Just seven weeks before the new state insurance marketplaces are set to open under the Affordable Care Act, it’s unclear whether the long-anticipated October rollout will be a smooth operation or the "train wreck" that some have predicted.
Systems testing for the marketplaces is months behind schedule, according to recent government reports. So are funding and training for navigators, the outreach and enrollment workers who’ll help people choose marketplace health plans.
In a final bit of down-to-the-wire drama, the data hub, which routes information from the marketplaces to various federal databases, might not get its final stamp of approval until Sept. 30, the day before people begin using the marketplaces to enroll for health coverage next year under Obamacare.
That timeline leaves the Obama administration and its information technology contractors virtually no margin for error as they fine-tune the system.
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Any unforeseen setbacks or complications at that late date might postpone the October grand opening, which would be the most embarrassing public relations stumble yet for President Barack Obama’s signature health law.
"I think there is a possibility that there could be a delay. I think it’s unlikely, but I think there’s a possibility," said Christopher Rasmussen, a policy analyst at the Center for Democracy & Technology, a nonprofit public policy organization.
The U.S. Department of Health and Human Services maintains that concerns are unwarranted.
"We are on schedule and will be ready for the marketplaces to open on Oct. 1," HHS spokesman Brian Cook said.
While a train wreck may not be in the offing, a delayed opening of the state insurance marketplaces would ensure a "rocky" and "bumpy" ride, which "seems the order of the day in terms of how this rolls out in the next six months," said Gail Wilensky, a senior fellow at the international health care organization Project HOPE.
In recent weeks, the administration has had to delay several important provisions of the law. First, it announced a one-year delay of the "employer mandate," which required companies with 50 or more employees to provide affordable coverage to full-time workers.
Then came the decision that applicants to the marketplaces, which previously had been called “exchanges,” would be taken at their word when providing information about their workplace coverage because the information wouldn’t be able to be checked against their employers’ data.
Earlier this year, the administration had agreed to a one-year waiver of a requirement that capped out-of-pocket spending for people with certain kinds of employer-based coverage.
Critics say the delays show how unwieldy and unmanageable the law is. Supporters say the moves haven’t altered its core mission, which is to insure more Americans and make the health care system more transparent.
In a recent podcast for the journal Health Affairs, Wilensky said the information and technology concerns surrounding the marketplace operations might overshadow the recent good news from many states about the lower-than-expected cost of marketplace coverage.
"I don’t have any doubt that if we were to try to do a full assessment about the workings of the (Obamacare) program in the first quarter of 2014, it’s not likely to look very good," she said.
Gerald Friedman, a health care economist at the University of Massachusetts Amherst, also was skeptical.
“It’s not going to be a train wreck. It’s going to be a mess," Friedman said. "I’m sure there’ll be places where you get on the website on Oct. 1 and it’ll crash. . . . I think October is not going to be the White House’s best month."
Their somber assessments about the enrollment phase of Obamacare reflect concerns echoed in several recent government reports.
While the administration has had to enact the sprawling law in the face of relentless criticism, limited funding and a Republican Party intent on defunding or repealing it, the biggest immediate threat to the debut of the state insurance marketplaces appears to be internal.
Getting the federally run marketplaces wired and working in 34 states by Oct. 1 has turned out to be a tough technological challenge. A report last week by the HHS inspector general’s office found that the marketplace computer systems haven’t been fully vetted. Department officials have downplayed the report, which was researched in May.
"We have made substantial progress in the three months since then," Cook said in a statement. "Our internal testing through August has helped us refine our security systems and eliminate potential security vulnerabilities."
But missed testing deadlines have pushed the due date for an independent risk assessment of the data hub into late September.
If that review finds security problems that can’t be fixed, the administration might delay the marketplace opening or decide to open the insurance exchanges with less-than-optimal assurances that users’ personal information is adequately protected.
HHS’s Cook said that based on Medicare, Medicaid and the Children’s Health Insurance Program, the administration had "extensive experience building and operating information technology systems that handle sensitive data.”
Rasmussen said it was unlikely that the administration would push ahead without completely secure technology.
“From a privacy and security perspective, you don’t want to go into it thinking, ‘We’re not 100 percent sure that this data hub can provide a secure routing of information,’ ” he said. "But at the same time, you’ve got the whole political question of this looks like a big PR disaster if things aren’t ready to roll Oct. 1.
“So I think in the end, I would hope, at least, that the way that they proceed is to make 100 percent sure that the system is secure."