Krugman: If Obamacare can work in a state of 38 million people, it can work in America as a whole

[frazzled]

13. It's not about not being "done right" at the federal level

It's that 36 states, with 36 different eligibility requirements and 36 different databases and software systems to tie into, decided not to set up their own exchanges. Integrating them is a nightmare beyond nightmares.

Seattle Times, on why Washington State (or California) isn't having the problems that the federal government is:

Under the Affordable Care Act, states that chose not to create their own exchanges are to use an exchange set up by the federal government — Healthcare.gov. Thirty-six states chose not to create their own exchange.

The federal system must be capable of integrating with multiple-state eligibility databases.

“It’s just the complexity of their scope vs. ours,” said Curt Kwak, chief information officer of the Washington Health Benefit Exchange, the public-private corporation that manages Healthplanfinder. “We focus on just one state, but they are having to focus on 36 states. It’s just that much more complex.”

Robert Booz, an analyst with consulting group Gartner’s health-care-industry research unit, noted that each state has different computer equipment, different software and different bureaucratic structures. Tying them all together, Booz said, “was an incredibly complex, very short-fuse situation.

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According to Kwak, his team benefited from being able to focus solely on the issues peculiar to Washington state. That meant, of course, building a clean consumer website and preparing for integration with the federal Data Services Hub, a data center managed by CMS that provides one connection to the common federal data sources (including the Social Security Administration and the Internal Revenue Service) to verify consumer application information for income, citizenship and immigration status.

But the trickiest part, Kwak said, was integrating the state eligibility system, which tracks services — including Medicaid — that residents are eligible to receive. The state decided to build that leg of the system from scratch.

http://seattletimes.com/html/localnews/2022149296_acaexchangesxml.html