IT threatens exchange enrollment

Consumers also have to determine if they’re eligible for federal subsidies to pay for insurance. The exchange verifies incomes and citizenship, but income verification will have to go through the IRS and the Department of Homeland Security for citizenship check.

There will be millions of files passing information back and forth. Communicating between systems is key but exhaustive.

User experience

Then there’s the user experience, which might not be as simple as most have been led to expect.

While some people might be able to easily sign up online, others with more complicated situations — say, when one spouse qualifies for Medicaid and the other one doesn’t — might have to be handled manually.

But a lot of the issues with the exchanges will come down to trust and confusion, insiders warn. First off, people have an inherent distrust of technology. And a handful of consumers who don’t regularly use websites now will be forced to go online to sign up for coverage. That can be a steep learning curve.

Industry experts also warn of potential scams and fraud that might hurt consumers who think they’re logged onto their state’s exchange.

“The unknowing public will be bombarded by scams,” Nelson says.

Scams could be amplified because Obamacare confusion is so high. Poll after poll confirms consumers remain unaware of the law and its details.

‘A model in place’

Though some say it’s an unprecedented IT challenge, Nelson doesn’t agree.

“I liken it to the Medicare enrollment process,” she says. “The technology is there to support that. We’ve got a model in place.”

But other experts note there have been challenges in Medicare’s online process. When Medicare’s prescription drug program launched in 2006, for example, some seniors mistakenly got enrolled in several programs; others paid the wrong prices. Nelson admits the Medicare model is “painful” and “confusing” for many users.

Nelson says she’s confident the technology can handle the open enrollment process—but that’s also because she doesn’t anticipate most Americans logging on at the same time.

“I think the technology model has been around to support it, and it will be capable of supporting the early attack because I don’t think the early attack will be very significant,” Nelson says.

That’s a viewpoint shared by Jim Sugden, Connect for Health Colorado’s small business marketplace manager.

He said earlier this summer that he doesn’t expect people to flock to the exchange as soon as it opens in October.

“We are realists,” he said. “We think people will start shopping, but we know they are going to really think about what’s best for them.”

Contingency plans

Meanwhile, state-run exchanges — and the partnership exchanges — should fare better than the federal-run exchanges.

That’s Riley’s prediction, at least.

“The majority of these states running their own exchanges have their own contingency plans,” he explains. “[State-based exchanges] have more skin in the game than anyone else.”

For example, Vermont officials have said if something goes wrong with the web portal, they have a paper process as a contingency plan. From October to January, the state is planning to print out Vermonters’ information and file hard copies with insurance companies — just in case.

Connecticut — which also is running its own exchange — is opening storefronts in seven cities in the state. Access Health CT will plant itself in the neighborhoods of the state’s biggest and poorest cities in an effort to reach the largest possible number of uninsured people.

That’s going to help send the message to residents directly, state officials say.

Kathleen Tallarita, Access Health CT’s public relations and outreach manager, says it’s not part of a contingency plan, per se, but it’s a method to make sure the state’s residents have the ability and knowledge to enroll.

“We think it will be helpful for people to go into a store and actually talk to a broker or navigator [who will be at the storefront] and have them walk them through the process of enrolling rather than possibly being intimidated online,” Tallarita says. The plan also is intended to help those who don’t have a computer.

It’s the perfect plan, Riley adds: “If it’s IT Armageddon, you can still enroll in Connecticut by going to these stores.”

Riley says he doubts the federal government has adequate contingency plans in every state.

“I predict [consumers] will still be able to enroll, but I just don’t know if the majority of it will be seamless, real-time, online enrollment.”

Instead, Riley expects a lot of consumers will default to the mail, phone, in-person or storefront enrollments. But who is handling those operations remains unclear.

Riley says consumers should expect a “plethora of problems.”

But the real test is the contactors who are helping create the exchanges, along with HHS, to “immediately resolve those bugs and correct them.”

For example, if there “are six things wrong [with the exchange] and 45 days later, there are still problems with those six things, then we have a problem,” Riley says.

“But if there’s six things identified, and in less than 24 hours they fix them, then there’s light at the end of the tunnel.”