“Wow, what can go wrong here? Let me assess this based on my years of experience in this industry. The federal government is going to build 50 exchanges, using a data hub that doesn’t exist physically and in fact, the design hasn’t been solidified, and must be accessible to a variety of data processing technologies that range from archaic to old. Each of the 50 states have different eligibility rules, and with a significant number of states opting out, the federal government now has to learn the intricacies of each state’s Medicaid eligibility models which then scale to different applicability rules for different members of a given family. The thousands of pages of bureaucratic rules that will drive requirements haven’t been completed yet, and those requirements are needed to drive design not only for the application programs, but for the entire processing architecture. The issue of network, processor, and storage performance has to be decided, modeled and tested. To complicate matters, the convoluted federal procurement rules for hardware and software have to be adhered to, which require mixing different hardware brands, software packages and service providers. Add to this compliance analysis to validate and re-validate trusted sources of data. All legal requirements at the local, state, and federal level have to be met by the design. And last but not least, staffing up for customer support which requires hiring, training on applications not yet designed and real world tested, the creation of support documentation, building or retrofitting facilities for these folks, setting up backup sites for the required redundancies, plus hardening the sites for natural disaster power failures. Additionally, the people hired must meet the Equal Opportunity criteria, and all GUIs must be handicapped usable, as well as the facilities themselves. I could be here all evening defining additional work to be done. Oh, did I mention this will be done by next year? Now I know why this has never been attempted. We are a country made up of 50 separate and distinct states, with all their own rules of governing, and to make things more unworkable are all the federal rules that have to be adhered to. I think we the people are going to be safe for quite awhile here.”