Margot Sanger-Katz at the New York Times has an excellent piece on the pragmatic implausibility of the Cassidy-Graham bill’s desire to let the states do everything on January 1, 2020:
The challenges would fall into two major categories. First, states would need to make political choices about what they want their system to look like. Next, they would need to submit applications, hire contractors and build new systems to run them. Neither would be easy.
The bill would make health care an active, high-stakes political debate in all 50 states. Under Obamacare, states had limited, rather binary policy choices, and even those were hard for state governments to make quickly….
Once states choose a policy approach, they would need to bring it to life. If they adopt a government-run approach, in which people can enroll in a single public health plan, they will need to develop the parameters for that program and put it out to bid. If they select something similar to Obamacare — some sort of insurance market with income-based subsidies — they will need technology systems that allow them to verify people’s eligibility and income, and link state assistance with their insurance purchases.
Most states have lengthy contracting processes, in which they must request proposals and review multiple bids before signing up vendors. Those deals would need to be in place before any software building begins.
The bill envisions that states would have complex programs up and running in twenty seven months from the moment the bill is signed. The bill has numerous instances where the Secretary of HHS has to make new rules and regulations. This timeline is ridiculous. I looked at this matter last November:
Any big bill will have major rule making. Any big bill will require insurers to reconfigure and retweak their systems. I worked 70 hour weeks from roughly July 2012 to October 2013 to get my little part of the QHP Exchanges to a point where the user facing chunk was minimally functional. I then spent another six months getting all of the back-end mechanics of directory and network information working cleanly in an operational, no human intervention sense. (I was up 53 of the 60 hours before October 1, 2013 launch date getting the final network directory ready to launch)….
the functional time frame is shorter as any insurance company changes need to have a code freeze at least three months before the open enrollment period for effective testing. We could hold a hundred million claims for the first quarter of
20192020 but that would be BAD (TM). So assuming an October 1, 201 89 open enrollment period, the insurers need to have their changes in the final test environment by the middle of July which means development specifications for minor changes need to be developed by January…
Twenty seven months is enough time to launch a tweak with a fair probability of success. Twenty seven months is grossly insufficient time to launch new, complex programs.