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Some explanations as to why the roll out for the Affordable Care Act online had so many glitches.

Courtesy of the Washington Post:

What do the Obamacare exchange websites do?

The exchanges are online marketplace where millions of Americans who don't receive health insurance from their employers will be able to purchase coverage. The system is designed to work like any other e-commerce site. Users can compare health insurance plans, choose the one that best meets their needs, and order it online.

How has it gone?

Not great. The system was overwhelmed with traffic on its first day. Since then, the site has become somewhat more responsive, but it is still plagued with problems.

Who is in charge of the system?

Responsibility for the system is shared between the federal government and some states. The Affordable Care Act gave states the option to run their own exchanges or to leave that job to the federal government. Only 14 states and the District of Columbia opted to operate their own exchange. The other 36 states opted to let the federal government do some or all of the work of setting up the exchange for their consumers. (In other words the Republican governors refused to cooperate so that all of the responsibility for the implementation of the ACA fell on the Federal government, and DHHS, which then allowed them to point out the problems during implementation and use that as an example of why the new law will not work. And don;t think for an instant they did not know this would be the outcome.)


That means the bulk of the Obamacare implementation has fallen to the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. As its name suggests, this agency has traditionally administered key aspects of the Medicare and Medicaid programs. The Affordable Care Act gave it a new role administering the exchanges that form the heart of Obamacare.

Even in states that have opted to run their own exchanges, CMS has played an important role. CMS has supervised states' implementation of their exchanges and provided them with access to federal data needed to run the system.

Private companies sell things online all the time. Why is the government having such a hard time setting up an online health insurance marketplace?

If the exchanges were just insurance marketplaces, getting them to work might have been a lot easier. Much of the complexity comes from the fact that the exchanges are used to administer the complex system of subsidies the Affordable Care Act provides to low-income consumers. Figuring out whether a customer is eligible for a subsidy, and if so how much, requires data from a lot of federal and state agencies. Here's a chart from Xerox that illustrates the complexity of the system:

The amount of subsidy depends on a consumer's income. To ensure each consumer receives the correct subsidy, the exchanges must request income data from the Internal Revenue Service.

The exchanges are only open to American citizens and documented immigrants. To verify an applicant's citizenship and immigration status, an exchange must first verify a customer's identity with the Social Security Administration, and then check her immigration status with the Department of Homeland Security.

The exchanges must also check to make sure applicants are not already enrolled in another government health insurance program, which would make them ineligible for Obamacare. That means retrieving data from the Veterans Health Administration, the Department of Defense, the Office of Personnel Management, and the Peace Corps. It also means checking with a state's Medicaid and Children's Health Insurance Program agencies to see if an applicant is already enrolled in one of those programs.

Finally, once a customer purchases health insurance, the exchange must provide her information to the insurance company she has chosen. Insurance companies across the country have been scrambling to integrate their own computer systems with the exchanges.

I think that should be helpful in explaining exactly what went wrong, and why.

The article goes on to explain what is being done to solve these issues as well as predicting problems that the system may face in the future.

The thing is that ALL bureaucracies face difficulties, and clearly this one will be no different, what sets it apart is that EVERY hurdle, both big and small, is being mined for political points and will be used in attempts to undermine right up until it provides no more ammunition.

However in the meantime, health care becomes more and more affordable, and the people who listen to these assholes become fewer and fewer in number.

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