Scandal Sheet

Failed fix for HealthCare.gov problem leaves Iowans in health care limbo

This article originally appeared on watchdog.org.

DES MOINES, Iowa — On the last Friday of 2013, almost 16,000 Iowans who believed they had enrolled in Obamacare and would begin receiving health care coverage Jan. 1, received an unwelcome surprise — an email telling them they needed to enroll again.

They were instructed to the use the Iowa Department of Human Service’s health care exchange website this time, instead of the federal government’s HealthCare.gov. What happened over the next two days was enough to snuff out any lingering holiday spirit in those trying to enroll.

The state’s website was down for part of the weekend. It was being updated so it could accommodate the increase in traffic the DHS was expecting.

The 800 number provided as an alternative way to enroll was for a call center that is closed on weekends.

Those who called an automated system to get information about their situation didn’t have any better luck. The Des Moines Register reports that following the instructions provided by the automated voice resulted in the call being disconnected.

The unlucky people attempting to enroll (again) were facing these state-level problems because almost a month after the Obama administration had announced it had mostly fixed the computer problems plaguing the rollout of Obamacare on the federal level, the attempt to fix a major remaining problem made things worse.

Those 16,000 Iowans had been informed by HealthCare.gov that they were eligible for coverage under Medicaid. But since the individual states actually determine who is eligible for Medicaid, the information provided by people HealthCare.gov deems eligible has to be sent to that person’s home state for final approval.

And getting that information from the federal government’s computers to states is where the major problem lies.

The file transfer software designed to send the information should have been working when Healthcare.gov went live in October, but it wasn’t even ready to be tested until mid-December. And when it was tested, it failed spectacularly.

According to the Washington Post, only a fraction of the files sent to the states were received. And many of those that did arrive contained errors.

With the Jan. 1 start of Obamacare only weeks away, the Centers for Medicare and Medicaid Services, which administers federal government’s health care exchange, turned to software that hasn’t been in favor since the early 1980’s: flat files.

A “flat file” is a very rudimentary program used to store and transfer information. It lacks the formatting that would make the information it contains available to most computer programs. That’s why it was abandoned by practically everyone decades ago.

But CMS, despite the millions spent to create the federal health care exchange’s computer system, still uses flat files. Originally, the flat files were used to give each state a rough idea of how many its citizens were registering through HealthCare.gov. Each enrollment generated a flat file. A state just needed to count the files that were sent to it and didn’t need to try access the information. Because flat files are so small and rudimentary, there was little trouble sending them to the states.

Following the failure of the software designed to transfer Medicaid enrollment information to the states, CMS asked the states to accept that information in the form of flat files. The CMS didn’t reply to questions from Iowa Watchdog about why it chose to use that antiquated format instead of one more compatible with current computing technology.

While many states refused, Iowa agreed to accept the flat files. Iowa’s health care exchange has a state-of-the-art computer system. But even that system, built using a $59 million grant from the federal government, couldn’t make up for the necessary information that was missing from the flat files.

CMS repeatedly promised that all necessary information would be forthcoming, DHS spokesperson Amy Lorentzen McCoy told Iowa Watchdog. As a DHS fact sheet she provided delicately puts it: “CMS has delayed a handful of times sending full file information needed to process applications. DHS got a notification Friday afternoon (December 27) that CMS would miss the newest target date of December 30 to send complete files.”

“That’s when we started to reach out to people,” McCoy explained. DHS found an appropriate use for the early ’80′s technology of the flat files: it used them to compile a list of people who needed to apply again.

The problem is much bigger than just Iowa. The inability of the federal health care exchange to coordinate with the states on Medicaid eligibility left more 100,000 people nationwide in health care coverage limbo as the new year began.

Tara McGuiness, a senior White House communications adviser, tried to minimize the problem, telling the Washington Post, the problem only “impacts a small fraction of Americans who will have access to health care from Medicaid.”

The DHS believes it can resolve Iowa’s enrollment problem before the end of the month. Those who qualify for Medicaid would then have their coverage applied retroactively to the beginning of the month and will cover medical expenses incurred since then.

But not all those who believed they were covered by Medicaid after applying at HealthCare.gov will qualify for the program. The initial estimate by DHS  is that 1,400of the applicants will have to seek insurance through private carriers instead. Those people will be responsible for any medical expenses they accrue during their uninsured period.

That those 1,400 represent an even smaller fraction of the “small fraction” the White House’s McGuiness described, is unlikely to provide them with much comfort.

Contact Paul Brennan at pbrennan@watchdog.org.

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