Maryland to stick with own health care site

As legislators grilled Lt. Gov. Anthony G. Brown on Tuesday over the dismal debut of Maryland's health insurance exchange, the O'Malley administration stood by the website and said it will not switch to the federal version.

Rejecting calls to shut down the state's bug-ridden website, Gov. Martin O'Malley's office issued a statement saying the state would keep it running while working to improve it for at least the next 21/2 months. The exchange was created to implement the federal Affordable Care Act and give Marylanders a place to buy health plans or enroll in Medicaid.

"The governor and lieutenant governor have decided that during the remaining months of open enrollment, the risks associated with a transition to the federal site would outweigh the benefits," the statement said.

Open enrollment for insurance under the health care law ends March 31.

State officials could revisit that decision after the end of enrollment, said Dr. Joshua Sharfstein, Maryland health secretary, at a Senate briefing on the exchange's botched rollout. He promised senators that any decision to stick with the state exchange would be based on objective factors, not whether a shift would be politically embarrassing.

Brown, representing the administration at hearings in the House and Senate, came under fire from Republicans.

"This is all malpractice," said Senate Minority Leader David R. Brinkley of Frederick County. "Because the people of Maryland expected something. They didn't get it."

Under pressure from Sen. Allan H. Kittleman, a Howard County Republican, Brown declined to apologize for the failed launch. Brown, a Democratic candidate for governor and the administration's point man on implementing the federal law known as Obamacare, said constituents want progress on insuring more Marylanders, not apologies.

"An apology would amount to very little for those Marylanders who are struggling," he told Kittleman.

When he followed Brown to the witness table, Sharfstein showed no such hesitancy.

"I apologize to the many Marylanders who have struggled with the website and the call center, and I regret the anxiety experienced by individuals and families who are seeking health insurance and who have been frustrated in the efforts to obtain it," Sharfstein said.

"I really wish the lieutenant governor had said the same thing," Kittleman said later.

Brown acknowledged that when many Marylanders attempted to shop for insurance on the website after its Oct. 1 launch, they encountered error messages or blank screens. But he said those problems now occur in less than 1 percent of cases.

"We have fixed that," Brown said.

He said the administration based the decision to stick with the state site in part on advice from insurers, particularly CareFirst BlueCross BlueShield, the state's largest insurer. Company officials warned it would be risky to try to switch systems before the end of open enrollment.

"Their belief was right now you're in better shape staying where you are," Brown said.

The administration had come under pressure from some — notably Democratic U.S. Rep. John Delaney — to switch to the federal website. That site had its own severe problems when it began operations, but the effort to fix it has gone faster than Maryland's attempts to improve its site.

Brown appeared before the committees with jurisdiction over health care in the House and Senate to urge swift passage of emergency legislation that would provide an alternative way for certain consumers — those who tried but failed because of glitches to sign up for insurance last year — to get coverage retroactive to Jan. 1.

The measure would open the Maryland Health Insurance Plan, a high-risk pool that's been in effect since 2003, to those unsuccessful applicants frustrated by the exchange's problems.

The lieutenant governor said the law is needed even though the four companies that offer insurance through the exchange have agreed to make retroactive coverage available to people who tried to sign up last year. He described the emergency bill as a "temporary, last-resort option."

Brown said there may be "a few hundred" individuals who won't qualify for the private insurers' offer of retroactivity. Previously the administration had estimated that several hundred to "upwards of 5,000" might qualify for coverage through MHIP if the bill passes.

The bill calls for people who qualify for that plan to be switched to a private plan as soon as possible.

Brinkley said he would likely end up supporting a bill to help people who couldn't navigate the exchange, but he used Tuesday's forum to press his case for further investigation. Referring to Brown's background as an Army officer, the senator said that in the military such a botched operation could easily have led to a court-martial.

Brown agreed that further inquiry is needed — but not until the exchange's problems are fixed. To conduct a probe now, Brown said, "we'd have to pull people off the front line."

Sharfstein delivered a detailed report to lawmakers in which he said one critical problem arose when the prime contractor, Noridian Healthcare Solutions, brought a subcontractor onto the project without receiving approval from the Maryland Health Benefit Exchange. He said that after promising system tests in June, financial disputes between the companies slowed progress during August and September.

Lawmakers encouraged Sharfstein to seek to recover damages from the contractor. The secretary said the state has not taken any of its legal options off the table.

"We're withholding some money from the contract," Sharfstein said.

Pressed by senators on how well he kept Brown informed about emerging problems with the exchange, Sharfstein said he didn't raise the issues until shortly before the launch.

"I didn't communicate to the lieutenant governor the kind of concern that in retrospect I wish I had," Sharfstein said. "We thought we were on track."

As part of his testimony, Sharfstein handed out summaries of audits performed by BerryDunn, an accounting and consulting firm, which identified dozens of shortcomings in the exchange's development.

A year ago, for example, a report found there was poor planning and oversight by exchange and state officials. Audits went on to identify data security risks, vendor staffing deficiencies and testing problems. Many were corrected, but others remained until the ill-fated launch.

The consultants recommended that officials scale back what consumers would be able to do on the exchange, at least initially.

"We are concerned that development has continued to the very last week prior to go¿live and there has not been time for testing to prove that the system will be capable of supporting the number of expected users or that performance will be acceptable in the live environment," wrote Charles K. Leadbetter, a principal at BerryDunn, to Rebecca Pearce, the former exchange director, days before the launch.

Pearce replied on Sept. 30: "My assessment is that the security of the system is strong, that (while we would always want more) user testing is adequate, and that we have some flexibility built into our approach to catch problems as they arise and fix them. For these reasons, we are proceeding for Oct. 1."

As Brown testified, Attorney General Douglas F. Gansler, a rival candidate for governor, issued a statement insisting that the lieutenant governor disclose any email or other communications his office received about the exchange.

"For over a year Lieutenant Governor Brown has taken credit for establishing Maryland's health exchange," said Gansler campaign spokesman Bob Wheelock. "Now, in the wake of the disastrous rollout of the exchange, Lieutenant Governor Brown is ducking responsibility, saying he was in the dark, yet refusing to turn over emails and correspondence about what he knew about problems with the exchange."

Brown said his office has fully complied with any requests for public records.

Baltimore Sun reporter Meredith Cohn contributed to this article.

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