Does HealthCare.gov have a future?
- By Chase Gunter
- Jan 04, 2017
The Affordable Care Act, since its inception, has faced staunch Republican opposition, and the botched rollout of the HealthCare.gov site in October 2013 only amplified calls to "repeal and replace" the law.
Now, as Republicans prepare for a congressional majority and control of the White House, ACA's foes are expected to seize the opportunity to rework the current health care system, including the HealthCare.gov marketplace.
HealthCare.gov is the web-based marketplace where users shop for health plans. It includes a data hub that transmits eligibility information across federal agencies and an identity management system that handles user registration and updates and pings insurance issuers and the exchanges in states that manage their own systems.
Repealing ACA would eliminate the federal role in providing federal subsidies for private insurance plans and end the need for a government-sponsored insurance marketplace.
In this sense, Healthcare.gov is "a single-purpose site in a lot of ways," former Health and Human Services CTO Bryan Sivak said. "The actual marketplace site will exist as long as there are plans to be sold."
Sivak added that dismantling the website is a trickier proposition than simply pulling the plug.
"The creation of the marketplace is actually something that's in law," he said. "It's not something that you can easily undo, and you'd have to pass a law to do that."
If the ACA is immediately repealed, these marketplaces "will cease to exist," former HHS CIO Frank Baitman told FCW. However, he added that he believes an immediate repeal and replace is unlikely.
"I strongly doubt… that they repeal it Jan. 20, and there won't be some period of time to install replacements and transition people off it," he said. "[Shutting down the site] is not just a hardware and software issue, that's a markets issue. The repeal has to be done in a way that doesn't disrupt" the marketplaces.
The Centers for Medicare and Medicaid Services announced Dec. 21 that 6.4 million Americans signed up for healthcare plans for 2017 on the site, including more than 2 million new customers and an increase of more than 400,000 compared to this point last year. In total, CMS estimates that HealthCare.gov supports almost 19 million users.
If the Republican strategy ends up being to pick away at pieces of ACA rather than to completely overhaul the law, Baitman suggested that avenue could "introduce instability into the markets."
In the short term, if Republicans opt to roll back Medicaid, patients' "only option will be to go to the exchanges, so you might see more people turn to the site," Sivak said.
However, if a full overhaul is ultimately pursued and effectuated, the online marketplace could be shut down in favor of "private sector actors that have built comparison sites on and off exchange," Sivak said.
But even in that scenario, Baitman said, a plan to wean citizens off the current healthcare system would have to be produced. During the transition to whatever the ultimate replacement plan is, the government could simply stop taking new customers via Healthcare.gov, Baitman said.
Another issue facing the law's opponents is the outstanding contracts held to work on the site.
The system ultimately cost more than $1 billion to stand up. After the rollout and subsequent "tech surge" to stabilize the HealthCare.gov site, operations have gone smoothly from a technical standpoint.
Currently, Accenture is handling software and support for the marketplace systems, under a contract that can be extended through July 2020. At least $301 million has been obligated under the deal, on a ceiling value of $596 million.
Booz Allen Hamilton has a five-year deal to act as integrator that could be extended through Dec. 2020 and has a maximum value of $192 million. So far, more than $72 million has been obligated under that contact.
"The new administration is not going to want to be seen as technically incompetent," Sivak said. "They're not going to let a contract lapse."
Chase Gunter is a former FCW staff writer.