S.F. programmers build alternative to HealthCare.gov [video]
cbsnews.com
cbsnews.com
E.g. the front end registration problem is due to a late requirements change in August that had the effect of preventing window shopping, plus we know there were changes ordered though the week before launch, and no integration testing until 1-2 weeks before launch, and that discovered it locked up if 200 simultaneous login attempts were made or if it had ~1,100 users on it.
So, yeah, those are scaling problems, but not ones we can necessairly blame the techies for, given that they didn't have enough time, and couldn't do integration testing (the government's CMS was the integrator and integration tester, now replaced by QSSI, the ones who did the "data hub"? I think it's called, which is supposed to be not so bad).
But also no, in that the fix-it czar's #1 declared priority is to fix the garbage 834 EDI transactions that are being sent to insurers. That includes incorrect data and incorrect transactions (e.g. multiple enrollments and cancellations for the same person). Based on that, the front end's problems have been a blessing in disguise, because the insurers are only getting a few hundred enrollees a week and that low volume allows the insurers to call each up and straighten out problems.
An estimated 16 million policies in the individual market, and an unknown number in Obamacare's interim high risk pool must sign up for new policies by December 15th or so or they'll suffer a lapse in coverage, which for many of the latter will be fatal. The only way to get subsidies is through the Federal system, i.e. the state exchanges use it for that (maybe with inaccuracies, but it's evidently working for the state exchanges that are working, but don't judge that for any given state exchange until you find out which are getting Obamacare and the much larger numbers reported to be signing up for Medicaid), and that makes sense to avoid fraud, since it results in direct payments from the Federal fisc.
The biggest problem, from a usability and a technical perspective, is the hiding of the information till you have signed up and given details. Apparently this constraint was added at the last minute, I wonder if insurance companies insisted on it?
What percentage of people with individual plans (who need to get new plans) would actually qualify for subsidies? I don't, so I have more options: (1) I can buy another individual plan from my insurer (2) I can shop other insurers or (3) I can buy from california exchange
In none of those scenarios do I actually care whether healthcare.gov is working. I suspect I am not alone.
People are going to suffer, because of lapses in insurance, or because they simply can't afford the costs of new Obamacare compliant policies (between the new essentials like coverage for your kids till age 26, and all the cost shifting), or are too proud, moral, or whatever to divorce to get their costs down.
ADDED: This is going to really hit the early retirement thing and availability of slots for people to move up in. A very large fraction of the horror stories I'm reading are about early retirees who are not yet 65 and therefore moved to Medicare.
Is CoveredCA really working that well? From an anti-Obamacare site, some statistics and analysis: http://insureblog.blogspot.com/2013/11/coveredca-statistics-...
I don't understand why you're required to use the exchange to get the subsidies, anyway. Why not let people claim the subsidy directly through an insurer? Then turn healthcare.gov into a static site that simply displays the options and redirects to an insurer's web site.
After all, the subsidies are only an estimate. The actual amount is only calculated on the 1040 tax return. So why should this be any different from tax withholding?
We don't make everyone pay estimated taxes through a centralized site. We let employers withhold an estimated amount, and then the IRS balances the accounts annually, in a batch process.
Erk: if you're right about estimates and it depending on that years tax return; what do you do if you lose your job and can't afford to pay the unsubsidized rate? What if you earn a lot more money, spend too much of it, and then get hit with a huge bill next April 15th?
I'm disabled and on Medicare so I haven't been looking into these fine details ... this all sounds unworkable to me at first glance, unless it's retrospective based on ... the last year's tax return, but, erk, can't do that either since that don't be doable before the mid-December deadline necessary to get you into a insurer's system.
WTF???
ADDED: this probably explains why the Federal system has to do this, access to IRS payments data (e.g. withholding) is required, it's sensitive data and only they have all of it. Although Experian has a income verification role (people without credit, like sick young adults who can't leave the nest are at last count thoroughly screwed because the Federal site isn't handling this manual intervention well or at all), but I assume that's a double check. Maybe not? Maybe they couldn't get that info out of the IRS's generally high latency (often weeks and months, sometimes years) computer systems?
But why is it any different than the desire to avoid fraud through underwithholding of income tax?
If someone files an in incorrect W-4 and underwithholds by $2000, then the Treasury is out $2000. If someone files a fraudulent insurance application and gets $2000 of unwarranted subsidy, then the Treasury is also out by $2000.
