Aside from Republicans, the biggest obstacle to enrolling people in Obamacare has been the Affordable Care Act’s own federal Web site. The feds intended it as a portal to health care for people in the three dozen states that didn’t set up their own exchanges, but it turned into more of a barrier than a gateway.
But HealthCare.gov’s role is now changing, as customers from the two-thirds of the U.S. it covers will soon have the chance to enroll in subsidized insurance through federally licensed commercial insurance exchanges — potentially changing the scope and flow of health care signups and shifting much of the activity to the private sector.
Web brokers for hire
Last year, the U.S. Department of Health and Human Services (HHS) and its Centers for Medicare and Medicaid Services – the department and agency overseeing health care reform – issued regulations that permit commercial insurance exchanges to enroll individuals who are eligible for tax subsidies under the Affordable Care Act.
In July, a number of commercial exchanges – including eHealthinsurance.com, GetInsured.com, ExtendHealth.com, ConnectedHealth.com and GoHealth.com – signed an agreement with HHS to act as web brokers through the Federally Facilitated Health Insurance Exchange (FFE), the new federal health data ecosystem of which HealthCare.gov is the most visible frontend.
The licensed exchanges are required to display and sell all Federally Qualified Plans (FQPs), although they may be brokers for only some of the insurance companies. The plans can be recognized by the “metal” in their name (bronze, silver, gold and platinum levels).
But the exchanges have not yet able to enroll customers in these FQPs, as they have been unable to provide ID verification and subsidy determination because of some of the same technical issues that have beset the federal site.
Without those steps, the enrollment for those plans at subsidized prices can’t move forward. On each of the brokering exchanges, the subsidy determination step is sent through HealthCare.gov’s data hub, and, when completed, the user’s application is sent back to the originating commercial exchange. Applicants at the lowest end of the income scale are sent to the state-appropriate locations for the CHIP or Medicaid programs.
Michael Mahoney, the SVP of Consumer Marketing for GoHealth.com, told VentureBeat that his company’s exchange has been ready to process applicants interested in subsidies since Oct. 1, when HealthCare.gov and most of the 14 state exchanges opened. But, he pointed out, “we default to the federal process for the official subsidy.”
The data hub is the key
The main reason that the HealthCare.gov project has been so beset with technical difficulties is that there’s a lot of complexity behind the scenes. It’s no mere web site, but rather a complex application that integrates with a lot of other databases.
The HealthCare.gov data hub communicates with the databases at IRS, Experian, and elsewhere that are needed to determine ID validation and subsidy determination. Built for the federal government by contractor Quality Software Services, Inc. (QSSI), the data hub reportedly is working fairly well. The evidence for that is that state-run exchanges, including smoothly working ones in such states as Kentucky, Washington state, and California, talk directly to the data hub to run their ID and subsidy determinations.
But unlike the state exchanges, the commercial exchanges are required to interact with the data hub through a technical interface built by CGI Federal, the contractor that has received a lot of heat for the HealthCare.gov problems.
“We’d like to have a direct connection to the data hub,” said Sam Gibbs, the president of eHealth Government Systems at eHealthinsurance.com. “But right now, we have to go through a HealthCare.gov interface.”
Since the state exchanges communicate directly with the data hub, the requirement for using HealthCare.gov’s technical interface is apparently not a technical issue for them — but it is for any commercial exchange. The last hurdle to fully opening these commercial exchanges appears to be working out the final kinks in that interface.
Bryce Williams, the managing director of exchange solutions at Towers Watson’s Extendhealth.com site, echoed several other commercial exchanges in his assessment that the pathway through the interface and the hub “has improved dramatically in the last six weeks,” but that it remains to be seen if the final issues will be cleaned up by the end of November.
In mid-November, CMS spokeswoman Julie Bataille said that commercial insurance marketplaces will be able to start determining subsidies, verifying IDs, and enrolling people “in the coming days.” The agency is also working to provide insurance companies with a similar capability to determine IDs and subsidies directly.