(Corrects paragraph 21 to say "the glitch may lie in itsintegration," instead of "the glitch may not lie in itsintegration." Removing the word "not.")
By Sharon Begley
NEW YORK, Sept 28 (Reuters) - Just days before the launch ofthe new U.S. state health insurance exchanges that are thecenterpiece of the Affordable Care Act, a nationwide push isstill under way to test and patch the technology behind theonline sites.
Officials working on the sites have acknowledged thatinformation technology (IT) failures will prevent many of themfrom functioning fully for weeks, and perhaps longer. That willslow the government's drive to enroll millions of uninsuredAmericans under President Barack Obama's healthcare reform lawstarting Tuesday.
From a political standpoint, a successful opening day willshape perceptions of Obama's signature policy initiative. Butthe system's functioning is to a large extent beyond the controlof politicians and policy experts, and instead sits in the handsof the battalions of coders working for IT sub-contractors.
Six months ago, people involved in setting up the exchangeswere more hopeful that everything would be ready on time, saidCristine Vogel, an associate director at Navigant Consulting.
"I don't think there were enough hours in the day, or enoughpeople with the skills," she said. "When we look back, I thinkwe'll see that we missed an opportunity to share technology."
Opponents of the healthcare reform known as Obamacare saythe computer problems bolster their view that the 2010 law is a"train wreck" and should be delayed or repealed. The Obamaadministration insists the exchanges will be open for businesson Oct. 1, even if some uninsured Americans may not be able tobuy coverage right away. More importantly, they say, the newhealth plans will begin to provide health coverage on Jan. 1, asplanned.
"So long as the website is accessible and the plans and theplan information are displayed properly so a consumer can shopfor coverage and compare the plans, they will claim victory,"said Chris C1ondeluci, an employee benefits attorney at VenableLLP and a former staffer at the Senate Finance Committee whohelped draft the Affordable Care Act.
This week, the Obama administration said itsSpanish-language website would not be ready in time, and that itwould be weeks before small businesses and their employees couldsign up online for coverage on exchanges operated by the federalgovernment.
The exchanges in Colorado and the District of Columbia,meanwhile, cannot calculate the amount of federal subsidiescustomers qualify for.
In New York, the exchange is not able to transfer data tosome insurers instantaneously, as planned, one carrier toldReuters. Instead, the data will be sent in batches once a day orso. The glitch will not affect customers, but it raisesquestions that New York might have other IT problems.
Oregon had sufficient qualms about its online insurancemarketplace that no one can enroll unless they use a trained,certified agent or other "community partner."
As late as this week, Oregon also had trouble correctlydisplaying information about insurance plans on a test site. Theproblem could mislead customers about deductibles, prices andother details if it occurs on the live site Tuesday.
In Ohio, Lieutenant Governor Mary Taylor, a fierce opponentof the healthcare law, said in a radio interview this week thather state's online exchange, which is being run by the federalgovernment, could well crash on its first day.
In testing, she said, some plans filed by insurers "sat in aqueue for the federal government for a week, so my concern issomething similar is going to happen on October 1 because of theamount of (online) traffic."
WORKAROUNDS OFFERED, TAKE TIME
In most cases, exchanges will offer workarounds that willtake time to execute. In Washington, D.C., off-line contractorswill calculate federal subsidies and inform applicants what theyqualify for in November, by which time the online calculatormight be working.
In Colorado, until at least November, customers will have tocall phone service centers, where representatives will manuallytake them through the calculations to determine what subsidiesthey qualify for.
Even before the exchanges open, the finger-pointing hasbegun, with states blaming contractors for glitches andcontractors blaming states or other contractors.
The system to calculate federal subsidies for the D.C.exchange was built by Curam Software, which IBM acquiredin 2011. In tests of complex family situations, the software wasgetting subsidies wrong 15 percent of the time, said exchangespokesman Richard Sorian.
In a statement, IBM spokesman Mitchell Derman said the city "decided that a phased-in approach best meets the needs of itscitizens." He pointed out that Curam also built the eligibilitysoftware in Maryland and Minnesota, "two states that plan tohave full functionality on Oct. 1."
In other words, a company that achieved its goal on time intwo states fell short in a third. The reasons, said outsideexperts, include relationships among contractors and thespecifics of existing computer systems in a state.
In Washington, Infosys, the giant Bangalore,India,-based technology company, is the system integrator - thecontractor that takes software from sub-contractors like Curamand puts it all together. The fact that Curam's calculationsoftware is working on other exchanges suggests the glitch may lie in its integration with the D.C. exchange's other IT.
"A software package like Curam's is put into the system bythe system implementer, not the software provider," said an ITexpert not involved in the D.C. exchange. A spokesman forInfosys was not able to comment on its D.C. work.
MEDICAID SYSTEMS POSE HUGE HURDLE
One of the most difficult IT jobs has been to integrate eachhealth insurance exchange with its state Medicaid system. Theselegacy systems are typically decades old. In Massachusetts, forinstance, the system runs on the COBOL programming language,which is to today's languages like a rotary phone is to aniPhone-5.
"These legacy systems are old and difficult to configure andre-configure," said Tom Dehner, managing principal at HealthManagement Associates, a healthcare consultant, in Boston andformer director of Massachusetts Medicaid.
"To change how eligibility is calculated," as federal lawnow requires, he said, "you need to modify your Medicaid system,and that's not something you can do by buying software off theshelf."
The difficulty of interfacing with Medicaid will keepColorado's exchange from calculating subsidies online.
To determine eligibility for federal subsidies, explainedNathan Wilkes, a member of the board of Connect for HealthColorado, the system "first goes through Medicaid determination.That means connecting to a legacy system," he said.
"Six or nine months ago we got an early warning that the waywe wanted to integrate these systems wouldn't work, and thentime got away from us."
Colorado's exchange tested 100,000 scenarios to see how itssoftware calculated subsidies, and got error after error.
"It's an IT nightmare," Wilkes said. (Additional reporting by Lewis Krauskopf and Caroline Humer;Editing by Michele Gershberg and Doina Chiacu)
- Barack Obama