It's the same $2000, whether the Treasury writes some checks to the insurance company, or fails to collect it from an individual on his paychecks. Either way, the $2000 gets paid back on the tax return -- or the IRS goes after you.
> Erk: if you're right about estimates and it depending on that years tax return; what do you do if you lose your job and can't afford to pay the unsubsidized rate? What if you earn a lot more money, spend too much of it, and then get hit with a huge bill next April 15th?
Again, not different in principle from income tax withholding. If you do not withhold the right amount, then you may get hit with a big bill or receive a big refund when you file your 1040.
The main difference is that the subsidy does not automatically adjust. Withholding tends to automatically go up and down with income, because it's calculated by the employer on the paycheck. Whereas the insurance subsidy stays constant unless you make changes.
If you lose your job, you're supposed to tell the exchange so that you can get a bigger subsidy. If your income goes up, you're supposed to tell the exchange so that you can get a smaller subsidy.
With insurance subsidies, scamming "insurance" companies can sign up nonexistant people etc. and collect those payments from the Treasury until someone catches on months or years down the road. Hence the need to reconcile everything in one central system.
In the case of individuals committing fraud, many would do so simply because they can't pay the higher premiums now demanded of their subgroup (there's a lot of cost shifting), so you have more of a "can't get blood out of a stone", and the optics for the IRS are horrible.
For your latter point, you're saying you make a 2013 enrollment based on partial 2012 data, and if you've got your act together you adjust with healthcare.gov or the linked state site as things change. Which I'm familiar with, the quarterly payments for those who don't withhold ... but I bet this'll hit a lot of people who aren't used to this sort of thing, but the automatic withholding of income that HR/ADT/whomever does for your paycheck....
If you claim an undeserved subsidy, then that means you earn too much for the subsidy. Which means you earn enough to pay for healthcare. You may want to spend it on something else, like your mortgage. But then we're back to the underwithholding situation.
The Social Security Number prevents subsidies from being claimed for nonexistent people. It's like the "phantom dependents" problem on income tax returns. When the IRS began requiring an SSN to be provided for each dependent, the problem went away.
I'm not convinced that fraud would actually be a major problem. It's not like you get the whole year's subsidy at once. You get it a month at a time. Instead of running the income-check interactively, run it as a batch process after the first month of coverage. Then investigate the most egregious cases -- either individual or insurance company fraud.
If an insurance company is committing fraud, take it out of next month's subsidy payments. Remember -- we're already trusting these insurance companies to provide a whole year's worth of coverage, until the next open-enrollment period. They're around to be accountable.
Your last sentence indicates you know the truth about the statement your penultimate sentence makes. Which might be better stated as "Which means you earn enough to pay for healthcare according to this dog's breakfast known as the Affordable Care Act", which following our version of Newspeak for the naming of political bills tells us it's unlikely to be always, or maybe generally affordable.
"The Social Security Number prevents subsidies from being claimed for nonexistent people."
Good point. Change "nonexistent" to "real people under 65 not in the system" (the SSA knows the age). Like illegal aliens using other's SSN numbers, a scammer "insurance" company could just harvest numbers and other ID information for people who aren't buying insurance through Obamacare (hard to say, but a selection of young ones should be fairly safe) and those covered by employer plans, unless and until those people are reported to HHS.
"[Insurance companies will be] around to be accountable."
I'm postulating the creation of new, entirely or partly fraudulent ones (e.g. Obamacare subsidizes the creation of co-ops), or the subversion of existing ones. If there's "free money" to be had, it's likely stupid people will try to grab some, no matter how likely or certain it is they'll get caught.
You cut off my actual last sentence in the paragraph, which compared it to underwithholding on income taxes. This is what I keep bringing up, and you keep ignoring. This is not so different from income taxes.
Someone who earns 400% of poverty level owes $5000 in federal income tax, plus maybe another $5000 in local property tax and possibly state income tax. They might want to pay that $10000+ towards their mortgage, rather than to the government.
Since you're clearly very concerned about the financial burdens imposed on those less fortunate among us, I hope you'll support eliminating all taxes on those earning 400% or less of poverty level. We can make up for it by taxing the rich more heavily. What do you say?
Or perhaps we should do the same for health insurance. Single-payer system, paid for by progressive taxation.
I'm afraid I don't follow. Why would self-employment or low wages make it more challenging to sign up directly rather than through an exchange?
I'm not proposing any changes to the subsidies. Simply remove the requirement to go through an exchange to get the subsidy.
