news coverage indicates that the system has been tested with real users and real data at anywhere near scale. And how could it be? According to AP, they're still writing specs four months from launch!

NOTE Of course, all that means is that Enroll America will be faced with public relations grassroots campaign "challenges"; see here for one set of talking points from the vile Herndon Alliance.) But never mind that.

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katiebird's picture
Submitted by katiebird on

I really don't understand the outsourcing at all - it should all be developed by Federal Employees in the same building. But, Whatever - they're outsourcing it. But, why to so many separate contractors.

My experience in developing complicated systems is that when they involve people who work in different buildings they don't get finished. The demand just disappears.

Developer1 in Company X can't require that Developer2 in Company Y get code to him. And he can't require that the code look or run in any particular way.

I get it that SOMETHING will have to appear by Oct 1. But, what? My 30 years of programming experience isn't giving me a clue.

goldberry's picture
Submitted by goldberry on

Let me guess, Accenture is running this show. That means it will be behind schedule by a couple of years, poorly implemented and way over budget.
We in the pharma industry have seen how Accenture does business. It's a real piece of work.