Pardon us if we are not completely reassured by officials' insistence that glitches recently discovered in the Connecticut Affordable Care Act health insurance exchange that Maryland is in the process of adapting will be fixed well before the site goes live here in November. To learn that a coding error there caused inaccurate bills, unpaid subsidies, mistaken Medicaid enrollments or outright dropped coverage for more than 5,000 people is not encouraging — particularly since officials there initially misdiagnosed the problem as an isolated incident before backtracking this month to acknowledge a problem with their software.
But we shouldn't be particularly surprised either. If there's anything we've learned so far, it should be to expect problems when it comes to Obamacare enrollment. The Connecticut exchange's CEO, Kevin Counihan, said as much last week, noting that "this kind of thing's going to keep happening ... We're going to have these continued little glitches for a period of time." The question is merely how big the problems and how manageable the fixes, and at least so far, this one seems decidedly minor compared to what Maryland has dealt with already.
Nonetheless, it prompted Republican gubernatorial candidate Larry Hogan to issue a news release blasting Maryland's Obamacare implementation. Insofar as he used the opportunity to criticize his Democratic opponent, Lt. Gov. Anthony G. Brown, the O'Malley administration's supposed point-person on health care reform who has been altogether absent from efforts to fix Maryland's insurance exchange website mess, it was entirely reasonable. Inasmuch as it suggested the state should be doing something different now, it wasn't. Mr. Hogan reiterated his call for the state to forget about Connecticut and instead use the federal exchange. That was probably bad advice when Maryland made the decision to adapt Connecticut's software in April; it's definitely bad advice now.
The federal government doesn't charge states to use heathcare.gov, but switching Maryland to it wouldn't have been either automatic or free. An analysis presented to the health benefits exchange in March estimated that it would cost as much as $10 million. But there was a big caveat: Maryland (along with all other states) needed to upgrade its Medicaid eligibility and case management systems to conform with the Affordable Care Act, and the federal exchange does not include that functionality. Maryland would have to build it separately, at a cost consultants estimated at about $46 million. And given that Maryland's previous system was two decades old and had not been significantly upgraded in recent years (it's programmed in COBOL), that figure might have been conservative; Virginia, for example, expects to spend more than $75 million to finish the task.
The Affordable Care Act requires states to be able to coordinate enrollment between Medicaid and the insurance exchange, and states that have relied on the federal exchange or have developed the two systems separately have often encountered problems, said Samantha Artiga, an analyst with the Kaiser Family Foundation who has been following the issue. In some cases, it's still not working properly.
Another major consideration is time. Maryland's consultants estimated that it would take 12 to 18 months to develop a new Medicaid system, meaning it would not be ready in time for November's open enrollment period. Connecticut's system, once adapted to the particulars of Maryland's Medicaid rules, will have the capability to handle enrollment in the program, and though the timeline for that adaptation is tight, it is feasible. But trying to switch the state's plans now would almost certainly leave Maryland with no viable option when open enrollment begins again in four months. That may not even be enough time to switch over to the federal exchange, much less create new Medicaid systems.
A spokesman for Mr. Hogan pointed out that we were enrolling people in Medicaid long before the Internet and could do so again. But that's not a long-term solution. The Affordable Care Act requires online Medicaid enrollment as an option, along with electronic verification of things like income eligibility. Even as a stop-gap for this open enrollment period, it wouldn't be wise; analysts estimate that creating an interim paper enrollment system would cost $5 million to $10 million, and then the state would still have the expense and challenge of developing a permanent software upgrade.
Maryland's health exchange board decided to switch to the Connecticut system based on evidence suggesting it would be simpler, faster and cheaper than the alternatives. That hasn't changed.
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