In the former situation, some people just cannot afford it.
In the latter situation, you can have some fraud (by the insurance companies).
I guess they could offer both options, and if you choose the latter, you need to apply through the government, so they can verify that you exist, etc.
Just do a random spot-check of all the policyholders that the insurance company is claiming a subsidy for. If the amount claimed is more than x% over the amount calculated by the government, then the insurance company gets cut off.
Right now, by forcing people to buy on-exchange to get the subsidy, we're essentially doing the spot-check interactively. This is putting tremendous load on the healthcare.gov back-end. There's no reason this couldn't have been done as a batch process instead.
I don't mean to pick on you; it's just a cumulative reaction, plus it happened to be the first thing I read this morning. I agree that back-end integration is likely orders of magnitude harder than UI for a system of this nature.
That said, they definitely did improve upon the government's front-end/implementation.
But without a doubt they eliminated all of the cruft and whittled the site down to exactly what consumers want. I want the ACA to succeed and would love to see some variation of this "quick lookup" on the official site. The government would be wise to pay it some attention.
http://www.thehealthsherpa.com/
Enter your zip
Look at a list of plans with filters for my info.
Click one of the plans for info and get a phone no
I didn't have to fill in some long forms, I got straight to the info which counts without giving out any identifiable info.
Click on see plans now - this leads to a page of info with no plans information - great! Hit back.
Go back to home and click 'apply online'
Choose a state - read some info on the problems with this state
Click another apply online button
Click 'get started' to really get started this time!
Am confronted with a form asking for all my personal details, I stopped here.
Now of course that doesn't mean they have replaced healthcare.gov, or done in two weeks what all those developers working for the gov took $400m, but I'd say they've delivered something which is more valuable because it delivers what people actually want - a quick set of choices about healthcare for their specific area, and contact details for the same. It's a good summary of a complicated situation, presumably based on lots of the hard work done for healthcare.gov (assume they scraped the data).
You're not going to sign up for a plan without verifying costs anyway (by phone or on the providers website), so providing a quick summary with contact info is really all they need. I'm not convinced the apply online side of obamacare is actually helpful...
In the UK and quite a few other countries, this monthly insurance cost comes out of taxes and we don't choose an insurer, I think I prefer that single-payer solution.
edit: fixed time period
From one of the comments, below
So the official healthcare.gov is by design then.
November 8, 2013
Eighteen percent of uninsured Americans have attempted to visit a healthcare exchange website. The percentage is slightly higher, 22%, among uninsured Americans who plan to get insurance through the exchanges.
____________________
== Working like a charm.
It is a beautiful and commendable project.
I wonder how much of Healthcare.gov's problems could have been eliminated if the sign up was more modular...users were allowed to browse before signing up for anything. Then they could sign up via email and tentatively pick a plan. Then in 3 days, they go through the full authentication process...this is similar to how Amazon does things...you can sign up without a credit card, you can browse without signing up, and you don't go through the processing bottleneck till the very end.
Since then window shopping has been allowed, but I don't know if the "under penalty of perjury" bit was dropped.
As to "what happened", I'll just point you at this Washington Post article and let you come to your own conclusions: http://www.washingtonpost.com/politics/challenges-have-dogge...
Note also the front end traffic jam has avoided sending the insurers more garbage 834 EDI enrollment and cancellation transactions than they can manually clean up by contacting enrollees. That's the #1 thing to correct according to the fix-it czar.
And I do agree with you, an Amazon system, which I'm sure is based on the BASE eventual consistency back ends, e.g. you don't get your confirmation email until it decides who "won" the last copy of an item, would have been a lot better. But then again the contractors were doing a lot less of that sort of top level design that you'd think (see the Post article).
In my view, a site like this is useful for a lot of purposes beyond actually signing up for health care. For instance, I've got employer sponsored care, but I was simply curious about what my costs would be through the exchanges. I also want to be an informed citizen, and "how much does it really cost" is an obvious question that anybody might be inclined to ask. In my view, knowing the magnitude of the numbers should help provide a reference point for political debate.
As others have mentioned, these sites don't actually solve all of the problems, but it seems to me that a few free tools that just help people gather information would take some of the pressure off of the main system. And if enough of these tools were to crop up, then none of them would have to be 100% reliable.
Simply making people less nervous about signing up will make the official process work better.
