Now think about trying to resolve problems like this among a few hundred databases run by insurance companies who are not necessarily going to be the most cooperative folks out there. Think about it: you’re an insurance company IT executive and the healthcare.gov folks ask you if you might change the format of your data reporting to coordinate with the other companies in your state. Your immediate response? Why should we change and not them? That’s more work for us and besides our system was designed better.
So not only are the healthcare.gov folks working against a few hundred different design decisions, but they’re also counting on having been able to anticipate all the data entry errors that might be lurking in hundreds of databases out there, and hoping that everyone has decent support staff, too.
It is hard to appreciate how bad humans are at this kind of interoperability. It seems to not be in our nature at some fundamental level.