Here’s something to think about. The rollout of the ACA has been neither a failure or a success. We just don’t know yet.  I cannot count all the times I have heard people that claim to support the ACA  pronounce what a disaster it was at its rollout. What rollout? The rollout of a handful of changes almost right after it was signed? Remember those? Your kids could stay on your insurance until they reached 26, and they could not be denied coverage for a preexisting condition. Or maybe you mean the changes that went in after that. The ones that started to close the “donut” hole created by the truly disastrous Medicare prescription coverage passed during the G. W. Bush years. The changes I mentioned and some smaller ones have already saved Americans millions of dollars and increased coverage. Oh, and I forgot to mention that many people got rebate checks because their insurance companies were not efficiency compliant with the ACA.  All of that adds up to real money in the pockets of millions of Americans. Money they can spend. The ACA is likely one of the reasons our economy hasn’t tanked under the backwards economic policy of austerity. The ACA is a stimulus, a tiny one, but it at least helped to keep the American economy from tanking.

And during those two years while these changes were coming on board, where were the opponents of the ACA? Were they scouring the bill to figure out a way to make it better?  How about rewriting a better and easier to understand Health System? Something to bring to the citizens as a plan their party could stand behind. Something that was not written on the 10,000 pages they repeatedly remind us is the size of the ACA. Speaking of repeating, that is exactly what they did. Repeatedly passing bills in the House. Bills they knew would not pass the Senate. Bills they knew the President would veto. Somewhere around 40 times the Republican House majority voted to defund, repeal, or shatter the ACA. Think about this, they never included changes to the ACA that might interest a few Democrats. Not once.

There was one other thing Republicans all across America were also neck deep in. They brought lawsuits. Lots of them. Eventually 2 of those suits ended up in the Supreme Court. And, as one could guess based on the Republican’s tendency to not fully understand the US Constitution, the ACA was upheld as Constitutional. But, the Supreme Court in its current incarnation is a conservative court.  They ruled that the expansion of Medicaid had to be left to the states to choose. And to make things easier for Republicans to attack, they reasoned that it was Constitutional because it was functionally a tax.

This all happened about 15 months before the next step towards the next rollout was to take place.

If you have any familiarity with the implementation of a large business system you will know what I am about to describe. If not, ask someone that has. Do not ask someone that writes apps for your smart phone, or the teenager next door that fixed your computer and even put that pretty picture on your screen. Be assured, the web screens that users encounter can be mocked up in a few hours by anyone familiar with web design.

The most difficult part of the online information exchange is the part you don’t see. It’s the database. That is where all the information is gathered into separate related groups. The information is pulled in from systems all across the nation. These are state systems and insurance company systems. Most of them have never “talked” to each other. One may store a common item like a name with the entire name as a single element, others break it down to each common component of a name; first, last, middle, suffix. The designers must integrate all these very varied data elements into something that can be mapped from one plan in one state to any person in that state. This all had to be ready for each state to access on their own system. Then the Court ruled that states could opt out of Medicaid and that meant they were not building their own web access. The US had 16 months to develop a web page to manage all that under the covers complexity. Actually, many states delayed deciding what they would do, so in many cases it was as short as 6 months or less.

The day came when the system went live, and what a surprise it didn’t work. Note the rollout of the next phase of the ACA, even now, as I write this, still has not occurred. That is an extended period from January 1st to March 15th.

When the web page was found to be unable to link correctly, would lose data, or just crash; the President brought in a team and they mostly fixed the problem. In IT, the true test is not so much does it do everything its supposed to do when you throw the switch, but can it be fixed. Because the bigger the system is, the less likely it will work on day 1. In this case it appears that ACA  is a success at signing up a large segment of formerly uninsured Americans by January 1st, 2014. And wasn’t that the intention?



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