Now that most consumer-facing parts of HealthCare.gov are working, the biggest problem is "making sure plans get paid," the lead manager of insurance exchanges and regulations at the Centers for Medicare & Medicaid Services told federal lawmakers.
Among the questions put to Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, at a House hearing was: "What problems do you still see with the federal website and what steps in the administration taking?" asked by Diana DeGette, a Democratic representative from Colorado.
The "major one, big picture," is "financial management, making sure plans are getting paid," Cohen said. The streamlined processes for transferring and making payments to insurers that had been envisioned by CMS are still coming up to speed.
Although the manual process they've used as a temporary fix that's slowed in the final stages of enrollment are "not ideal," Cohen said, the agency, contractors and health plans are customizing a software program to digitize the process and shorten its time.
A "more automated process will be going into place next month," Cohen said.
The chair of oversight and investigations at the House Energy and Commerce Committee, Tim Murphy, a Republican from Pennsylvania, titled the hearing "2014: Seeking PPACA Answers."
With consumers in some states still reporting uncertainty over whether they've successfully enrolled and whether health plans have received their payments, Murphy asked Cohen about how CCIIO, which oversees much of the federal exchange, weren't able to reach all of the planned functions and systems, including the small business exchange website.
Why wasn't the agency able to ensure the website ran smoothly after a March 2013 McKinsey "Red Team" assessment commissioned by HHS identified problems such as a lack of end-to-end testing, no inter-agency consensus on ID verification and "limited focus on financial management."
"We took it to heart what the McKinsey people recommended what we do," Cohen said, while also arguing that not all of the consulting firm's predictions came true. For instance, the federal data "hub is doing very well," he said, noting the relative lack of serious problems at California's health insurance exchange, where he was previously chief legal advisor.