The temptation, upon hearing the news that Maryland has fired the prime contractor building its troubled health insurance exchange, is to echo Rep. John Delaney's question: What took so long? Indeed, there have been signs for months — dating to even before the site's launch — that Noridian Healthcare Solutions was not up to the task. Switching from that firm to the Columbia-based company credited with fixing the federal site would seem like a no-brainer. But the truth is, this move is unlikely to be a panacea for Maryland's exchange, which still faces grave challenges in the weeks leading up to the end of open enrollment on March 31.
Noridian was chosen as the exchange's lead contractor through a streamlined procurement process in early 2012. It beat out three other bidders, and state officials have said they were impressed with the company's track record in processing Medicare and Medicaid claims and with its plans to use off-the-shelf software — a decision that seemed like the simplest solution at the time but which has proved fateful.
Noridian proposed using Curam software — the marquee product of a well established Irish company that was bought by IBM during Maryland's selection process — and Curam advertised itself as providing an information technology solution that would require minimal customization by Maryland or any other state that used it. But the product has proved to be deeply and fundamentally flawed, both here and in Minnesota, which also used it as the basis for its exchange. Both Maryland and Minnesota are considered among the worst performing of the 14 states that built their own exchanges, and officials in both places say they have gotten their websites to work only through unwieldy software patches and time consuming manual work-arounds.
Perhaps if Curam had worked as advertised, Noridian would have been up to the task. But under the circumstances, it should have been clear as long ago as the summer that the company was in over its head. It hired a subcontractor, Calverton-based EngagePoint, without the state's approval and entered into a profit/loss sharing agreement that caused deep strains that were evident to Maryland officials months before the website's launchm, and that eventually landed the two companies in court. In the midst of it all, Noridian tried to hire the EngagePoint workers it had just fired — an indication, if there hadn't been enough already, that it was not in control of the project.
The state's new prime contractor, Optum/QSSI, has been working on Maryland's exchange since December, and despite its success in helping make the federal health exchange functional, its presence here has not been a magic bullet. Given the underlying structural issues with the exchange software, the best we can hope for is that the site weathers the likely uptick in applications before the March 31 deadline a bit better than it would have with Noridian in charge. It doesn't change the odds that the state will abandon its exchange in favor of one developed by another state or the federal government after open enrollment ends — a course that appears increasingly likely, and one that Minnesota is also contemplating.
Might it have made a difference if the state had fired Noridian six or eight months ago? It looks like we may not have enough information to make even an intelligent guess at that until after Gov. Martin O'Malley leaves office and until well after Maryland voters have decided whether to promote the administration's designated point-person for implementing health care reform, Lt. Gov. Anthony G. Brown. A legislative oversight panel decided on Monday to authorize a full performance review of the exchange by state auditors, but it won't be complete until July 2015. The committee had already requested a smaller-scale review of documents related to the website's construction, due by March 31, but auditor Tom Barnacle testified at Monday's hearing that most likely "those observations will not reflect the entire story of what happened and why it happened."
Republicans in Annapolis are right that the Democrats who control the legislature have not been sufficiently aggressive in determining what went wrong and who is responsible. Unfortunately, the latest idea to rectify that, Sen. David Brinkley's request that Attorney General Douglas F. Gansler launch an investigation, is fundamentally unworkable. Mr. Gansler is running against Mr. Brown in the Democratic primary for governor, and he has been the lieutenant governor's chief critic on the website roll-out. Any inquiry he or his office was associated with would inevitably be viewed as tainted by politics, and that would not serve the public well.
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