And having learned that, you could now go to individual insurer's sites, or various ... marketplaces? like http://www.ehealthinsurance.com/ which I've also tried, shopped around (that site even integrates "is your doctor in the network", at least for Humana), and gotten yourself covered.
But everyone was told to go to Healthcare.gov, and right now individual states are doing a lot of marketing for their own sites, some of which aren't sufficiently functional....
However a lot of people are due and need subsidies, e.g. see this link I found using Google right after the Kaiser one: http://obamacarefacts.com/obamacare-subsidies.php
A smaller fraction of the individual market I'd assume, but I also assume a rather large fraction of the temporary Obamacare high risk pool, many of whom could die if they suffer a lapse in coverage (I imagine kludges will be arranged if Healthcare.gov is not too late in becoming a MVP).
Yes. That is the message that is not getting thru, I think.
And I think most of us know why that message "is not getting through".
(Totally unrelated side note: damn it, we really should change standard legitimate English so through -> thru and leave thorough standing "by itself".)
It's worse than that.
You are required to buy through the exchange to get a subsidy. The way the law is written, you cannot get a subsidy if you buy insurance off-exchange.
The absolute worst case is someone who earns precisely 400% of federal poverty level, buys a policy outside the exchange, gets laid off on April 1, and can't find a job for the rest of the year. Open enrollment is over, and he's stuck paying full-price even though he only earned 100% of federal poverty level.
This is the absolute worst-case scenario -- but even less dramatic examples could still benefit from the exchange. Earn 600% of FPL? Are you 100% positive that you won't get laid off before August? The optionality is worth keeping.
We've only got 7.5 weeks to go before some plans start expiring. Healthcare.gov had better be 100% operational by then.
> damn it, we really should change standard legitimate English so through -> thru
Teddy Roosevelt thought so, too. That was 100 years ago. It didn't really stick, highway signs excepted.
And we've got less time; realistically, the insurance companies need finite time to process enrollments. The official deadline is December 15th, which I've been modifying to "mid-December" assuming they do a Maximum Effort if the exchanges are working well enough to give them a lot of valid enrollments.
And of course a lot of people who don't realize this, got to a subsidy calculator like the Kaiser Foundation's and satisfy their gut feeling they aren't due one, will bypass the dysfunctional exchanges and just buy on their own ... then some subset who hit hard times will get screwed.
Blah. Thanks for the good discussion and bringing up yet another screw case.
That's why I selected April 1 as the worst-case scenario. When open enrollment ends, the potential lost subsidy jumps from 25% to 100%. You have to wait until the next open-enrollment period to change plans.
But that having been said: why should anyone give up even $1 of the subsidy due to him, because of a failure of healthcare.gov? That's why I think the subsidy should be claimable off-exchange: https://news.ycombinator.com/item?id=6702966
Problem is, the requirement to buy on-exchange to get the subsidy is written into the law. That means that it is not changing. The Republicans certainly won't want to fix any screw-ups in the implementation of Obamacare.
Even though I'm a Brit, some governments are making moves to modernise and open up their data for others to play with, over here we've got a great government-funded team working on exactly that (called the GDS). (http://digital.cabinetoffice.gov.uk/)
Frankly I think this is a massively expensive and missed opportunity for the US Government's digital service team.
http://www.independent.co.uk/life-style/health-and-families/...
Still, it's an epic failure, said to be the greatest single one in government IT contracting.
(E.g. I'll bet the FAA's eternal quest to upgrade from their 1940's (sic) technique and '60s or so architecture has cost more over time, but not any single failed effort.)
Also note that the NHS system was about building a database for every NHS health record across the country; prescription notices, medial history, etc. etc.
I'm not sure it'll even be legal now. HealthCare.gov isn't going nearly as far as that.
So you ought to say "The government should of just built healthcare.gov..." ... except that's very clearly not the style of this government.
E.g. one simple way to take traffic off most of the system would be to provide an interface to the subsidy calculation to entities beyond the state exchanges (who have to use it; when Verzion accidentally took the site offline, they couldn't do much), like insurers. It's said to be on the todo list, but at a very low priority.
I've been wondering for a while, though, why the federal government can't just buy/beg a copy of software running one of the exchanges for one of the states doing things themselves. Then they could modify it to work for other states. Maybe they'd then have to replace existing federal exchange with 26 different instances (one for each state that's a member of the federal exchange), but I can't imagine that the technical difficulties of modifying one state exchange's software to run with another state's data would be as bad as fixing what seem to the problems with the existing federal exchange website.
