Sarah Kliff at the Washington Post has a good account of the first week of the Obamacare Exchange Federal war room:
Thirty-four states decided to either operate an insurance marketplace in partnership with the federal government, or leave the entire task to the Obama administration. That means, that in about two of every three states, its the people in the CCIIO War Room, and their colleagues, who are managing the back end of the exchange….
it wasn’t clear that this extra workload would be a huge factor. There were arguments about whether the federal government’s work could be easily scaled. If you’re building one insurance marketplace, the thinking would go, its easy enough to plop that model down in any state where the feds are running the show.
In terms of the Web site’s consumer facing design, this worked: Each state on the federal marketplace uses the same homepage for HealthCare.gov. The application process looks the same, whether you’re buying coverage in Alaska or Wyoming.
But behind the scenes, the war room notes paint a completely different narrative, where each state’s idiosyncratic issues didn’t lend themselves to scale. Alaska and Wyoming, in other words, had totally different problems — ones that couldn’t be addressed with a singular fix.
On Oct. 4 alone, three separate states reported three completely different issues…..
This makes a lot of sense. The front end is a single user experience but the back end is thirty four seperate pathways of fail. This is not unexpected:
State built exchanges have three significant advantages over the Federal Exchange. The first is that there was political will to make things work so active problem solving has been an ongoing process. Secondly,the number of unique data interfaces at the state level is far lower than the number of data interfaces that the Feds must manage. Finally, most states that are building their own Exchanges are working with insurers where there was a pre-exisiting working relationship…..
The original plan for PPACA was to have forty to forty five state exchanges and a few small states piggybacking on federal efforts but sabotage and massive resistance to improving the standards of living of the non-1% has been the name of the game for the past four years. And so we get a kludge of system that seems to be working better now but not working well enough yet.