Is Obamacare too much work for the Obama administration?
By Sarah Kliff on November 12, 2012 | The Washington Post
By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload.
“These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.”
When Walsh meets with state officials deciding whether to build a health exchange, he brings a chart. It outlines how to build the insurance marketplace required under the Affordable Care Act. To call it complex would probably be an understatement:
These marketplaces often get described as a Travelocity or Expedia for health benefits. While that might be the case for the consumer experience, experts say the underlying technology is hugely more complex, a maze of interconnecting computer systems meant to deliver health insurance to 30 million Americans.
“The reality is, states and the federal government are building something new,” says Pat Howard, who runs state health issues for consulting firm Deloitte. “There’s a rough blueprint in terms of federal regulations, but there’s still a number of decisions that need to happen to operationalize this.”
A health exchange’s first task is ensuring that those who are eligible for benefits know about them — right now, research suggests three-quarters have no idea.
That suggests a huge outreach challenge — and one the federal government may not be ideally suited to completing. Evidence suggests that it works better when it caters to local markets. Massachusetts, for example, saw high enrollment after it partnered with the Red Sox to promote its health-insurance exchange.
After people become aware of benefits, the health exchange faces its biggest challenge: Figuring out who is eligible for what. In many states those who earn less than 133 percent of the Federal Poverty Line are eligible for Medicaid — except if the state has already extended benefits to an even higher level, as 35 states have for children.
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