They also have only 4 well functioning states' systems to chose from as I understand it.
The centralized subsidy calculation/verification/etc. process, which the Federal system does for all the exchanges is another issue, although I've only heard that some time ago is was known to produce incorrect results under testing.
Also would require the Federal government to admit a much bigger screwup than they've been willing to so far, in a process entirely driven by politics (http://www.washingtonpost.com/politics/challenges-have-dogge...) until the last week of last month when CMS was fired and the fix-it czar was appointed.
If you've been in this game long enough you've seen projects and companies destroyed by a failure to take decisive action when it could have made a difference (or read, for example, Churchill's The Gathering Storm, or any shorter version of how WWII could have been so easily averted by preventing German rearmament). The odds are pretty high this is going to be another example of that.
The states were given federal money to build their state ACA programs... so the government already owns it.
Now, imagine if they had been forced to open source this stuff, at least between the contractors.
Here's the link to the site: http://www.thehealthsherpa.com/
Also, around 80% of people are in private insurance plans through a plan at work. Some fraction of these people are happy with their HMO or PPO. These are the middle class and upper middle class or rich. They are also politically resistant.
The support for national health care or even single payer would come from the uninsured and people who have lower-end insurance (high deductible plans) and are forced into a kind of expensive PPO (insurance that makes you pay most of the costs of doctor visits).
Hilary Clinton's single payer plan was demolished by the insurance industry. So this time around, they kept insurance companies in the reforms. That negated some of the resistance from the well-insured.
"Plan Results
Found 0 exchange plan."
Today I searched my zip again, this time even messing with the different options of insurance type, and still zero results. Is this saying there are no insurances available for people in my area?
Not saying healthcare.gov is any better, but there is just no mention of the information given and/or calculations done being correct.
All this site now needs is the ability for the insurance companies to upload information about their plans directly to thehealthsherpa.com and we can forget about healthcare.gov all together. People signed up for years for insurance coverage by phone, directly with the companies, and they can continue to do so. The exchange should be just be an informational tool. This site does the trick.
I think thehealthsherpa.com should provide links, or better yet, add pages to the site directly, to explain the different plans and regulations for different states, so it can be more of an information hub. Great Job!
And the question isn't about whether or not I should get catastrophic plan. I have the right to get it under the new law, and CA's Exchange site should have the duty to show me it as an option. Instead, they hide it, which is very underhanded.
So, here's what I would have done. This is completely sit-of-the-pants. I'm sure it has holes. Nothing that couldn't be sorted out by applying real thought to the problem beyond this quick and admittedly faulty definition:
My approach would have been to first develop a specification for an API all insurers would have to implement. They would be required to have a full implementation of this API in order to participate in the service. Now you have hundreds of teams working for you. This would cost almost not taxpayer money.
The next step would be to develop an automated test suite to test for API compliance. Open source it and release it. Setup a method through which this API could be used to certify compliance. Perhaps this would be an insurer's portal in healtcare.gov. Upon certification they would receive an expiring token identifying the plans submitted as being fully compliant with the API. More on this later.
Now everyone knows what they have to do to communicate their plans and how to make sure their API is fully compliant. No tokens. No participation.
Each plan has a token. The token is also the GUID for each plan.
Unit and regression testing are your friends. Insurers would do their own testing and they would be forced to continue to guarantee compliance by means of the tokens expiring at preset intervals (a year?).
Next the API would be released for anyone interested to implement health insurance browsing sites. Yup, let entrepreneurs battle it out for best-in-class discovery services. You would have hundreds of sites pop up with all kinds of really good solutions.
You would then publish another API anyone could use to actually communicate with government servers and "book" insurance.
Now you have a potential of tens of thousands of people working for you. And still virtually zero cost to taxpayers.
If that's too open, perhaps the plan browsing sites simply redirect you to a government site for the actual booking. They pass the token for the plan that was selected and a secure government site takes it from there.
Not done yet.
I would also hold a pre-release contest with cash prizes in the range of $1,000 to $100,000 for faults found during penetration testing of the government booking site. Release the code to the .gov site and let hackers mount massive attacks from every angle. Do this until top hackers agree the site is pretty damn hard. Give the top ten contributors cash as well as some kind of a presidential recognition at the White House. In other words, make it very public and very prestigious. Money and time well spent.
Once there, load test for something in the order of a million simultaneous users. The site must be built with elastic capacity as it will have to be able to manage insane traffic for a few months and then scale down to a more reasonable baseline.
