Presumably, the healthcare.gov website will be more or less operational after a few months. But that's not even the biggest problem with the program.
Insurers are getting bad information from the enrollments. The federal data hub that is supposed to tell consumers how much of a subsidy they will get is so dysfunctional that insurers have no confidence in the data. And come January 1, insurers believe there will be lots of outraged consumers who were misquoted on coverage and cost.
Affirming what health industry consultant Bob Laszewski has written, my source said that insurers have received a relatively small trickle of enrollments through the federal website, but they are seeing problems.
Duplicate enrollments are a recurring issue. This means that the insurer is notified that somebody has enrolled in an insurance policy through the government exchange, but then receives another notice that the same person has un-enrolled, followed still later by another one that they re-enrolled, and so on.
As of now, it's unclear whether this duplication problem is triggered by a failure in the way Healthcare.gov interacts with the systems of insurers, or if shoppers on the federal exchange are enrolling and un-enrolling themselves as they go through the selection process. Insurers can't ascertain the ultimate choice of the shopper because there are no time stamps attached to transactions on the site.
Other potential challenges involve whether the website will be able to properly communicate with a massive federal data hub to verify applicants' income accurately, calculate subsidies they may be entitled to under the law, and display the correct plan price.
There's also a question of whether the federal website is properly displaying information about plan deductibles, co-payments, and benefits.
Administration officials have emphasized that Americans have until the end of next March to purchase health plans through the exchanges.
But insurers are focused on a much earlier date: Jan. 1. That's when the insurance plans will start to become active. The nightmare scenario for insurers would be if, at the beginning of the new year, they are bombarded by complaints from consumers who, based on information displayed on the federal website, were expecting a certain set of benefits that don't correspond to the plans to which they signed up.
This doesn't even get to the broader health policy issue. The success of Obamacare hinges on the exchanges being able to enroll enough young and healthy individuals to offset the cost of covering older and sicker patients, particularly those with pre-existing conditions.
Given that Americans with higher medical costs are more likely to endure an arduous enrollment process than healthier individuals, sustained technological problems could be devastating to the program.
After January 1, other Americans are also going to be in for a nasty shock. The IRS is sending a separate form to all taxpayers requiring them to declare what health insurance they carry, what the benefits are, and how long they've been enrolled.
It is the IRS who will decide whether or not you're carrying the proper insurance. If not, taxpayers will be forced to pay the fine. It won't matter what your insurance company tells you. If the IRS determines you're not in compliance -- tough luck for you.
We're only finishing the first chapter in the Book of Obamacare. So far, it's living up to its billing as a horror story.