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Tag: health care exchanges
Maryland Looks To Connecticut As Health Care Exchange Model

Maryland Looks To Connecticut As Health Care Exchange Model

By Meredith Cohn, The Baltimore Sun

BALTIMORE — Maryland will likely dump all or part of the state’s health insurance exchange website and adopt Connecticut’s system, a move that could make it the first state to abandon a dysfunctional site.

Officials with Maryland’s exchange plan to turn to the “Connecticut solution,” which was developed largely by Deloitte Consulting LLC and considered among the most successful in enrolling consumers in private health insurance under the Affordable Care Act, said two sources with knowledge of the situation.

Exchange officials insist that no decision has been made.

Connecticut’s software is “on the table, among other options, but we’ve not made a final decision,” said Carolyn Quattrocki, interim director of the Maryland Health Benefit Exchange.

“It’s a multistep process that we’re undertaking,” she said. “Then it becomes a recommendation to the board. The exchange board makes the final decision. We’ll also need to work with our federal partners.”

Many details remain to be worked out, and the plan could be derailed by logistics, costs or the federal government, which would likely be tapped to pay for the move, said the sources, who asked not to be named because discussions are continuing.

Maryland officials still need to decide how much of Connecticut’s technology to use, how much of the existing architecture is salvageable and who would implement the changes. A big issue is how to enroll consumers in Medicaid, which Maryland now does through its exchange but Connecticut does not.

Officials in Connecticut declined to discuss any talks with other states, but they have been marketing such services to Maryland and others with potentially unfixable websites.

Leaders there said recently that they would have room to run one or two other states’ sites wholesale on their servers out of their offices or provide guidance on how to hook up the technology. Connecticut also plans to integrate Medicaid enrollment into its exchange, called Access Health CT, but the timetable isn’t clear.

So far, Connecticut, a much smaller state with fewer uninsured, has enrolled almost 57,500 in private health plans, compared with Maryland’s enrollment of just over 38,000.

Maryland officials acknowledge a tight timeline to ramp up a new system. The current open enrollment ends March 31 and the next one begins in November.

They have outlined several options, such as moving to the federal site, fixing the existing site and adopting another state’s technology.

Maryland’s exchange — the Maryland Health Connection — crashed as soon as it launched on Oct. 1 and has been plagued by problems ever since.

Maryland’s exchange officials brought in Optum/QSSI to assess options last December, and then the firm took over the site’s management after the state terminated its relationship with its prime contractor, Noridian Healthcare Solutions.

The ultimate decision may be as complex as the website itself, one technology consultant said.

All of the technology developed by contractors for exchange websites is free for other states to adopt because it was paid for with federal dollars, but integrating the technology won’t necessarily be simple or cheap, said Rick Howard, a research director at Gartner, an information technology research and advisory company.

Maryland has already reported that it expects to spend $261 million by 2015 on its exchange.

The state’s website architecture is far different from Connecticut’s, so saving any portions of it could be tough, Howard said. But adopting Connecticut’s system wholesale would require customization because Maryland has its own rules, consumer data and insurance companies, for example.

Maryland may be best off using the whole system and adopting new ways of doing business, he said.

“From a cost point of view, leveraging what’s on the ground in Connecticut would probably pencil out as a lot less expensive than duplicating it in Maryland, which already has spent a lot of money,” Howard said. “They could take Connecticut’s work flows and processes to minimize customization.”

Howard did say that even if Maryland is the first to dump it site in favor of another state’s, it won’t be the last. Fourteen states opted to run their own sites, leaving the rest on the federal site, which stumbled at first but now runs more smoothly.

Photo: Michael Hilton via Flickr

Obamacare Beats An Enrollment Target In January

Obamacare Beats An Enrollment Target In January

According to new enrollment data from the Department of Health and Human Services, 3.3 million Americans have signed up for private health insurance through the Affordable Care Act’s exchanges.

About 1,146,100 people enrolled in new private health plans in January, marking a 53 percent increase from the roughly 2.2 million who signed up during the three previous months. That also makes January the first month in which the Obama administration outpaced its enrollment target; it had projected that 1,059,900 people would enroll throughout the month.

The encouraging numbers are still far short of the administration’s original goal of 4.4 million enrollees by the end of January; that target fell out of reach during the exchanges’ disastrous launch in October.

