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ObamaCare Clusterfuck: Will the All the State Exchanges Launch on Time? A Secretive Project Out of Control

“Let’s just make sure it’s not a third-world experience.” --Henry Chao, HHS, of the ObamaCare Federal Exchange

UPDATE "Credit Reporting Agency Hired to Verify Incomes for Insurance Subsidies" -- and lambert scooped the world. The Times, 2013-07-17:

The Obama administration has hired a credit reporting agency to help verify the incomes of people who apply for federal subsidies to buy insurance under the new health care law.

The company, Equifax Workforce Solutions, a unit of Equifax Inc., will provide information that is more current than what is available on federal income tax returns.

So the other shoe drops: Income verification by the IRS got triaged on July 5; and Obama just privatized the function; yet another market state solution. You read it here first on 2013-05-12; the context is the change from the 21-page ObamaCare application form to the 3-page form, with new wording added to the 3-page form:

It looks like young Ezra (and, to be fair, everybody else) missed a major policy change in Obama’s shift to the new, shorter (for individuals*), final version of the basic application for ObamaCare.** [The form now reads:]

We’ll check your answers using information in our electronic databases and databases from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security, and/or a consumer reporting agency. If the information doesn’t match, we may ask you to send us proof.

[H]ere’s the bottom line: You fill out the ObamaCare form under penalty of perjury. And “if the information doesn't match” “we may ask you to send us proof.” So, if you play “the match game” [with dirty data from Equifax] and lose, you could be facing a perjury charge driven by credit reporting data (or payday lending data, or utility data, or….). Data that you may not know about, that may well be false, that might even be about somebody else, and for which the burden is on you, personally, to correct, which is extremely difficult and costly to do.

Check out the post for lots of detail, and screen shots of the changed form.

I know gloating is so unattractive, but it's nice to see that an English major's old-fashioned close reading of the ObamaCare application form, plus an realistic dose of cynicism and paranoia assessment of the administration's capabilities, can yield a good outcome, and well before the very well-paid access journalists, too.

* * *

Will the state Exchanges launch on time? Even if the Exchanges (now also called "marketplaces") will only cover 7 million of the 56 million uninsured in 2014, this answer to this question is still important to some; and the political fortunes of the Democratic nomenklatura are not necessarily their first concern.

Katiebird writes:

[T]his implementation issue is not a trivial thing. Many, many, many people are counting on it. They expect to have access to health insurance and for that health insurance to give them access to actual health care. I repeat: This is not trivial. It is not a game.

The answer given by administration officials is "Yes!" Just this week:

“The marketplaces [note plural; she includes all the states] 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.”

In fact, there's not even a Plan B. HHS Secretary Kathleen Sebelius, back on April 12:

“No,” Sebelius said when asked whether there’s a backup plan in case that deadline slips. “We are determined and on track to meet the Oct. 1 deadline."

But then they can't say anything else, can they? Given that Obama nailed his colors to the mast of the October 1 launch date in his April 30 presser: "We will implement it." So, no matter what, we can expect -- the ObamaCare rollout being, after all, an off-year employment opportunity for campaign operatives -- a ribbon cutting ceremony, a public relations campaign, happy "consumers," parades, ponies, rainbows, and so forth. Maybe even cute videos and some apps! Something's going to go up at healthcare.gov, no matter what and come what may. But what? How, at this point, do we verify any of the claims the administration is making? I mean, some of us need to know whether we're going to be mandated to spend thousands of dollars or not! Even if employers did catch a break and won't have to.

If ObamaCare were a multibillion fighter plane I'd expect fly-bys, glamour shots of pilots and cockpits, YouTubes of aeronautical maneuvers, and plenty of breathless stenography in the fan press. Even if the aircraft was years late, over budget, and not up to spec! But from ObamaCare, none of that. It's a remarkably secretive program:

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.

Bob Laszewski:

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. …. [W]hy all of the secrecy? … Last week Washington was abuzz with detailed reports in the Washington Post about how personal phone and computer records are being monitored by the federal government. It's notable that more is now known about that national security enterprise than exactly where HHS is on "ObamaCare" implementation! Why is the implementation of "ObamaCare" by the Obama administration a top-secret enterprise?

The Exchanges are software, so let's talk about testing.[1] Testing is, one hears, in process as of July 12:

States and health plans [can they not be named?] 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.[2] Ultimately [that is, in 81 days], the data hub will need to identify people and their information even with typos and errors.

