Why President Obama Will Have To Delay His Health Insurance Mandate

Forbes –

A current protestation aside, President Obama is going to have to delay the individual mandate that penalizes consumers for not carrying health insurance under Obamacare. The President can’t force people to have healthcare coverage when they can’t even purchase it on the law’s signature exchanges.

Despite the Obama Administration’s refrain that the IT woes are a sign of heavy web traffic, or are just temporary glitches, the problems are far more systemic. They are unlikely to be soon resolved.

The issues are unlikely to be mere coding errors, but stem from the way the modules are constructed to speak to different systems and networks.

This is especially true when it comes to communicating with the state Medicaid systems, which are often decades behind current IT standards. Some are still operating on the COBOL programming language.

It is likely that large chunks of this middleware will need to be re-written, or was never firmly in place form the start.

For a crude analogy, remember how hard it is to get electronic health records to speak to each other and to different health system software. The exchange challenges, in some respects, are a similar task, albeit made easier because you are not dealing with so many lines of discrete health information (although at least health information has been largely standardized. A lot of the payer-based information that the exchanges are passing back and forth, especially with the state computer systems, doesn’t exist in any standard format).

These kinds of interoperability issues are revealed by where the biggest problem exists right now: With the program that calculates the subsidies that consumers are offered, to help reduce the cost of Obamacare.

These calculations are dependent on the ability to query across the different systems at the IRS, HHS, DHS, and state agencies, among others.

The Administration started building these systems late, and rushed them online, without perfecting these networks. Working them out now, in real time, is going to take months, and maybe a year.

All along, the Obama team set a low bar for itself, seeming to take comfort in just getting this program started. They underestimated the cost of a shoddy roll out.

It didn’t have to be this way. When Medicare’s national Part D drug system was being designed, getting the software architecture in place was the first task embraced by the leadership. The enrollment portal was on line weeks before the program went live. Testing the systems with real data started months in advance.

For the Obama team, the need to design an analogous system seems to have been an afterthought. These “glitches” aren’t just the usual fare when a new IT package goes live. The basic architecture of this system simply doesn’t work.

As I noted earlier this week on the editorial page of the Wall Street Journal, in planning these systems, the Centers for Medicaid and Medicare Services dawdled for more than a year until the current CMS Administrator took over.

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