Despite the Obama Administration’s presumed win in the Supreme Court, Obamacare faces significant hurdles in implementation. Healthcare is complex, and made much more complex by state and federal regulations. It is administered using massive computer systems, some of them decades old. These systems are difficult to change and modify, yet they will all require modifications to comply with the raft of new regulations introduced by Obamacare. Private organizations face the added burden of making these changes while complying with SOX procedures. It is no exaggeration to say that SOX doubles development time and doubles the staff needed to do development. SOX makes it very difficult to use modern rapid development methodologies and forces organizations to use older methodologies that are long on paperwork and short on results.

The difficulties that existing IT systems face pale in significance compared to the challenges of creating the IT systems to support the insurance exchanges. From Politico:

If state health care exchanges survive the Supreme Court challenge to health care reform, the election and state tea party activists, health policy experts are worried they could still be brought down by a much more mundane problem: information technology.

Even states that are solidly committed to pursuing an exchange are facing major logistical challenges in building the computer systems that will be able to handle enrollment when exchanges open for business in 2014.

That’s largely because the system that will actually connect people to the right coverage will have to “talk” to many other systems, and the systems don’t use a common language. This includes a yet-to-be built federal “data hub” with tax and citizenship info, the enrollment systems of multiple private insurers selling exchange plans and — hardest of all — state Medicaid enrollment systems, many of which are not yet fully computerized.

Even if all the states that have taken the biggest steps to launch exchanges — fewer than 20 at the moment — were charging full speed ahead, there’s a lot of concern that they’ll have to switch to a “partnership” exchange model, with the federal Department of Health and Human Services running key functions. That’s because their IT systems could fail final tests in the months before the exchanges open in 2014. And that would mean losing some of the ability to customize the enrollment process for a state’s needs.

Anyone who has observed the Government’s sorry record on implementing complex IT systems on time and within budget just know that this is a disaster waiting to happen. Here’s a sorry tale from the English National Health System, reported by the Tax Payer’s Alliance:

Once again central government has come under fire because of one of its costly and failing IT programmes. … They’ve said that £2.7 billion of taxpayers’ cash has been wasted by the programme, as the Department of Health has very little to show for that huge amount of cash.

Launched in 2002 by the Department of Health, the central aim of the programme was to develop an all-encompassing e-records system to make accurate patient records available to NHS staff at all times. But the project has courted controversy at every stage from its inception. Data management issues, patient confidentiality problems, numerous missed deadlines; NPfIT has it all, completely undermining its goal of increased efficiency. It has been dubbed the super-computer but there’s nothing super about it: the project takes every single failing of past IT projects – of which there have been many – and rolls them into one giant failure.

The implementation of the Obamacare Exchanges is going to be a colossal and expensive failure. Yet, without IT systems to support them, they cannot function.