The only state we've been able to get detail on testing for is Maryland. ("Covered California" +testing" yields no hits.) And for good reason. As of June 13:

[Rebecca Pearce, executive director of the Maryland Insurance Exchange, told the audience at a recent Gorman Health Group forum outside Washington, D.C.:] "We are the only state to have actually connected to the Federal Data Services Hub live during the FDDR [Final Detailed Design Review]. I can tell you[3] that all of the 18 state-based Exchanges must be in some sort of test phase with CMS on the Federal data hub. And that is definitely happening.” The demo included verification of Social Security numbers, citizenship and eligibility for advance premium tax credits.

The Maryland test apparently took place May 30:

Last week, I received my weekly email update from the Maryland health insurance Exchange:
Maryland Health Connection completed its Final Detailed Design Review (FDDR) live system demo on Thursday, May 30. The FDDR is a federal stage-gate required of all state-based Exchanges. Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier. This major information technology milestone received high marks by federal partners. We will continue with development of Maryland Health Connection over the next several weeks and begin user acceptance testing in July.

So what the heck is a Final Detailed Design Review? The Google yields one hit besides dupes of the above quote: The RFP for the Nebraska Exchange:

1. CMS ENTERPRISE LIFE CYCLE ARTIFACTS

The project will comply with CMS’ Enterprise Life Cycle requirements by ensuring that the deliverables and artifacts associated with CMS reviews are prepared and available to the Exchange at least three (3) weeks prior to each of these reviews. For reviews that have already occurred (such as the Planning Review and Design Review), the Exchange will require the contractor to review the artifacts and make appropriate updates to reflect the contractor’s solution and methodologies.

a. Project Reviews

b. Architecture Review (AR)

c. Project Baseline Review (PBR)

d. Preliminary Design Review (PDR)

e. Detailed Design Review (DDR)

f. Final Detailed Design Review (FDDR)

g. Pre-Operational Readiness Review (PORR)

h. Operational Readiness Review (ORR)

In a perfect world, I'd use the names of those "life cycle artifacts" as search terms to find [PDF, no doubt, ick] status reports for all the other states with their own Exchanges, but it's very late. (Enterprising readers?) Here, however, is the [PDF of a PowerPoint deck, double ick] status report from the Massachusetts Health Connector ("HIX"). Remember RomneyCare? Of course you do. From the Board of Directors Meeting, May 9, 2013:

• The HIX-IES project recently completed the Federal Detailed Design Review (FDDR) which comprises a comprehensive IT systems and infrastructure review, including the following areas:

–System architecture

–Detailed system design specifications

–Business rules and use cases

–Data, interface and integration design

–Privacy and security

–Project schedule

• Key upcoming Federal milestones

–Pre-operational Readiness Review (Optional) –TBD, likely August

–Operational Readiness Review (Required) –TBD, likely September

OK, so there we have a timeline. But now get this slide:

At this stage, the team continues to aim for a successful launch of the Exchange on October 1st, with ACA-required core functions available to our customers

Further development, testing and stabilization of the system will continue throughout 2014

• However, we are mindful that there is zero “wiggle room” in our timeline. While the project team is working at maximum capacity, we continue to anticipate risks and uncertainties, both internal and external, that will expose us to additional pressure

Let's look at that slide more closely. Does anybody remember the great designer Edward Tufte's brilliant demolition of the slides NASA's engineers used in the Columbia Disaster? Here's Tufte's key insight in PowerPoint Does Rocket Science:

As the bullet points march on, the seemingly reassuring headline fades away. Lower-level bullets at the end of the slide undermine the executive summary. ... The format reflects a common conceptual error in analytic design: Information architectures mimic the hierarchical structure of large bureaucracies pitching the information. Conway's law again [q.v.].

We see the exact same pattern here: For the Directors (and for CMS (HHS (Sebelius (Obama)))) the key point is "successful launch." For the project manager, "Further development." For the cube dweller down at the bottom of the food chain, "zero 'wiggle room'." (At this point we are reminded of the programmers of the Connecticut Exchange working nights and weekends after Obama changed the application form.)

And yet the Massachusetts Health Connector has had a working, fully implemented Exchange since 2006, for seven years. Even they are finding "risks and uncertainties" in moving through Pre-operational Readiness Review to Operational Readiness Review to launch in 145 days (May 9 to October 1, 2013). So, surely states that have never launched an Exchange at all must feel even greater levels of concern?

And now let's return to Maryland. Remember what the Exchanges are supposed to do:

Building the Exchanges has proven a heavy lift.[4] 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.

And let's repeat what the Maryland Exchange is said to have done, when successfully completing its Final Detailed Design Review:

Maryland Health Connection successfully demonstrated end-to-end enrollment of a split family scenario including user log in, eligibility determination, real-time data verification through the Federal Data Services Hub, enrollment into plans, payment and file generation to be sent to an insurance carrier.