Then open the doors.
However. This does not happen all in one shot.
Segment the population around data centers. Perhaps a couple of states on the east coast and a couple on the west. Announce it across all media. Schedule additional population segments across a period of a few months in order to average out a reasonable load on the system.
All independent browsing sites would have API access to the schedule. They could then save your selection and email/sms you when your turn comes up.
In other words, decouple the act of browsing and researching plans from actually booking it. And, at the same time, utilize a mechanism through which the rate of booking per unit time might be controlled. The browsing sites would simply not be able to forward to healthcare.gov unless it is your time slot. Now you have a situation where you simply can't have a hundred million people hitting healthcare.gov.
One could further segment booking by implementing time slots based on other criteria. For example, the last digit or two digits of your SSN.
Yet another approach would be to offer a limited number of booking time slots per hour. Browsing sites, through the API, would have access to this information. This means they could provide a virtual appointment system where you pick the time and date that is most convenient for you to actually book your plan. If a slot is available you are in. Otherwise you are offered alternatives. With this you could easily throttle the number of people who hit healtcare.gov per unit time. Again, healthcare.gov would NOT be a browsing site. You'd have to go through private sites for plan discovery.
Once booked, healthcare.gov would --via a pre-published API-- forward a completed and validated application to the insurance company.
I am sure further checks and balances would be required. And, as I said above, this game-plan surely has holes. It is seat-of-the-pants, I am coming up with it as I type. No way it is perfect.
However, there is one thing I know: The general idea here is to leverage the free market and private enterprise in order to delivery a massively better product. I realize this goes counter to the ideas the current administration must have about how a country ought to be run. However, if this healthcare disaster has done anything at all for all of us is to potentially prove, once and for all, that central planning and management by government is a horrible idea.
This is exactly how everything is done in government. We simply don't get to see it and experience it in daily life. With the ACA there was no way to hide it. This has been and continues to be a very unique opportunity for the American public to really see how bad government is about specifying, planning, managing and executing anything at all. If this makes people understand the fallacies in that school of thought this could very well have been the best $600 million we ever spent.
Right now the Federal system is doing that for everybody, Healthcare.gov and all the state exchanges (single point of failure as Verizon's goof demonstrated). In theory insurance companies will get access, but it's said to be a very low priority.
Then there's, oh, the straight out fraud problem, i.e. you sign up, pay your first payment, then come January you or one of your fellow enrolees find out when you try to get services or prescriptions, the insurer you thought you signed up with has never heard of you. That pretty much requires starting at a blessed government site, I don't think your stopping at a government booking site would work since that could be spoofed, right? So could close the loop snail mail confirmations from insurers.
In addition to that the transaction from healthcare.gov would, of course, ultimately reach the actual insurer who would have to further authenticate it, communicate with you and possibly also send some kind of an ACK to healthcare.gov.
The process could be full circle with many layers of confirmation and verification. This does not need to be overly complicated.
The idea is that the free market would handle the implementation of the massive first layer of a national system such as this one. Get government involved only where and when absolutely necessary.
For your second point, I posit a scammer simulating all of that, right down to sending out authentic looking enrollment snail mail. Or just disappearing after getting your first, up front payment.
My point here is that we need something like what you describe in your last paragraph, with people like you putting on white hats to design the system and people like me putting on black hats to break it in principle. And of course trading hats as we see fit, etc. This most damning article yet, from the Washington Post, points out how unopen, often the point of secrecy, the process was, even to the point of suppressing release of architecture diagrams to the state exchanges: http://www.washingtonpost.com/politics/challenges-have-dogge...
As I said in my opening to the prior post. I know it's full of holes. At the same time, I know it would be a million times better than what we have now and it would probably cost $595 million dollars less.
Have you ever dealt with any of them? I suspect not, for it's in my experience unforgettable, and unique compared to every other governmental IT person I've ever dealt with.
See this diagram drawn from the first set of hearings:
I have no idea what HHS's computer systems role in this is ... well, tracking, I suppose. Healthcare.gov is for managing enrollment in plans; does it's remit even include knowing who has what at the moment?
"SSN" is I assume the Social Security Administration, and I also assume is to verify citizenship.
IRS in theory has all the relevant income data and is the non-criminal enforcer.
Equifax is also used for income verification, suggesting IRS isn't up to delivering all that's needed, or not reliable enough. Not part of the government, fortunately!