Crucially, 27 percent of January enrollees are between the ages of 18 and 35 — up 3 percent from the previous three months. Young, healthy customers are critical to the law’s success, as they are needed to hold down insurance premiums in the health care exchanges.

There is still no data on how many people have paid their first premium.

“These encouraging trends show that more Americans are enrolling every day, and finding quality, affordable coverage in the Marketplace,” HHS Secretary Kathleen Sebelius said in a statement. “There is still plenty of time for you and your family to sign up in a private plan of your choice, so visit HealthCare.gov to learn more and sign up.” Open enrollment ends on March 31; after that date, Americans without some form of health insurance will face a tax penalty next year.

AFP Photo/Karen Bleier

Epic Fail: Where Four State Health Exchanges Went Wrong

Epic Fail: Where Four State Health Exchanges Went Wrong

by Charles Ornstein,ProPublica.

Much has been written (and will continue to be written) about the spectacular failure of health insurance exchanges in Minnesota, Massachusetts, Oregon and Maryland — all blue states that support the Affordable Care Act.

All were woefully unprepared for their Oct. 1 launch, and unlike HealthCare.gov, the federal marketplace, they are still having trouble getting back on their feet. As a result, enrollment in those four states has lagged behind other states, including many that actively oppose the health law.

The New York Timesrecently reported on how problems in these states could give Republican candidates an opening. “Last month, the Republican National Committee filed public-records requests in Hawaii, Maryland, Massachusetts, Minnesota and Oregon seeking information about compensation and vacation time for the exchange directors, four of whom have resigned. All five states have Democratic governors whose terms end this year. Three of them 2014 Gov. Neil Abercrombie of Hawaii, Gov. Mark Dayton of Minnesota and Gov. John Kitzhaber of Oregon 2014 are seeking re-election,” The Times reported.

One common element emerging in the coverage of these exchanges is that at least some state employees knew they were heading for disaster but didn’t take action early enough to remedy it. All the states have blamed some, if not all, of their problems on outside tech contractors. Here’s a sampling of what has been reported in each state.

Oregon

The Oregonian newspaper has done a great job chronicling the unfolding disaster with Cover Oregon. The state is the only one in which no one has been able to enroll using the website. In an article last month, the newspaper reported that a technology analyst at Oregon’s Department of Administrative Services warned last May that managers at the exchange were being “intellectually dishonest” in claiming it would be ready Oct. 1.

As the Oregonian set forth in its findings:

  • The project’s significant flaws were well documented dating back to November 2011. Multiple independent analysts repeatedly raised questions about poor management along with strong doubts that it could be operational by the Oct. 1, 2013 deadline.
  • Cover Oregon leaders wavered between despair and an almost evangelical enthusiasm that they could complete the site. In the end they charged ahead, piloting an unfinished, largely untested exchange project right up to the Oct. 1 go-live date with no backup plan ready to go.
  • Senior officials in Gov. John Kitzhaber’s office and elsewhere read at least some of these warnings but took no significant steps to intervene, apparently after being convinced by others the project was on track.
  • A key official in the massive IT project took steps to silence the critics. The Oregon Health Authority last January withheld payment from the company hired to monitor the project, claiming its persistent criticism was inaccurate and inflammatory.

The director of Cover Oregon left on medical leave in December. The Oregonian also has a good piece comparing Oregon’s failures with the successes of Kentucky, whose exchange has been lauded.

Minnesota

Blame is being spread around in Minnesota, where the MNsure exchange is sputtering and its call center is unable to keep up with demand. As news site MinnPost reported last month: “The vendors are blaming the state. Gov. Mark Dayton and state officials are blaming the private companies who built the faulty technology, and MNsure leaders are quick to point out that they weren’t around when controversial decisions were made. Republican lawmakers, meanwhile, are saying that the governor needs to take responsibility for the project.”

MinnPost reported that despite their efforts to blame vendors, state officials were responsible for key decisions:

Newly released contract documents suggest the state and MNsure leaders had a more direct role in the health exchange’s many missteps than they have publicly acknowledged.

In recent weeks, Gov. Mark Dayton and MNsure officials have increased their criticism of vendors, blaming the private technology companies for some of the underlying problems and glitches with the health exchange’s operation.

