The unexpected volume of visitors that overwhelmed the federally operated health insurance exchange last week is only one of many problems confronting this entity and the state-based exchanges.
For starters, some insurance companies have received faulty enrollment data from the U.S.-run insurance exchange, according to insurance industry consultants interviewed by Bloomberg News. Either the plans have been unable to open files forwarded to them from the exchange or have found that the information on the enrollees is incomplete.
According to consultant Bob Laszewski, the plans are trying to fix the errors manually. Another consultant, Dan Schuyler, told Bloomberg that unless these problems are rectified in the next few weeks, some enrollees might not have coverage on Jan. 1, 2014.
In a recent blog post, Laszewski said that health plan executives concerned about these errors have had trouble getting through to the federal exchange on the phone. When they have reached the help desk, they've received a "ticket" and been told that someone will call them back.
"That may be a good process if the carriers are only enrolling 20 people a day, as many are now, but this is going to be problematic when the real enrollment volume ultimately begins," he pointed out.
In the first few days of the exchange rollout, insurance company executives reported that they'd received little data from the federal or the state exchanges on how many people had enrolled in their plans. So the fact that they're getting some enrollment files -- even if they're flawed -- is a sign of progress.
Overall, the state exchanges are functioning more smoothly than the federal exchange, which operates the insurance exchanges in 36 states that were unable or unwilling to set them up on their own, according to reports. Some of the states with their own exchanges may have experienced fewer problems because their Web portals allowed "window shopping" -- people who weren't sure whether they wanted to enroll could check out their options without creating user accounts.
In contrast, the federally run exchange requires all visitors to create accounts, because the government needs to verify personal information that is used to determine an applicant's eligibility for government subsidies. Todd Park, chief technology officer of the U.S., told the New York Times that this feature had contributed to the system's inability to handle the volume of visitors.
On Wednesday, IRS official Sarah Hall Ingram testified to a House subcommittee that the IRS system that communicates with the insurance exchanges was operating smoothly and that personal identification numbers were secure. The IRS helps establish the eligibility of applicants for subsidies and will fine people who don't obtain health insurance.
But the federal exchange cannot yet communicate online with Medicaid agencies in the 36 states where it is operating. Federal officials said that connectivity will not be in place before November 1, due to technical difficulties.
The Medicaid link is important because it is not clear whether, on January 1, applicants will be eligible for Medicaid or will be allowed to buy insurance on the state or federal insurance exchanges. Until the computer systems at the federal exchange and the Medicaid agencies can talk to each other, people will have to go to their state Medicaid offices and fill out applications.
Meanwhile, the Department of Health and Human Services (HHS) said that it is adding additional servers and installing software upgrades to enable the federally run exchange to support a greater number of users.
But technology analysts told the Washington Post that flawed software alone does not explain the system's glitches. They noted that the government tends to buy "outdated, costly and bug-ridden technology." One reason is that a shortage of analysts in government agencies requires the agencies to outsource much of the work to contractors. These contractors are better at navigating the procurement maze than at delivering world-class technology.