As a trial lawyer for many years, and as an individual long involved with Planned Parenthood, I have always been deeply concerned about delivery of health care to the poor. Unfortunately, the leadership implementing the Affordable Care Act in Maryland missed the mark by a long shot, leaving Maryland's 800,000 uninsured in the lurch. While there will no doubt be finger pointing as the public continues to learn about the state's botched rollout, there can also be no doubt about who was responsible for leading the effort.

"Leader" is the one word that has been used most to describe Lt. Governor Anthony Brown's role in Maryland's effort to implement the Affordable Care Act. The day after President Barack Obama signed the act into law in 2010, when Gov. Martin O'Malley appointed Mr. Brown to be co-chair of the state's Health Care Reform Coordinating Council, Mr. Brown said he was honored "to lead this effort" and expressed his confidence that "we will provide a national model for other states to follow." And two months ago, when Mr. Brown announced the ad and outreach campaign for the soon-to-be launched state health benefits exchange, he proclaimed that Maryland, under his direction, would "lead the way in implementing the Affordable Care Act."

Maryland has long been seen as an ideal state for the Affordable Care Act's health exchange model to succeed. Even before the Act's passage, the O'Malley-Brown administration touted the fact that we are a state of "manageable size," and with ample talent to put a web-based health exchange in place — having outstanding health care institutions, more Ph.D.s per capita than any other state in the union, and IT as one of our state's core strengths. Because of our state's ideal conditions for success, President Obama himself put his faith in a well-led health reform effort here. As he said in a speech at Prince George's Community College just days before the exchange went live, "Like any law, like any big product launch, there are going to be some glitches as this thing unfolds," but it's "going to be smoother in places like Maryland."

Well it has been over three years since Mr. Brown took the helm of the state's health reform effort, and over a month since he launched the state health benefits exchange, so it's time for a leadership check-up.

Here are the vitals:

Of the 180,000 Maryland residents expected to enroll by March 31, 2014, fewer then 5,000 — or under 3 percent — have successfully enrolled so far, and the state exchange's website has been rife with technical problems, preventing many Marylanders from even creating accounts. Access to online enrollment is not even available for Spanish speakers and won't be until January, despite the state's sizable Latino population.

The state has also missed the federal deadline for launch of a small business exchange and more delays are being debated. And workshops aimed at helping small businesses navigate that exchange have been abruptly canceled.

In short, under Mr. Brown's supervision, the state's health reform implementation has been halting at best. Despite $163 million in funding from the Obama administration — putting Maryland in the top 10 in terms of state exchange funding levels — our exchange has not delivered. Even Mr. Brown admits the state "stumbled out of the gate." Not a sanguine picture of leadership.

But is this simply a spell of bad luck, or is it a symptom of larger leadership issues? The success of other state health benefit exchanges offers a clue. In the time it has taken for Maryland's exchange to enroll about 5,000 residents, 40,000 Kentuckians, 48,000 New Yorkers, and 55,000 Washingtonians have enrolled through their respective state exchange websites. And Washington was able to do it with nearby IT contractors. Despite our core strength in IT, Maryland's online exchange was outsourced to North Dakota, and top state officials now concede the contractor has come up short.

The successes of these states show that, with the right guidance, a positive roll-out was possible. Maryland's poor start was not a fluke; it was a sign of weak leadership.

The good news is that we still have time to recover. If we want to get Maryland back on track to be a national model for other states to follow — both in health reform and beyond — we need a new model for leadership in this state. We cannot rely on the status quo. We need to reorganize, starting at the top, and re-energize our state to be the strong, innovative reformer we know it can be. With health reform in particular, we can lead again, and we owe it to our state's uninsured to get it right.

Dan Clements is a partner at Salsbury, Clements, Bekman, Marder & Adkins, and a former chairman of Planned Parenthood of Maryland. His email is clements@scbmalaw.com.


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