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HIX Bedeviled By Tech, Resource Hurdles

Scott Mace, for HealthLeaders Media, July 23, 2013

This IT effort dwarfs many previous governmental and non-governmental interoperability efforts, yet the PPACA states must be up and running by Oct. 1, 2013, when state-run and federal-run health insurance exchanges open for business, initially primarily through healthcare.gov.

As yet, private health insurance providers such as HealthInsurancePlus are, for now, locked out of the development process. Somehow, just 70 days from now, it will all be different. Exchanges are planning bronze, silver, and gold plans, but won't be able to reveal final rates until October, Hege says.

Even more confusingly, employers with groups of 50 or more employees don't have to offer insurance to those employees until January 1, 2015. That deadline was extended, in part because of employer concerns about the complexity of the data reporting requirement.  

"It is unlikely to be perfect out of the gate," says Rep. Jackie Speier (D-CA), in what was the understatement of last Wednesday's hearing.

The make-or-break technology of health insurance exchange has to be CMS's Federal Services Data Hub, which was never actually formally described in PPACA. Instead, the Hub arose out of PPACA's language requiring the exchange of information between IRS (for income verification, filing status, number of dependents), DHS (for citizenship verification), and HHS, which will compute rebates due Americans on their health insurance premiums, and communicate that information back to the IRS.

Got that?

Well, talk that kind of talk about aggregating that much information about any one American, and you are going to run into every sort of privacy concern you can imagine, even in this day of Facebook and generally acknowledged big-data surveillance by the NSA, credit bureaus, and the like.

It's easy to imagine that IRS/CMS/DHS/HHS information sitting in a single, massive database somewhere in the federal government's computers. Yet, that's not how the system is architected, say federal officials.

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