"Time and ultimate success," Gov. Martin O'Malley says, will tell whether the state's approach to the implementation of the state health insurance exchange under the Affordable Care Act (better known as Obamacare) was the right one. Time, and the much greater success of other states, have already told. Maryland's exchange website rollout was a disaster and continues to put the state's residents at a severe disadvantage when it comes to enrolling in health insurance plans. The director of the exchange resigned Friday amid reports that she had taken a seven-day vacation in the middle of the crisis, but she is far from the only one responsible. The General Assembly needs to investigate so we can get real answers about what went wrong and who is at fault.
The federal government's own massively troubled Obamacare exchange website enrolled more people in the first two days of December (29,000) than in the entire month of October. Other state-based exchanges have had notable success from the beginning. Kentucky, a state with a smaller population than Maryland, has enrolled more than 69,000 people for health insurance through its exchange. In Maryland, it's less than 3,800. (And what exactly "enrolled" means — whether someone has simply chosen a plan or whether they have successfully exchanged paperwork, not to mention money, with an insurance company — is unclear.) Other states report surges of enrollment as the deadline approaches for people to buy care that takes effect on Jan. 1. Here, Governor O'Malley is promising that the website will be largely fixed by mid-December, leaving residents about a week to enroll if they want coverage in the new year.
On Sunday, The Sun's Andrea K. Walker and Meredith Cohn provided a behind-the-scenes look at the dysfunction at the Maryland Health Connection, much of it related to disputes between the state's prime contractor, Noridian Healthcare Solutions, and a subcontractor, EngagePoint Inc., which have led to litigation. It's clear that those problems crippled the state's efforts to develop the site and fix its problems. Whether that could have been avoided with stronger oversight from state officials is hard to say based on the limited information state officials have released so far. But that's hardly the only question that needs to be answered.
Most fundamentally, did a politically motivated desire on the parts of Mr. O'Malley and Lt. Gov. Anthony G. Brown — who, at least on paper, was the administration's point man for health care reform — to be in the vanguard of Affordable Care Act implementation hurt the state in the end? For both men, proving that Obamacare could work in a state where people want it to despite Republican doomsaying would have furthered their ambitions — presumably presidential for Mr. O'Malley and gubernatorial for Mr. Brown. Did that override good judgment along the way?
Because of the desire to be an early adopter, the Maryland legislature, at the O'Malley administration's behest, exempted the $71-million contract for developing the website from the normal procurement process, and Noridian — a North Dakota firm whose core business is not in website development — beat out three others. Were they really the most qualified for the job? The degree to which work broke down when Noridian broke up with EngagePoint certainly raises the question.
Before she resigned, former exchange director Rebecca Pearce testified before a legislative committee that attempting to be in the forefront of implementation put the state at a disadvantage. She said Maryland tried to press forward even before the federal government finalized its regulations, forcing it to redo work after the fact. Nordian's CEO said the same thing in a statement to The Sun. Who was pushing for Maryland to be in the lead, and why?
States like Kentucky have looked smart in hindsight for developing relatively bare-bones websites and adding functionality as time went on. States like Maryland that attempted more robust sites have struggled. On Friday, Governor O'Malley said that developing the exchange's website is far more complicated than building an e-commerce site because of all the various systems that need to communicate in order to verify an enrollee's identity and income. At what point, exactly, did state officials realize that? Was there any discussion of putting forward a simpler site initially? Who decided against it?
We don't know the answers to those questions in part because the O'Malley administration has exempted from disclosure many of the emails and other documents related to the website's development and rollout on the grounds that they are related to the decision making process of high-level officials. But the decision making process of high-level officials is precisely what's in question here. Messrs. O'Malley and Brown would have been more than happy to take the credit had the website been a success. Now they need to accept the consequences for its failure. If they don't see fit to provide a full accounting of the fiasco through the Public Information Act, the legislature needs to use its subpoena power to ensure that we get answers.
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