What happens to Healthcare.gov?

Under the new GOP health care proposal, future online health care marketplaces could be state-based, private or non-existent.

Shutterstock image: medical professional interacting with a futuristic interface.

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Two House committees voted last week to advance a healthcare bill touted as legislation to "repeal and replace" the Affordable Care Act.

If the American Health Care Act becomes law, it's not clear what happens to the more than $1 billion investment in IT to support the online purchasing of health plans through government exchanges. The Healthcare.gov site is a hallmark of ACA, and cost hundreds of millions of dollars to get to a point where all its operations run smoothly.

A House source told FCW that the site's infrastructure will remain in place, but "there is no longer going to be a Healthcare.gov from a consumer-facing standpoint," adding, "I don't know what year or when this happens."

By moving away from a centralized marketplace, "the idea would be to devolve that responsibility to the states" to give them the option of creating their own marketplace, the source said.

This would largely supplant the function of the single marketplace site, unless a state opts not to build its own site, in which case, it could rely on the current centralized infrastructure.

The source readily acknowledged that the plan for online marketplaces is not set in stone.

"There will be a lot up to the discretion of the secretary [of Health and Human Services] … to put some guidelines on there for states," the source said.

Former Health and Human Services CIO Frank Baitman told FCW he thinks "there's no reason the states can't be the innovators for democracy, and not build redundant systems."

"If the law lays out a framework, with many building blocks, the states could customize their implementation, but save taxpayers a lot of money that would be spent on building similar systems," he said.

However, he noted that the current bill lacks "that level of detail."

Another option is the development of private-sector marketplaces from qualified candidates could obtain insurance.

The government is expected to retain control of the data hub that confirms applicant eligibility, the source told FCW, with ownership of the system moving from HHS to the IRS.

The fate of Healthcare.gov is opaque because Republicans have opted to pursue their ACA replacement under the budget reconciliation process, which is not susceptible to filibuster rules in the Senate requiring 60 votes to end debate on legislation. However, the reconciliation process is confined to spending changes, and not a vehicle for a detailed IT policy.

"I don't think there's anything [Republicans] could do through reconciliation that would allow them to roll back Healthcare.gov, unless there was some way they could affect the funding," said Bryan Sivak, HHS' former chief technology officer.

Of course, the end of the ACA could make Healthcare.gov an empty storefront.

"Many of the provisions will make the actual markets basically non-functional, which serves the same purpose," Sivak said. "If there's nothing on the shelves, what's the point of going to the store?"