Commentary by Barry Rascovar, for MarylandReporter.com
(March 31, 2014) Today is the deadline for folks in Maryland to start the application process for health insurance under the Affordable Care Act. If you miss this deadline, you face a tax penalty next year.
The good news is that tens of thousands of people have health insurance who couldn’t — or wouldn’t — obtain it before.
The bad news is that Maryland’s health exchange has been an unmitigated disaster — a painfully small number of people actually applied and paid their initial insurance bill.
Those responsible for this stupendously costly debacle aren’t going to be held accountable.
The deeply flawed computer software continues generating daily horror stories. Failure to adequately advertise community sign-ups led to sparse turnouts till the deadline neared.
Stonewalling at the top
Those at the top of Maryland’s political food chain still stonewall this issue hoping it fades from public view.
State legislators have ordered a slow-motion assessment of the damage by their own analysts. It’s doubtful this will be a detailed, CSI-style examination of what went wrong.
By the time the report surfaces in mid-summer it will be too late: The decision on what comes next – most likely connecting Maryland to Connecticut’s software system — will be made as early as Tuesday.
By the time that legislative report appears, the June 24 primary will have come and gone — and with it any danger Lt. Gov. Anthony Brown’s gubernatorial campaign might be fatally damaged by the findings.
It’s also possible any legislative report will be sanitized by House and Senate leaders so as not to embarrass Brown (by then he could be planning his inaugural) and Gov. Martin O’Malley, who has national aspirations.
What a shocking lack of accountability to the public.
The Oregon Way
It stands in stark contrast to the way another liberal, Democratic state, Oregon, handled its own Obamacare calamity.
Oregon, like Maryland, has a two-term Democratic governor, John Kitzhaber. It has Democratic majorities in both houses of its Legislative Assembly.
But unlike Maryland, Oregon has a strong second party. Republicans hold 26 of 60 House seats and 14 of 30 Senate seats.
With such a potent countervailing force, it’s no wonder Gov. Kitzhaber wasted little time launching an independent probe of his state’s dysfunctional health exchange, known as Cover Oregon.
Its Oracle-based software crashed so badly that all insurance applications since Oct. 1 have been done by hand. Yet Oregon still signed up more people for health insurance than Maryland.
What the independent review in Oregon found is likely to be mirrored in Maryland — if there’s ever a similar third-party critique.
Among the Oregon findings:
-- ”There was no single point of authority on the project.”
-- The governance structure “was not effective.”
-- There were “competing priorities and conflicts between [state] agencies.”
-- Cover Oregon failed to hire a prime contractor or a system integrator.
-- The governor and others were repeatedly warned by Cover Oregon’s quality assurance firm, Maximus, that the project was seriously off-track. These warnings started years ago and were ignored.
-- In 2011, Maximus wrote that the state was acting as its own prime contractor and thus was assuming “more of the overall project risk.” How true.
-- There was no Plan B as required by federal law – but there was a backup plan in case the lights went out.
-- Cover Oregon picked off-the-shelf software; Oracle claimed it required only 5 percent customization. The actual number was 40 percent.
-- The selected software ”was not stable” and to this day “more items are breaking than are being repaired.”
-- Top state officials “did not understand or acknowledge the significance of the website issues” until it was too late.
-- There was a lack of “a consistent, cohesive enterprise approach to management of the project.”
-- There was “no authoritative direction.”
-- There was “Ineffective and at times contentious” communications and a “lack of transparency.”
Critical of oversight
The Oregon report is highly critical of the Executive Steering Committee leading the project — similar to Maryland’s oversight panel co-chaired by Brown and Health Secretary Joshua Sharfstein:
-- ”Oversight authority was inconsistent and at times confusing or misinterpreted.” This led to “unclear or incorrect understanding about the true state of the project approaching the Oct. 1, 2013 deadline.”
-- The steering group lacked “formal meeting notes and decision tracking and documentation.”
-- Perhaps worst of all, the Oregon project did not have “a single enterprise decision-tracking tool to document and manage decisions across entities.”
When Kitzhaber received the damning 77-page report in March, he cleaned house.
He fired the state’s top health official — a longtime friend and ally – who had been running the exchange since January. The chief operating officer and chief information officer of Cover Oregon also got the heave-ho. (The exchange’s original leader had been forced out in December.)
The Maryland way
Don’t expect such drastic action in Maryland. It doesn’t fit the image O’Malley and Brown want to project going forward. Accountability is giving way to practical political considerations.
Still, the Oregon autopsy rings many familiar bells in Maryland. What happened in Oregon seems to have happened here.
Here’s what a forensic analysis of Maryland’s failed healthcare sign-up effort is likely to show:
-- O’Malley and Brown created the exchange as an independent agency unshackled from the state’s formal procurement process. Support services and the normal chain of command within state government were lacking.
-- Brown and Sharfstein never gave the project the intense oversight and strong, authoritative leadership it needed.
-- They hired the wrong contractor — a minor-league player in the world of healthcare IT — who then quarreled bitterly with the sub-contractor it hired to do the IT project’s heavy lifting.
-- No one was riding herd on the contractor.
-- The state’s IT gurus picked off-the-shelf software to save money and time, software that never had been used in this way.
-- There was no back-up plan in case Plan A failed (as it did).
-- Quality assurance and system integration were lacking. There was no general manager and no effective tracking system.
-- There was no exhaustive trial period built into the schedule.
-- There was a lack of clear and honest communication up and down the line. Transparency continues to be a problem.
What citizens deserve
That pretty much sums up what went wrong in Maryland — even without an impartial investigation by outside experts.
But it is worth considering whether Maryland citizens deserve the same type of no-holds barred forensic autopsy Oregon conducted into its health insurance debacle.
In a lopsided one-party state like Maryland, that may prove far too embarrassing for those in power to let it happen.