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Health

O'Malley considered delaying exchange launch

Laws and LegislationExecutive BranchConsumersAnthony Brown

Gov. Martin O'Malley acknowledged for the first time Thursday that he briefly considered delaying the Oct. 1 launch of the state's health insurance exchange when staff members raised concerns about potential problems.

The anticipated glitches turned out to be major problems as the Maryland exchange, designed to provide one-stop shopping for the 800,000 uninsured Marylanders, experienced one of the nation's most troubled launches.

State officials and private contractors have been working to correct the site, and O'Malley said Thursday that three major fixes remain to be done and reiterated that they would be completed by "mid-December."

He declined to set a specific date, but Nina Smith, the governor's spokeswoman, said he considers mid-December to be a window from the 10th to the 20th..

In a pledge akin to one made at the federal level, O'Malley said in November that officials expected to have the exchange running smoothly for most users by mid-December. The work involved fixing nine major problems with the site. He said he expects one to be completed by Monday and the remaining two as soon as possible.

"Is it perfect? No. Is it functional? Yes," the governor said during a news conference.

O'Malley likened the technical fixes to "changing the tires on a moving car, changing the engine on a moving car" and he said that the short-term goal was "not perfection, but functionality."

O'Malley downplayed the significance of the concerns raised before the launch, saying the broad, systemic problems would not have become evident until after the site had gone live.

"At the time, some people said, 'We're worried this, that and the other might not be in place.' We had passed every test. If we hadn't launched, we would have found out now" about the problems, he said. "I've got a six-month window that I wasn't going to piddle away for two months waiting for everyone to be perfectly content that everything was perfect."

The governor and Lt. Gov. Anthony Brown, O'Malley's point man on the Affordable Care Act in Maryland, have begun regular media availabilities to answer questions about fixes to the website and their involvement.

They said they've been getting regular updates from exchange officials on their progress, which aimed to smooth the process for users who have complained about freezing screens, error messages and other problems.

Brown said earlier this week that about 22,000 Marylanders have obtained coverage through the exchange as of Dec. 7. That includes about 5,200 in private plans and about 17,000 low-income adults eligible for Medicaid under an expansion of that program.

O'Malley said the state still aims to sign up 150,000 people in private plans by March 31, the deadline for Americans to enroll or face penalties.

"We have had a rocky first half," the governor said, "but we hope to make up as much as we can in the second half."

Brown also reiterated that the state considers the end of open enrollment as its deadline to get people coverage.

"The end game here is the end of March," Brown said.

The federal site appears largely fixed and enrolling people at a much faster clip. But the state site, while signing people up at a faster rate, is still falling below expectations.

The governor said Thursday that five of the nine problems had been fixed. In another, officials simplified a process. And another problem that created nonsensical responses to whether enrollees could qualify for a health care subsidy was expected to be repaired before Monday.

O'Malley said the remaining issues involve screen freezes that have prevented potential health care enrollees from moving through the site. O'Malley called them "the toughest to get to the bottom of" and said that technicians were expected to start testing possible solutions soon.

The governor said he was hopeful that the state could get the site functional enough to begin aggressively marketing the exchange. The call center still gets overwhelmed by calls, and O'Malley said the state may have to hire more people to deal with them.

"We make progress by degrees; the best proof of that progress is enrollments," he said.

Those helping sign people up for coverage in the state have complained that the site still freezes and users cannot easily get through the process. But that is changing, if slowly, even as more people are seeking aid ahead of the Dec. 23 deadline to enroll for coverage starting Jan. 1.

"We're continuing to see improvements to the electronic systems," said Eric Masten, a spokesman for the advocacy group Healthy Howard. "We have seen a significant increase in interest throughout the region and are adjusting staffing and increasing our office hours to accommodate consumers."

At Evergreen Health Cooperative, which offers its own plans to consumers, Dr. Peter Beilenson, the founder and CEO, also said the ability to sign up consumers is improving. He said of the 25-30 appointments they have a day with consumers, about five are able to enroll in plans through the exchange.

"The trend is going in the right direction, but it is still far from satisfactory," he said. "It is ever so slightly better."

Some observers say that fixing the enormously complicated website will not be easy, especially given the reported contractor in-fighting.

The prime contractor on the Maryland site, Noridian Healthcare Solutions, fired a key subcontractor, EngagePoint Inc., in October, and the discordant relationship ended up in court. Noridian has obtained access to information and workers from EngagePoint, which had been linking federal, state and private insurers' computer systems to make the exchange work.

Picking up where others have left off is problematic in general, said Alexander Howard, a fellow at Harvard University's Ash Center for Democratic Governance and Innovation and Columbia University's Tow Center for Digital Journalism.

He has been following the rollout of the exchanges across the country, and said it is possible to bring in new code writers and fix a botched site, "with many caveats."

If new people have been brought in, Howard said, "it can be quite hard to figure out someone's code, particularly if it's bad, has poor documentation and the folks who designed and wrote it aren't there anymore."

He said that had been a headache at the federal level.

"Great engineers might be able to build an alternate solution, and terrific architects and developers can work over a system to find bugs and issues," Howard said, "but it's difficult and time-consuming."

Baltimore Sun reporter Timothy B. Wheeler contributed to this article.

meredith.cohn@baltsun.com

ecox@baltsun.com

Copyright © 2014, The Baltimore Sun
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Laws and LegislationExecutive BranchConsumersAnthony Brown
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