Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
Days until marketplace launch: 38.
When Becca Pearce thinks about the next 38 days (she has the countdown memorized) until Obamacare launches, she thinks about a party. A very, very big party.
"Now we're at the point right before a big party where everyone is putting the tablecloth on the table," Pearce, who runs the Maryland Health Benefits Exchange, says. "All the people in black-and-white are running around, getting everything in place."
I've spent the past few days talking with state marketplace directors, alongside a few Medicaid officials, about what they expect to happen when the marketplaces go live.
What I heard back was this: We'll be ready to launch, and good chunks of our technology testing are done. But there's a lot of work left until we flip the switch – and the product we launch won't be what was initially envisioned.
"The IT folks are doing nights and weekends right now," says Jon Hager, executive director of the Silver State Health Insurance Exchange in Nevada. "They're working seven days a week and getting very little sleep."
One area where states have made significant progress is testing with the federal data hub, the massive repository of consumer information that will help the marketplaces determine who qualifies for benefits. One recent report warned that, due to federal testing delays, the marketplace could be at risk of falling behind schedule.
Five of the six state marketplaces (about a third of all the state-run marketplaces total) I spoke with said they had finished waves of testing with the federal government. Idaho is relying on the federal government to run its technology backend so did not go through this testing.
"There were 36 test scenarios that we had to go back and forth with the federal hub on," Mila Kofman, executive director of the District of Columbia Health Benefits Exchange, says of her testing experience. "That tests different aspects of how the data flows. For us, there was one case [out of the 36] that we couldn't get the flow to work. So we have to fix that."
There were some bumps for some states,but nothing that derailed testing from completion, the exchange officials say.
"There were times when the hub had to be taken offline...," Hager, of Nevada, says. "So we couldn't test until they got it back online. But I think the end result, and everything I've seen, says it will be ready."
Even with the federal data hub testing behind them, states are spending a lot of time thinking about contingency plans, such as what to do if the data hub does do down – and it's not a test.
"If there's a new rule, that could throw us into a quandary," says Hager. "You could have, I don't know, a disaster or a fire. I think we've got back-up and contingency plans for everything."
In Maryland, Pearce has a sort of SWAT team assembled to address glitches that might pop up when the Web site goes live. Nearly everyone involved in building the marketplaces expect that, like any new venture, they will not work perfectly on day one.
"We're looking, literally, at what do we do if the call center phone number doesn't work," Pearce says. "Everything we're doing, we're getting an operational readiness response team in place. The unit would know, in that case: Well, we need to get in touch with Verizon. Or we've got a Medicare call center, and let's route people there."
Hitting the Oct. 1 deadline has involved trade-offs. Kofman decided a few weeks ago that her team didn't have bandwidth to get a Spanish-language marketplace site up and running by then and that it will wait until later this year. Spanish speakers will still have access to bilingual call center agents and Health Link Assisters.
"We had some things ready in Spanish but not others," Kofman says. "So we made a decision [that] for the consumer experience to be positive we don't want to start everything in Spanish and then switch to English. We essentially made the decision it would be better not to mix languages."
Out in Oregon, officials have decided to use Oct. 1 as a "soft launch," allowing only brokers and community agents to use the Web site. The general public will gain access a few weeks later. Amy Fauver, chief communications officer at Covered Oregon, says the exchange will have the technology to handle the capacity of a bigger launch. But staff is worried about what the consumer experience might look like on day one.
"When Google launched Gmail, you had to be invited, and that was their Beta launch," Fauver says. "That was the way that they identified bugs. Our benefit is that our initial users will be community partners who will be already trained on these systems."
KLIFF NOTES: Top health policy reads from around the Web.
Alaska is eyeing an Arkansas-style approach to expanding Medicaid. "Does Arkansas have a health care solution that would work in Alaska? The state’s Health and Social Services Commissioner, Bill Streur, is looking into that. Arkansas wants to use federal Medicaid expansion money under the Affordable Care Act to enroll people in private plans on its health insurance exchange." Annie Feidt for the Alaska Public News Radio.
The Huffington Post's Jeff Young made a Twitter list of all state-based health marketplaces. Follow it here.
Defining a small business under Obamacare can be difficult. "The legislation features a number of requirements and exclusions that apply only to small businesses; however, the new rules rely on different measures to determine which firms are considered “small,” and several are scheduled to fluctuate in the years ahead. Some say the inconsistency adds an unnecessary layer of complexity to the law, confusing many employers and making it difficult to gauge the legislation’s impact on Main Street." J.D. Harrison in The Washington Post.
How mad, exactly, should UPS employees be at Obamacare? "The economists and industry representatives I interviewed on Thursday mostly thought the new Obamacare requirements were one factor large employers like UPS might be weighing—but only one factor and, most likely, a modest one at that." Jonathan Cohn in the New Republic.