However, in early May, the state of Minnesota in effect took over responsibility from its lead contractor, Maximus Inc., for constructing MNsure’s technical infrastructure, according to contract amendments released to MinnPost by MNsure.

The new documents show that the exchange staff quietly made a significant change to its key contract for building MNsure 2014 just months after making major revisions to the timeframe and size of the project.

Dayton later said he was unsure if senior MNsure staff were keeping him apprised of the serious issues with the exchange as soon as they came up.

The Star Tribune has reported on lengthy delays at the exchange’s call center and how officials in charge of the project received bonuses before its disastrous launch.

As in Oregon, the head of Minnesota’s exchange also resigned.

Massachusetts

In many ways, Massachusetts should have been a leader in setting up its own exchange. After all, its 2006 health reform law signed by then-Gov. Mitt Romney has been cited as the model for Obamacare. But the state’s exchange, the Massachusetts Health Connector, has fumbled.

The Boston Heraldreported last month that “state officials overseeing the Health Connector website knew as early as February 2013 — some nine months before launch — that parts of the $69 million Obamacare gateway would probably be delayed, public records obtained by the Herald last night revealed.”

The Boston Globefollowed up with another report:

Massachusetts officials knew in July, three months before the launch of the state’s ill-fated health insurance website, that the technology company in charge was far behind on building the site and that there was “a substantial and likely risk” it would not be ready, according to a state official’s memo.

The website launched on Oct. 1 was incomplete and riddled with errors that frustrated consumers, blocked some from getting coverage, and required the state to move tens of thousands of people whose applications could not be processed into temporary insurance programs.

The head of the Massachusetts Health Connector Authority, which runs the insurance marketplace, was copied on the July memo. But the executive director, Jean Yang, and her staff never told the Connector board during its monthly public meetings that the project was off track, according to meeting minutes.

The Globereported in a separate story how an untold number of people who “applied for Connector plans without financial assistance have not gotten coverage, because their payments were lost or somehow never linked to their accounts.”

John J. Monahan, a columnist for the Worcester Telegram & Gazette, put it like this last weekend:

Massachusetts’ universal health care program was the model for Obamacare. And now, it seems, the Obamacare website fiasco has been modeled by Massachusetts.

The state contracted with the same software company that messed up the launch of the Obamacare website to redesign its Health Connector website for people to buy insurance. It was scheduled to be working Oct. 1 to renew insurance for Jan. 1. It still isn’t working.

Maryland

The Maryland Health Connection, like the exchanges in other states, knew well in advance that it wasn’t ready to launch, but the problems weren’t fixed in time.

The Washington Post reported last month how “senior state officials failed to heed warnings that no one was ultimately accountable for the $170 million project and that the state lacked a plausible plan for how it would be ready by Oct. 1.”

Over the following months, as political leaders continued to proclaim that the state’s exchange would be a national model, the system went through three different project managers, the feuding between contractors hired to build the online exchange devolved into lawsuits, and key people quit, including a top information technology official because, as he would later say, the project “was a disaster waiting to happen.”

The repeated warnings culminated days before the launch, with one from contractors testing the website that said it was “extremely unstable” and another from an outside consultant that urged state officials not to let residents enroll in health plans because there was “no clear picture” of what would happen when the exchange would turn on.

Within moments of its launch at noon Oct. 1, the website crashed in a calamitous debut that was supposed to be a crowning moment for Maryland officials who had embraced President Obama’s Affordable Care Act and pledged to build a state-run exchange that would be unparalleled.

Weeks later, the Baltimore Sun’s Meredith Cohn wrote a piece about just how much trouble she personally had trying to enroll:

For a chunk of two recent days, I tried to buy insurance on the Maryland health exchange.

My editors asked me to do this because Gov. Martin O’Malley recently told a national television audience that the “website is now functional for most citizens.”

They wanted to know what “functional” meant, especially after hearing stories from consumers about a glitch-prone website created under the Affordable Care Act for the uninsured and underinsured. Marylanders have described frozen screens, lost information, error messages and even mistaken identity.

My own enrollment took 5 hours and 22 minutes over two days, two calls to the exchange’s call center, seven times entering my personal information, two computers and two web browsers.

