What a difference a year makes

This is more of a personal note on the scramble to get the Exchanges up and running which then ran into a brick wall of Healthcare.gov not working at all last year.

Last year, I spent thirty one of the thirty six hours before go-live either at work or online at home.  My major challenge was to get the web directories up and running so that they would reflect the accurate at that moment network that we were offering.

We had “finalized” our networks a week before hand, and the web developpers were still working on a long term solution to reflect the networks as it was a massive discontinuity from our previous practices.  Previously, we had embraced big, broad, everybody who wants to get in can get in networks.  The Exchanges were narrow networks with significant targetting.  The “final” networks were not really final, as we received a contract amendment to opt-in to Mayhew Narrow at Medicare + a smidge from a two hospital chain and its 300 docs at 8:30pm the night before go-live.  Since the long term solution was not in place, I had an ad-hoc solution that was ‘good enough’ to work and that required a four hour rebuild process.  I launched my final good to go web directory at 2:30AM

This year, the web directories entered the production stream three weeks ago.  One doc had the nerve to die on us, so we had to remove her, and another practice bought out a four doc cardiology practice so we had to add them, but that is the normal churn of networks.  It is routine.

I received one call from a co-worker this weekend.  She wanted to know where the financial attribution schema for SNP was stored. This year, I went to a wedding where the brides were beautiful.  I refereed a championship game where I loved that it was 31 and snowing instead of 33 and raining.  I went to the birthday party of a friend’s daughter.

Last year, I had a 110 hour week .

This year, it is business as usual.

32 replies
  1. 1
    mai naem says:

    Ted Cruz just informed me that Obama’s death panel killed that female doctor because Obama hates wimmens.

  2. 2
    a hip hop artist from Idaho (fka Bella Q) says:

    Happy news; thanks.

  3. 3
    Wag says:

    Best ACA news I’ve heard this month.

  4. 4
    srv says:

    This year, it is business as usual.

    But you were alive last year.

    Got asked to cover Black Friday ops for my favorite (as in crazy) major, major retailer. And I’d have done it if they asked before my reunion was planned.

    17 hours a day for a week, terror, splash screens, elation and a lot of stories I can never tell…

  5. 5
    Remfin says:

    This year, the web directories entered the production stream three weeks ago. One doc had the nerve to die on us, so we had to remove her, and another practice bought out a four doc cardiology practice so we had to add them, but that is the normal churn of networks. It is routine.

    But Obama said I could keep my doctor!

  6. 6
    divF says:

    Since I’m in early to the thread, so that Richard is likely still reading it, I would just like to thank him for his thoughtful and well-informed commentary on health insurance issues he has given us over the last year or so. Yet another example of the A-list front-pagers that John Cole has recruited here at Balloon Juice (not to mention the great commenters!).

  7. 7
    Omnes Omnibus says:


    (not to mention the great commenters!)

    As well as the mediocre, bad, and demented ones.

  8. 8
    joel hanes says:

    This year, my gormless step-daughter lost her health insurance, and waited more than 60 days to attempt to enroll in ACA (but made the attempt before the 15 Nov open window). I was at work, and unable to advise untl after the fact.

    We live in California.
    The Covered CA site has a separate “apply” image for each of the major insurance organizations; she clicked them all and entered her name, age, and the house phone number.
    The phone commenced ringing off the hook.

    The high-pressure jargon-laden approach of most of the callers scared her off, but finally a woman with a soothing approach talked her through the process, and sold her a policy.
    – includes term life insurance !
    – cost $240 / mo for 44-y-o stepdaughter and her 20-year-old daughter
    – has a one-year exclusion on coverage of pre-existing conditions
    – is called “Platinum”, but has big deductibles and co-pays, and high out-of-pocket limits
    – is structured as a PPO with a network so narrow that we had a difficult time finding a GP/internist/family practitioner in the South Bay that would accept it — only one such doctor at Sutter/Palo Alto Medical, a huge medical consortium
    – is put together by some outfit I’ve never heard of, out of Texas

    Am I justified in sending all the materials for this to Debra Bowen, the excellent CA Insurance Commissioner? It was sold outside the ACA enrollment window, but from an initial contact through the Covered California site. I’m not sure that the provisions are even ACA-compliant.
    And what’s this about bundled life insurance?

  9. 9
    Mnemosyne says:

    @joel hanes:

    I would send it to both Debra Bowen and to the feds at HHS. I think you can file an official complaint online at both websites.

    ETA: The premium isn’t that bad for two adults, but the “no pre-existing conditions for a year” clause may be illegal.

  10. 10
    Omnes Omnibus says:

    @efgoldman: The Pats are my back-up, cheer-for team. My time in Connecticut is to blame.

  11. 11
    Mike J says:

    @Omnes Omnibus: I grew up in a town with no pro teams. My parents moved to Boston while I was away at college, but I found them anyway. I tend to cheer for Boston teams, and sometimes I add in my new local teams. I support the Mariners, Seahawks, and Sounders, but United was the only DC team I liked, despite having a Caps fanatic gfriend.

    And everybody hates my premier league team, but I actually lived in South Kensington, so I don’t apologise.

  12. 12
    Omnes Omnibus says:

    @Mike J: Who is your Premier League team? I am an Arsenal guy. Gunners? Where else could I go? Plus, I was a longtime Thierry Henry fan.

    ETA: It should be understood that my support for any team that is not the Packers is about 10th on my list. Except the ‘Hawks who are 7th.

