States Lowering the Bar for O-Care Implementation
Facing tight deadlines and daunting workloads, states across the country are scaling back ambitions for implementing the Affordable Care Act. At a monthly board meeting of Connecticut's health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won't be completely ready on time.

"It is highly complex, it's unprecedented and it's not going to be smooth," Kevin Counihan, chief executive of the state's exchange, Access Health CT, told the group.
The man whose job didn't exist until O-care. Who is paying HIS salary?
That's why Connecticut -- like other states across the country -- has lowered the bar, doing what it can in the time it has left before the health-care law's major programs are launched Oct. 1. Although the states are promising to provide new marketplaces for individuals to compare and buy health insurance plans, the Web portals will be a bare-bones version of what was initially envisioned.
Can't you already get comparisons at Progressive?
And then there are the federal setbacks. The Obama administration has put off significant aspects of the health-care overhaul as it races to finish provisions that will give Americans more insurance options and provide many with financial assistance to buy coverage. On Tuesday, the White House announced a decision to delay the "employer mandate," a requirement that employers with 50 or more workers provide coverage.
Once again demonstrating it is harder to actually govern than to bloviate.
"In 2011, there was this 'we're going to save the world' mentality," said Rebecca Pearce, executive director of the Maryland Health Benefit Exchange. "In 2013, it focuses more on how do we deliver on the requirements of the law."
Another executive's salary paid by borrowing from the Chinese.
The District of Columbia and 15 states -- including Connecticut -- are building their own marketplaces. Those jurisdictions, among the Affordable Care Act's most ardent supporters, took on the responsibility of building Web portals that are at the heart of the federal health-care overhaul. Most states, eschewing the heavy workload, left the task to the federal government.

The White House expects 7 million people to buy health insurance or enroll in Medicaid through these Web portals. Millions more are likely to browse these sites for health plans and explore possible options under the federal law, which imposes an "individual mandate" requiring most people to obtain coverage or pay a penalty.
Or be excused through a political favor.
In Oregon, officials decided to delay a feature that would allow consumers to customize searches for rating the coverage provided by insurers. And a feature for insurance brokers to track the consumers they enroll will wait for two to four months.

How will brokers keep track of potentially thousands of customers in the interim? Cover Oregon's executive director, Rocky King, suggested that they might use "index cards". "I know the agents will have all their Excel worksheets," King said. "We've gone to them and said: You're our priority sales force, but you're not necessarily the priority for how you access the system. The consumers are. "

Connecticut has made progress. It was the first state to complete an intensive technology test in which the state's portal successfully connected to a federal data hub. But officials have learned that good news can have a downside. The state agency spent weeks reprogramming its Web site after the federal government shrank the insurance application from 21 pages to three.

When the Supreme Court struck down a key element of the federal Defense of Marriage Act, Access Health CT board members cheered. Then, they remembered that it would add to the workload: The marketplace would now need to recognize same-sex marriages, a coding change unlikely to be ready for October.
"Everything continues to change all the time," Van Loon told his staff at a job-security meeting later that day. "We're going to have to adjust some processes around that. If DOMA requires a manual work-around, we'll do that."
Van Loon. He's in the right place!
Posted by: Bobby 2013-07-05