Maryland’s exchange director resigned in December. Last week, Maryland Gov. Martin O’Malley signed a law that would provide a backup method for hundreds of residents to get coverage effective Jan. 1 if they can show that they tried unsuccessfully to get coverage from the exchange.

Have you tried signing up for health care coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story.

Photo of Governor John Kitzhaber: OregonDOT via Flickr

Obamacare Website Fixer Has Thing For Tax Havens

Obamacare Website Fixer Has Thing For Tax Havens

If you had to hire an outside company to run the Patient Protection and Affordable Care Act’s enrollment website, which would you rather have: a goody-two-shoes outfit that doesn’t know what it’s doing or a competent, well-known consulting firm that makes liberal use of offshore tax havens?

The best choice is neither, of course. Ideally, the U.S. government would set a good example and pick a skilled U.S. contractor that isn’t a poster child for clever tax shelters. Instead, the job of taking over construction of HealthCare.gov, which failed miserably when it debuted in October, is going to Accenture Plc, which switched its place of incorporation in 2009 to Ireland from Bermuda. It will replace Montreal-based CGI Group Inc., which got the blame for many of the website’s early problems.

It was only last May that the Senate Permanent Subcommittee on Investigations held hearings excoriating Apple Inc., which is based in Cupertino, California, over its use of Ireland as a tax haven. So it’s a bit surprising to see that hardly anyone is complaining about the Accenture hire. This may be an example of an orphan controversy. It’s sitting there waiting for someone to make a big deal of it, but there aren’t many politicians with an interest in doing so — even on a hot-button subject as politicized as Obamacare.

Democrats in Congress generally don’t want to be seen badmouthing the White House or the Affordable Care Act. Many Republican lawmakers (and plenty of Democrats, too) may be reluctant to criticize corporate tax dodges. For instance, Senator Rand Paul of Kentucky, a reliable Tea Party basher of Obamacare, spent much of his time at last year’s Senate hearing defending Apple’s use of offshore refuges to avoid U.S. taxes.

Accenture has endured so much criticism over the years for its use of tax havens that it even has a disclosure in its annual report warning investors to expect as much.

“Some companies that conduct substantial business in the United States but which have a parent domiciled in certain other jurisdictions have been criticized as improperly avoiding U.S. taxes or creating an unfair competitive advantage over other U.S. companies,” Accenture said. “Accenture never conducted business under a U.S. parent company and pays U.S. taxes on all of its U.S. operations. Nonetheless, we could be subject to criticism in connection with our incorporation in Ireland.”

That isn’t the whole story. Accenture got its start as part of the Chicago-based accounting firm Arthur Andersen. The firm’s consultants won an agreement in 1989 to form their own unit, Andersen Consulting, which remained affiliated with Arthur Andersen until 2000, when the two organizations severed ties. Andersen Consulting changed its name to Accenture in 2001 and went public the same year. Then, in 2002, Arthur Andersen imploded after being indicted in connection with its audit work for Enron Corp., the failed energy trader.

In other words, Accenture’s roots date back to a once-iconic American business, which helps explain why it’s gotten a lot of heat for incorporating in tax havens since spinning off.

In a 2002 report, the Government Accountability Office found that four of the 100 largest publicly traded federal contractors were incorporated in tax-haven countries. Accenture was one of them. The others were conglomerate Tyco International Ltd. and oil-services companies McDermott International Inc. and Foster Wheeler Ltd. Since then, Foster Wheeler and Tyco have switched locales to Switzerland from Bermuda. McDermott is still incorporated in Panama, while its executive offices are in Houston.

Plenty of other companies have drawn similar scrutiny. In 2008, the GAO released a report that looked at the 100 largest U.S.-based federal contractors that were publicly traded. It found that 63 of them had subsidiaries in tax havens. Citigroup Inc. had the most with 427, including 91 in Luxembourg, 90 in the Cayman Islands, 19 in Bermuda and 16 in Ireland.

All that said, if Accenture can make HealthCare.gov work properly, there probably won’t be many people criticizing it as a poor choice, model corporate citizen or not. The government doesn’t need angels for this job. It needs people who know how to build a good website.

(Jonathan Weil is a Bloomberg View columnist. Follow him on Twitter @JonathanWeil)

AFP Photo/Karen Bleier