Thursday, October 24, 2013

If You Need Health Insurance, Please Stand By

With the amount of time I spending reading and trying to learn more about politics, I'd like to think I'm not terrible at vaguely predicting things. Sometimes I get things right, sometimes I get things wrong, but I'm usually in the ballpark. It's the times when something hits me completely out of left field that I take notice. The disastrous ACA rollout is one of those times.

For a background of anyone that is not used to reading this blog, here are two qualifiers:

-I am not a fan of vast majority of the policies President Obama has pursued done during his time in office.

- I am not a fan of the ACA as a law, and to this day debate whether I would have voted for the law had I been a member of congress.

With that out of the way, here is why I'm shocked:

-My endless policy disagreements aside, I feel like Obama's Administration has been well above average as far as executing their agenda competently. I actually get annoyed when liberals confuse Obama having a different policy agenda to theirs with incompetence.

-I have spent years writing about the ACA and reasons I think it is a shitty law and could/will be a disaster. Technical fuck ups of this scale would not have made the top 1,000 of those reasons. I think that creating all this infrastructure was no an efficient way of doing things and not needed if we had done my preferred option of a medicare buy in... but that's not even really the same as this. These are purely technical fuck ups could actually prevent the law from working:
This is an "834 EDI transmission." Insurers sometimes call it, more simply, "an 834." It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It's the form that tells the insurer's system who you are and what you need. And it might be the new health-care law's biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That's a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law's rollout.

If people can't get into the Web site, then they simply have to come back later. But if they believe they've signed up for a plan but their 834 is a garbled mess -- or, even worse, clear but wrong -- it could mean chaos when they actually go to use their health insurance. For that reason, inside the health-care industry, the 834 problems are the glitch that is causing the most concern.

To back up a moment: 834 transmissions aren't new. They have been around for decades as the standard form that employers use to tell their insurance companies which workers are on their health insurance plan each month.

An 834 transmission contains enrollment data like an individual's social security number, their dependents and the plan that they picked. That data is, obviously, critical: If it comes in wrong, an applicant may not get the right plan, or family members may not be covered, or identity may not be verifiable.
The 834 transmission is the one form, in the giant machinery of, that lets insurance companies know who signed up for their product. It is the electronic file that lets them get to work printing member cards, mailing them out and, eventually, paying claims.

The 834 transmissions have begun filtering out to health insurance plans. The only problem? A lot of them are wrong.

The Wall Street Journal reported that one insurance plan got an 834 for a subscriber who, according to the data, had three spouses. This was surprising because the individual was not a polygamist. Two dependents had been incorrectly coded as spouses.

Others have gotten reports for people joining the plan, unenrolling and re-enrolling multiple times in the course of a week -- or even the same day.

Right now, health-insurance plans say they can manage these problems. Few enough enrollment forms are coming in that they're able to hand-check each one. "What our company, and I'm assuming others, are doing is throwing people at it," one insurer told Wonkblog. "We're overcoming the tech flaws with manual reviews and manual rigor and manual processes. That's fine right now, but when you start looking at the scale of what the Obama administration wants to do, that's just not going to scale up."

This approach undermines the very point of 834s, which is to make it possible for the computer system to automate the process of enrolling tens or even hundreds of thousands of applicants each day.

"The purpose of the electronic transaction is to be able to do this with a minimum amount of human intervention," says Stanley Nachimson of Nachimson Advisors, a health IT consulting firm. "The hope would be that the health plan's computers will be able to understand the transaction and do all the processes automatically."

Some in the industry believe's traffic problems have been a blessing-in-disguise for the program: If applicants were being able to sign up easily but the 834 forms were coming in with this many errors the results could be disastrous.

"Some days its going to be 100,000 coming in," Laszewski says. "The good news right now is there is a small enough number that they can scrub the data manually."
There are plenty of other problems, but I wanted to highlight this because I think it's something that's been missed in the coverage. You can fix a shittily designed or slow website. This is a far more serious problem. If people think they're signing up for insurance and they aren't or even worse, they are and they are signed with the wrong information - that is obviously a disaster, maybe one the implementation can't recover from.

I know the Republicans have been trying to destroy Obamacare and hurt it's implementation every step of the way. That sucks, but if you expected any different you should be out of a job.You had THREE FUCKING YEARS to get this up and running.

There is still time to get this together, but while they fix it people are getting letters like this, telling them they are being kicked off their current plan, and must find insurance in the exchanges by January 1st or go without insurance.

The stakes are high and they better get their shit together. I had honestly thought the technical feasibility of this law was the least of their concerns, and boy was I wrong.

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