Monday, November 4, 2013

ACA website – it’s complicated and some users are just SOL

NetworkThe computer systems of all levels of government are so diverse it is amazing to me any operating system can talk to another government operating system. Just look at Virginia’s debacle with Northrop Grumman. Have we forgotten that so soon. DMV downtime – every agency doing their own computer “thing.” The original contract was for $2.3 billion over 10 years. Then with disagreement and missed deadlines $9 million was added to that in a revised contract.

Now consider that at the federal level. It is no wonder the rollout had a “glitch” to put it gently.

Though I don’t know exactly what systems the federal government has I feel IBM mainframes are involved. As a consultant not that long ago that is what I encountered.

This is what I suspect. The operating system at the front end is UNIX based or oh Lord I hope it isn’t LDAP on a mainframe. Anyway that front end has to validate enrollees income at the IRS to check for subsidies. Then they must connect to the state’s system (whatever it may be) to validate there.

For my IT friends I suspect it might be CICS or DB2 databases on the IBM Z/OS mainframe for the IRS – possibly Oracle. Hope to hell it isn’t MS SQL database somewhere too.

The best way to communicate with disparate operating systems is with IBM’s MQSeries, a messaging interface that can kick off a transaction or program on many disparate systems. Anybody know what I’m talking about? No that’s OK because I just want to throw out how complicated this is at a federal level versus the state level. If you have not heard the state exchanges are doing much better.

Native UNIX is not so secure but the old reliable IBM mainframe is – so I hope to hell most of the data is stored there. A little encryption on the data would do wonders too.

Validation is returned to the unsuspecting user through comparing their SSN and name to IRS and state records (note it asks for your state upfront so it knows where to go). Needless to say the network and routing of all this data (through routers that direct this traffic on the internet) is intense.

Say everything goes OK and no router fails and the user enters their information correctly then they are presented with the insurance company(s) that have applied to be on the exchange for that users particular zip code. It can be only ONE or two as in some North Carolina counties.

The insurance company’s policy plans are displayed for the user. This data is probably stored locally (I hope) as the insurance company application to participate must have been entered at some point.

Then at this point all the users information is stored locally I assume so the user can leave and come back and log on after they think about it for awhile.

Now some states like North Carolina and Virginia have not expanded Medicaid. Those families between 46% and 100% of poverty earn too much to qualify for Medicaid coverage and they won’t receive subsidies to buy health coverage.

The message returned to these working poor applying for insurance will say something like “Your state has opted out of Medicaid expansion – you are SOL.” Seriously this message is returned to the user … well maybe without the “SOL” part.

For the sake of analysis say you can continue with or without a subsidy and you pick your Bronze to Gold insurance plan. All your data is submitted to the insurance company to issue your policy. NOW this great newly written program has to format the users data into something the insurance company’s computer operating system can read, evaluate and confirm back to the user. They will store the user’s data and plan selection also to pay submitted claims later.

Money eventually changes hands through automated deduction or billing and the user is insured on January 1, 2014.

There is another “glitch” or more likely a data formating error according to insurance company accounts. Valid data executed by the programs and procedures that the Canada contractor CGI geniuses wrote missed the boat on passing that data correctly. The insurance companies are receiving duplicate data, missing data and erroneous data like a woman having three husbands.

Get the picture? It IS all about volume, disparate computer operating systems, poor programming and poor testing. Even the robust MQSeries feature can’t help with poor programming. It can only execute what it is told. Using MQSeries is just my assumption but I do know it executes in a secured channel. Banks are famous for using it for credit card transactions.

For example it can be a “read only” channel or a “write only” channel. I’ll just leave it at that. As you can tell I’m a big fan of MQSeries due to its reliability, speed and security.

THE END but not really – that will be November 30. We hope. I dare say that flowchart would be a sight to see.

Posted By Valerie Garner

Categories: Finance, National, Politics

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