Alrighty then. Maryland is the only state to have connected to the Federal Data Services Hub and that is reported to have successfully performed "eligibility determination," which includes income validation, in real time, just as advertised.[5]

But if Maryland's income validation FDDR on May 30 was indeed successful, then why did Obama triage income validation on July 6?[6]

  • Was the Maryland FDDR really not successful?
  • Did the Maryland FDDR merely test the Federal Hub API with fake data? And now it turns out the Hub can't deliver real data?
  • Are Maryland (and Massachusetts? and Washington?) still the "only" states to have reached the FDDR stage in the CMS Enterprise Life Cycle?
  • And what about California?[7] Surely, if the huge, Democratic, Hispanic "battleground" state's Exchange had passed its FDDR, victory would be in Obama's grasp?
  • Or (as some on the right think, reinforced by Howard Dean) is this all a cunning [Kenyan Socialist] plot to encourage people to join the Exchanges by making fraudulent attestations about their now unverified income?

I don't know. But I do know this: When the project lead (project manager (department head (CEO))) start triaging requirements, that's a sign of a project that's out of control:

“I think that the administration right now is in a triage mode. Seriously, they do not have the resources to implement all of the provisions on time,” Washington and Lee University law professor Timothy Jost, a supporter of the ACA, testified Wednesday at a House Ways and Means Committee hearing on the delay in employer penalties.

And, as I keep saying, LBJ implemented Medicare for all over-65s in a year, back in the day when crewcut guys in white shirts wearing skinny ties shoveled punch cards into the ravening maws of giant steam-powered mainframes. Of course, Medicare has a very simple single payer systems architecture: Over 65, bang, done, let's go deliver some health care. LBJ didn't need to engineer a cluster**** of rentier-driven complexity to keep the sucking mandibles of the health insurance companies firmly planted in our unprotesting flesh. ObamaCare's "wicked" implementation problems are one and all a consequence of a "market state"-style policy choice by the political class[8] that ignored proven health care successes in favor of rental extraction.

* * *

At this point, Serco, Obama's July 4 pick to administer to the ObamaCare rollout starts to look a lot like the backup plan Sebelius said didn't exist:

White House officials say that in many cases federal and state computers will be able to verify a consumer’s income and citizenship status and determine eligibility in a matter of minutes [huh? That's not "real time"!]. But contract documents indicate that federal officials still expect that one-third of the 19 million [not 7 million?] applications in the first year will be filed on paper.

Because if the Exchanges go belly up, good old-fashioned paper has passed the test of time. I'd say "Pass the popcorn!" if so many people wouldn't suffer.

NOTES

[1] Time for this hoary old chestnut: "Program testing can be used to show the presence of bugs, but never to show their absence!"

[2] We know the problems with dirty big data from looking at the issue of false positives in NSA's surveillance programs.

[3] "I can tell you?" What kind of language is that? It's like Obama's "insider threat" program got applied at HHS, besides DOD.

[4] I hate the Beltway insider phrase "heavy lift" with the hatred of a million burning suns. Try working in an Amazon warehouse. That's a heavy lift.

[5] Washington is also reported to have done testing. From July 14:

Michael Marchand, spokesman for Washington's Health Benefit Exchange, said the state's online marketplace had conducted frequent tests with the federal data hub, which had worked well so far.

But "worked well so far" doesn't tell us where Washington state is in terms of Lifecycle Artifacts, which is the key question for determining whether they are on time.

[6] Hat tip Katiebird for this insight. And I don't care that "progressives" and Obots say that income validation really wasn't all that important. If it wasn't important, it would never have been a requirement!

[7] I'm seeing an FDDR completion date of 3/1 in what looks like a Covered California Grant Proposal. That's all I can find. Readers?

[8] Let's face it: The Republicans would have no problem with RomneyCare if Romney were President. And ObamaCare is RomneyCare. Howard Dean: "Barack Obama's health care bill is nothing new. Mitt Romney signed one just like it four years before."

NOTE Originally published at Naked Capitalism.

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Comments

Submitted by chadwick newsome on

I am taking bets on which provisions of O care roll out first, which are delayed, & which blow away like dust in the wind.. I am betting that, right out of the gate, harsh, punitive provisions will be enforced and hapless low income people will be made examples of. But insurance companies will continue to exclude people with pre-existing conditions. They will also ignore the 20% rule that would require them spend the balance of their revenues paying claims. They won't do it and they won't be held to account for not doing it..

