After the state severed ties with the contractor that built its problem-plagued health insurance exchange, officials face the looming question of what to do with it — continue throwing money toward fixing it or replace it.
Every option is potentially fraught with more technical headaches and expense.
Exchange officials are mulling five possible scenarios in the wake of the disastrous launch of the exchange, where technical difficulties have thwarted thousands of people from signing up for health insurance.
Maryland could graft onto another state's exchange or form a consortium with other states, though some have had their own problems and such a partnership could be technologically difficult. Maryland officials say they have reached out to Connecticut, Kentucky and other states whose exchanges are working about the feasibility of adopting their systems.
Maryland could also join the federal exchange, which has had its own glitches, or try building a new site, a potentially time-consuming endeavor. Or state officials could fix the one they have — an option that may be the least onerous but one that has rankled critics.
"Insanity is doing the same thing over and expecting a different result," said state Senate Minority Leader David R. Brinkley, a leading critic of the state's exchange, implemented under the Affordable Care Act.
Persistent problems with Maryland's exchange prompted state officials last week to terminate the contract with the prime contractor hired to build and operate the website. Noridian Healthcare Solutions had missed several deadlines for fixing parts of the site, where hundreds of defects have been identified. The company laid at least part of the blame on constant changes sought by the state.
Exchange costs have exceeded projections for this year by $33 million. And last week, officials acknowledged that delays in fixing the site will cost the state as much as $30.5 million to keep residents covered by Medicaid — even though some may not be eligible — because the exchange can't properly screen them.
Once open enrollment is completed at the end of this month, the state must decide how to proceed in time for the next open enrollment period that begins in November.
So far, Maryland's exchange has enrolled fewer than 36,000 people in private plans. That number is far below the 75,000 target, which is half the original goal set by outside analysts, who recently said their original estimate was flawed. The state has exceeded its goal of enrolling 90,000 people in Medicaid, the federal-state insurance program for the poor.
For a better outcome, the most sensible solution may be to team up with another state or group of states, analysts said.
Connecticut's exchange has been so successful that officials there are fielding calls from a half-dozen other states wanting information on its strategy. Interest in Access Health CT prompted them to begin marketing the system to other states. The exchange has beaten enrollment expectations, with 55,000 people signed up for private health insurance.
Kentucky, California and New York also are running successful exchanges.
"If other states have managed to successfully create an exchange website and it works, from the technology perspective, the most expeditious, reliable and cost-effective thing to do is to use the known-working software," said Scot Silverstein, a consultant and adjunct professor at Drexel University's College of Information Science and Technology.
A partnership with another exchange could happen in various ways. Connecticut's exchange officials said they could take over another state's exchange completely, from determining eligibility for subsidies and enrolling consumers to marketing and operating a call center.
Or they could offer a la carte services, such as consulting on how to install its Deloitte-developed software, said Kevin Counihan, CEO of Access Health CT. That $40 million software was paid for with federal dollars and would be free for another state to use, he said.
He couldn't say how much services would cost, but he said there is ample room on Connecticut's servers and enough time to set up a website for another state before the next open enrollment period. He expected to work with one or two other states in the next year.
But the process isn't simple. It would take some customization for one state to serve another's population while accommodating other insurance carriers and meeting different state requirements, analysts said.
"When a state has a successful website, it is mostly because the website is in harmony with issues — such as IT infrastructure and structure of governance — specific to that state," said Tinglong Dai, assistant professor at the Johns Hopkins University's Carey Business School. "Maryland has its own issues different from others. The same factors leading to other state websites' successes could easily lead to a failure at Maryland."
A state consortium could come with similar obstacles, but Silverstein said it also could allow states to collaborate and learn from one another about what works and what doesn't.