Obamacare Fixes Hide a Big Mess on the Back End
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The Fiscal Times
December 6, 2013

This week, President Obama and his deputies kicked off a campaign to convince Americans to give Obamacare a second try now that the website is operating. But according to health care policy experts, most of the fixes made to the site are purely cosmetic and hide a back end that remains broken

These experts said the problems might deprive people of insurance, despite consumers believing they had completed the transaction and purchased insurance through the exchange. They also warn that a key component of the site needed down the line has yet to be built. 

Related: Will Obamacare Actually Make You Healthier? 

The first problem deals with forms known as 834s. These electronic back-end forms are used by the Health and Human Services Department to communicate to insurance companies that people have enrolled through the federal exchange. 

However, HHS has encountered problems with these forms from the start of the rollout. In some instances, insurance companies were getting the wrong information on who had signed up and what plan they had chosen, leading to mistakes when insurance companies tried to enroll new signups. Now, since the Nov. 30 re-launch of Healthcare.gov, the problem has yet to be resolved.

“You could get a bad plan or incorrect plan, a plan other than the plan you picked, a plan where the premium was wrong,” said Tim Jost, a professor of law at Washington and Lee University. “You could end up with a plan that didn’t cover all the members of your family.” 

The Obama administration has repeatedly refused to say how many problems related to 834s still exist. But according to Bob Laszewski, the 834s problem is endemic of a broken back end at the federal exchange. The administration may have fixed many of the problems that the public encounters in their interactions with the site. Problems that the insurance companies are facing are only going to get worse.   

Related: No Hope Left for Obamacare’s Website, Techies Say 

"They fixed the front end before they had the back end fixed. You got this tremendous wave of people coming through healthcare.gov and the back end isn’t finished," he said. "Before the insurance companies were only getting 10, 20, 30 enrollments per day. Thirty thousand coming through? They can’t handle that."

"The administration is creating a hell of a mess for themselves by opening the front end before the back end is fixed," Laszewski added.

More Problems Coming
Even if the White House is able to correct the 834 problems, a new hurdle looms: The e-commerce transaction functionality that allows the federal government to pay insurance companies isn’t ready. In fact, according to Henry Chao, the CMS official who is Obamacare's chief project manager, they haven’t even begun building it. 

Related: Why Divorce Attorneys Will Love Obamacare

"We still need to build the payments system to make the payments [to insurance companies] in January," he said in front of a House panel last month

This means that the mechanism meant to pay insurance companies the government’s share of health costs doesn’t yet exist, despite the fact that payments from Treasury to insurance companies are due to start in about three weeks. 

The Center for Medicare and Medicaid Services is now scrambling to find an interim solution. According to guidance released to insurance companies Dec. 4, the federal government is currently testing a system that allows insurance companies to be paid through an existing channel. 

“Right now Treasury is planning to use the same method they use to pay Medicare program costs,” Jost said. “That will get the insurers the money they need for tax credits and cost-sharing reduction payments.”

It remains to be seen if this proposed fix will work. But even if it does, Laszewski said the administration is overselling the fixes it says it’s made. 

“I think we are where we were in October,” he said, referring to the disastrous rollout earlier this year. “They launched this thing when it wasn’t ready. They had the political imperative to fix the front end. The back end, because it’s behind the curtain - it doesn’t matter how bad that is.” 

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An editor-at-large for The Fiscal Times, David Francis has reported from all over the world on issues that range from defense to border security to transatlantic relations.