A flurry of recent reports detailing technical glitches in the federally facilitated exchanges slated to run in 34 states, including how medical charges and deductibles are displayed, has HIX industry watchers on pins and needles with the October 1 start to enrollment close at hand. But some knowledgeable observers also point out the enormity of what’s at stake to quell widespread fears.
The federal government isn’t about to squander a significant opportunity to add millions of Americans to insurance rolls, explains Rick Howard, research director of technology consultant Gartner. Anything short of delivering “a world-class consumer experience” would serve to “reinforce the notion that government entities can’t get anything right,” he says.
Adds Don Garlitz, executive director of bswift Exchange Solutions, a leader in cloud-based technology and services for employee benefits: “My sense is that the exchanges are going to open 10/1, even if some of the connectivity doesn’t work” and it becomes necessary to establish a backup plan for manual processes. Glitches on a first-time project are nearly unavoidable, adds Garlitz, whose firm is also involved in Connecticut’s Small Business Health Options Program (SHOP).
The Centers for Medicare & Medicaid Services issued a statement reassuring the public and industry watchers that it expects the new online platform to be on track for the looming enrollment deadline. U.S. Chief Technology Officer Todd Park indicated that security testing and certification to operate have been completed.
In addition, representatives from four vendors involved in the process recently delivered the same message to a House subcommittee hearing. The group included CGI Federal Inc., Equifax Work Solutions, Serco Inc. and Quality Software Services Inc.
Be that as it may, there’s still too much uncertainty to gauge the full impact of technical glitches on the first HIX enrollment. “One of the big unknowns is how many people are going to be hitting the system and expecting to enroll on Day One versus Day 30, 60 or 90,” Howard notes.
Quality assurance may be uneven, considering the hodgepodge of state-run and federally facilitated exchanges that could offer consumers varying experiences. “Most of the sites I’ve seen are as good as any you could find in a commercial setting,” reports Howard, who also cites the buzz that has built around Enroll UX 2014, a public-private partnership to streamline online insurance shopping.
He adds that “some states are setting up mirror sites that are able to give the consumer the full shopping experience without necessarily working in the production site and their wish list that they're still working on. They’re what I would call at ‘soft launch’ where they’re really trying to manage risk by being very conservative and assuming the worst.”
Beyond the upcoming enrollment, Garlitz believes that state and federally run exchanges could attempt to “bring in other lines of business” as the private HIX model has done with disability, life, retirement and other benefits made available through the workplace, as well as sophisticated decision-support tools.
But there are key differences between these two models. Howard believes the private exchanges are nowhere as complex as public exchanges, whose mission is much broader. For example, the latter must factor in premium tax credits, as well as external systems interfaces to validate citizenship and income levels.
“There’s a much more stable consumer base in the private exchanges than you see in the public exchanges,” he says, predicting that “private exchanges are going to get a lot sharper over the next couple of years.”
A greater number of options and deeper level of competition is seen on the horizon for the emerging HIX marketplaces. Public exchanges will increasingly focus not just on covering more Americans, but also consolidating group insurance contracts, reducing the administrative overhead of open enrollment and ultimately achieving more value for the overall health care spend, according to Howard. He foresees expanded enrollment, “even if it’s just publicly financed health care,” involving public employees, people who work in higher education and Medicaid populations.
As for any potential impact on employee benefits practitioners, Garlitz doesn’t anticipate that HR departments will be overrun with employee inquiries about the exchange, though there could be a slight uptick in activity once the HIX notices go out. He believes the lion’s share of questions will be directed toward public officials. “A lot of people who are now covered through their employment are not going to pay that much attention to the public exchanges,” he adds, because they already have a means of obtaining coverage.
Another reason may be apathy. “Employees have been getting health-related notices from their employers on COBRA and other areas for years, and most people never read them,” Garlitz observes.
Bruce Shutan is a Los Angeles freelance writer.
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