O care is every bit as scary and regressive as Lambert says it is, and probably more so.

jo6pac's picture
Submitted by jo6pac on

save this because I do believe you are right because that's how 0s wh works. If people think that this important to him for his so called legacy I do believe you are dreaming that he'll do the right thing. He only going to do what his puppet masters want so he & wife can live the good life with his new friends and there isn't any among us on Main Street.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... will be all the rage among employers who want to comply with PPACA, which is totally a-ok per PPACA. ("Skinny Plans" being insurance in name only, and the sort of fraudulent consumer product that was supposed to be eliminated by PPACA. Ha ha ha ha.)

Rainbow Girl's picture
Submitted by Rainbow Girl on

"David Simas is still thinking about turnout." (photograph too; guy is well groomed)

Fascinating this focus on PR and enrollment and just zero on the actual product (which, given the product, is of course unsurprising). Enroll-At-Any-Cost, damn the crap we're selling them, is David Simas's FULL TIME JOB, fer Chrissakes! Gaawwwd.

Rainbow Girl's picture
Submitted by Rainbow Girl on

And I should have added a quote from your posts to this effect to the post. It's just so hard to believe that a President of the US would really, really, for real, for really real, make an election campaign out of health care for citizens.

It is hard to swallow. Or get one's (even infinitely cynical) mind around.

Alexa's picture
Submitted by Alexa on

It worries me. They are masters at microtargeting, and at "spin."

The "left" needs to do much more to expose the truth about the PPACA. What--I'm not certain.

For instance, the "Moms Rising" group that is such a joke, appears to be supported by the unions, Democratic women's groups, and the LGBT community--which makes it at least marginally formidable.

Screenshot_071713_030630_PM

And then there is the "fawning MSM." It at the deception--a headline that "screams" that
ObamaCare lowers NY premiums by half, when the truth is "ObamaCare will cut the cost of healthcare premiums in half for many New Yorkers who buy insurance on their own, according to The New York Times," according to the first line of the actual piece.

strong>ObamaCare lowers NY premiums by half
By Sam Baker - 07/17/13 08:57 AM ET

ObamaCare will cut the cost of healthcare premiums in half for many New Yorkers who buy insurance on their own, according to The New York Times.

The Times reported that the average premium in the state's insurance exchange will be be at least 50 percent lower than currently available policies.

New York is the latest of several states to report lower-than-expected rates for policies sold through their exchanges.

The exchanges are open to people who do not get insurance through their employer, but rather purchase it on their own. Most people who use the exchanges will receive a tax subsidy to help cover the cost of their premiums.

Before those subsidies are applied, the average plan for an individual living in New York City will cost $308 per month — down from $1,000 per month now, the Times reported.

The state expects about 65,000 people to purchase coverage through its exchange in the first few years.

Officials told the Times they have approved 17 insurers to sell policies in the state exchange, eight of which are entering the state's market for the first time.

I've never seen anything like this.

It makes me think that they just might pull off--at least through the 2014 midterms.

Which means that the majority of Democratic Party voters will go to the polls under the impression that ObamaCare is indeed a huge success. (By time 2016 rolls around, I doubt that there will be any such illusions.)

Got to give them credit--they seem to have mastered manipulating the mainstream media.

Oh, and DKos has wasted no time in carrying the ball on the "NY Premiums" story.

Wed Jul 17, 2013 at 08:10 AM PDT

Obamacare will bring dramatic savings to New Yorkers

byJoan McCarter

BTW, both Marcos and Joan are regular guests on Mark Thompson's radio program, on XM Radio.

So diaries like this do get quite a bit of exposure.

Rainbow Girl's picture
Submitted by Rainbow Girl on

That something as patently fake and astroturf as "Moms Rising" (ugh, it turns my stomach just to write it) gets picked up and amplified across media in about 5 minutes.

We need a well-oiled machine like that too!

Rainbow Girl's picture
Submitted by Rainbow Girl on

It certainly doesn't show up on any of the annual free credit reports I've been getting from the Cartel of Three.

On the other hand, they may not in fact have such data. See the line (further down, tucked away) about how the Lucky Vendor (Equifax) will be able to use "credit card" usage as some sort of proxy for earnings. (Yes, and leaving the aside exactly how that is supposed to work?!##$%).

jo6pac's picture
Submitted by jo6pac on

thanks and guess because we'll never really know until we apply for aca what it means. I would think this might have an effect on the 35 and under group the most with all the debt they have from going to college then only able to get $10.00 job so they might not be able to qualify for the aca plan from hell. Then even those that use the card to much or have a running balance, wow this is fun someone in a call center will once again make the guess if you are a good citizen and can make the payments.

I think if all those 3 letter agency that are collecting info on citizens tie this into people such as myself who's not a fan of the present govt. would be banned also, kind of like the no fly list.