The nightmare of setting up state insurance exchanges

What a clusterfark.

The Hill:

The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems.

The exchanges were designed as the centerpiece of President Obama's signature law, and are intended to make buying health insurance comparable to booking a flight or finding a compatible partner on

Sixteen states - most of them governed by Republicans - have said they will not set up their own systems, forcing the federal government to come up with one instead.

Another five states said they want a federal-state partnership, while four others are considering partnerships.

It's a situation no one anticipated when the Affordable Care Act was written. The law assumed states would create and operate their own exchanges, and set aside billions in grants for that purpose.

Oh my, are the American people who are forced to use these exchanges in for a big surprise:

Since different states have different insurance markets and different eligibility requirements for Medicaid, Obama's Health and Human Services Department can't simply take a system off the shelf as a one-size-fits all failsafe.

"You can't simply deploy one federal exchange across the board," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

"Each state is different - their eligibility systems are different, their insurance markets are different. [HHS is] going to have to build these exchanges to fit into the context of each state."

And using the system is going to be nightmarishly complex:

In practice, the process will require websites that can process massive amounts of personal information from users and yield search results for everyone.

An exchange portal might tell an uninsured woman she is eligible for a premium tax credit, for example, after processing her Social Security number and tax-return figures. Officials hope that woman would go on to compare relevant health plans available in her state and then enroll online.

Constructing these sites is just one task facing HHS when it comes to states that have decided not to do the job themselves.

Each portal will require a front end - the interface consumers will use to submit their information and shop for plans - and a specialized back end that is customized based on the state.

HHS will also construct a range of other systems: a federal data hub for verifying user identity; programs for user assistance; a way to certify that health plans meet federal standards; a way to navigate the exchanges via phone, or apply for coverage by mail; and so on.

It is a lie that these websites will be "comparable to booking a flight or finding a compatible partner on" A made in hell, maybe. You don't have to enter your private tax data to book a flight or find a mate. But to get access to insurance, you will have to laboriously fill out online forms and then be presented with limited options.

Bottom line; the chaos that has been predicted since Obamacare was proposed will become a reality. I wrote recently that problems with implementing Obamacare could help the GOP achieve majority status:

Put simply, the American people are unprepared for such a massive change in their lives. Most people don't realize that their current insurance coverage is inadequate. They actually believed the president when he looked into the cameras during his 2010 State of the Union address and assured citizens that they could keep the insurance plan they have now. Instead, government-mandated coverage for a wide variety of services that many current insurance plans don't cover will radically alter health insurance for millions.

Many economists are already predicting a recession as a result of implementing Obamacare. Coupled with voters doing a slow burn over the sheer complexity and maddening bureaucracy that will come with Obamacare, the Republicans, if they play it right, should find themselves in an excellent position to put a stranglehold on Congress and set themselves up for an excellent chance to win the White House in 2016.

The GOP will be blameless in this fiasco. The warnings from Republicans since Obamacare was first proposed about the consequences of the law will make the party seem like soothsayers. The Democrats will be forced to defend a law that caused a recession, significantly increased insurance costs to families, and brought many businesses to their knees. It's hard to see how the elections of 2014-16 won't severely damage the Democrats and make them a minority party for the foreseeable future.

Democrats will try their best to put lipstick on the sow but dressing a pig in a formal gown won't make it a prom queen. The implentation of Obamacare will show the American people what they've been missing by not living in Europe.

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