  13. 13
    divF says:

    @Omnes Omnibus:
    We’re not demented. It only appears that way because all of our cultural touchstones are 40+ years old (mine are, anyway). I was practically incoherent with gratitude when a 20-something played Leonard Cohen’s “Sisters of Mercy” on his iPad Saturday.

    In other news, I just got done making cheesecakes and butternut squash puree. The latter will be turned into soup for dinner tomorrow night. The cheesecakes will be consumed by a primarily under-30 set who have metabolisms so that they are not a health hazard (just looking at them shows up as +2 lbs on the scale for me). Mainly trying to get warmed up for the holidays. They begin with hosting my in-laws for Thanksgiving, who are kind of like the lines from “My Fair Lady”

    She’ll have a booming boisterous family
    Who will descend on you en masse

    Plus, all of them, save Madame, are football fanatics, and I am totally uninterested (for me, pitchers and catchers report to spring training in three months), so I have to get caught up on who is doing well or badly so as not to be shunned.

  14. 14
    Omnes Omnibus says:


    We’re not demented.

    I will simply cite mclaren as proof that some are.

  15. 15
    Mike J says:

    @Omnes Omnibus: I have a neighbor down the street whom I have never met. He flies my team’s flag (in suburban Seattle!). I put a stalk of celery on his mailbox after the Liverpool game last week.

    When I was spending weeks in Welwyn Garden City, I had to pass through Finsbury Park on Sunday afternoons. Couldn’t stand the Arse after sharing a train with the fans. The fans marching to Stamford Bridge were always very polite.

  16. 16
    Omnes Omnibus says:

    @Mike J: In your favor, Joe Strummer was a fan.

    ETA: I find that I am a “north of the Park” sort of guy.

  17. 17
    ruemara says:

    @Mnemosyne: Wish me luck. applied at giant evil corp.

  18. 18
    divF says:

    @Omnes Omnibus:

    I will simply cite mclaren as proof that some are.

    Your point is well-taken. OTOH, I live in Berkeley, where the Overton window looks more like a Klein bottle. By local standards, mclaren is, at worse, a bit of a crank. We were out at a play last night, and on the corner there was a sandwich board for a lecture by Bob Avakian. Then there were the LaRouchites soliciting yesterday afternoon in the middle of the Gourmet Ghetto – wanting to impeach Obama and bring back the golden age of Bill Clinton (all fusion-powered, of course).

  19. 19

    @ruemara: That’s suitably obscure. There are so many!

  20. 20
    Mnemosyne says:


    Good luck! I finally got an interview after sending out about a dozen resumes, but rumor has it that they already have an internal candidate. :-(

  21. 21
    Omnes Omnibus says:

    @divF: I am in Madison, WI; I get where you come from.

  22. 22
    Mnemosyne says:


    I’ve been trying to get her to apply to the Giant Evil Corporation I work for, so I know which one it is.

  23. 23
    divF says:

    @Omnes Omnibus: I always enjoy my visits to Madison. I also enjoy asking Madame’s physician colleagues if they know where the name for Warfarin (a blood thinner or rat poison, depending on the dose) comes from.

  24. 24
    Mnemosyne says:

    Charlotte is never going to convince us that she didn’t miss us if she keeps insisting on sitting on our laps now that we’re home. Silly kitty.

  25. 25
    Ruckus says:

    That’s a pretty big cat to sit in 2 laps at the same time.

  26. 26
    Ruckus says:

    I’m wishing you good luck as well.

  27. 27
    Joel Hanes says:


    ETA: The premium isn’t that bad for two adults, but the “no pre-existing conditions for a year” clause may be illegal.

    Thanks for the advice.

    I suspect that the coverage is deeply sub-Bronze, and that’s why the premium is low.

  28. 28
    Elizabelle says:


    You made me look up Klein Bottle.

    Someone at Acme Klein Bottle had fun with the website copy.

    These elegant bottles make splendid gifts, outstanding classroom displays, and inferior mouse-traps.

    $49 buys a pair of zero-volume earrings – so exclusive that they’ve never been featured in the most high class fashion magazines!

  29. 29
    rikyrah says:

    Add me to those that have found your posts on Obamacare so informative. Haven’t replied to all of them, but I’ve read all of them.

  30. 30
    Matt McIrvin says:

    Here’s hoping that next year, or the year after that, we aren’t looking back on this year as the brief golden age of the ACA.

    (I’m trying to figure out just how bad it could be. Presumably even if the federal subsidies get canned for the federal exchanges, it won’t lead to an outright repeal of the ACA before 2017. But it’s conceivable it could make the ACA so dysfunctional that a Republican President could get in on the strength of promising to repeal it.)

  31. 31
    JustRuss says:

    Last year, I had a 110 hour week .

    This year, it is business as usual.

    So….updating existing systems is easy but creating them is a brutal, time-consuming cluster? I see. Can you explain that to my new boss please?

  32. 32
    Another Holocene Human says:

    @divF: Maybe during Bill Clinton era more people took them seriously because there was just less volume of websites exposing LaRouche’s past and his organization at that point? And it was pre-B.-Diddy “Ballpark” Frank mocking the fuck out of them going viral? Of course it was pre-Obama-Hitler posters. Like a lot of lefties they took Obama for a lefty and there’s nothing a dead-ender Marxist cult hates more than a successful rival.

    Sometimes I wish the US were a tad more authoritarian and we could shut the LaRouchies down. They put the abusive in abusive cult.

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