By Josh Archambault
Date: April 10, 2014
Read it here.
Seven months after open enrollment began under the Affordable Care Act, Massachusetts’ online health insurance exchange doesn’t work, and the state government is just firing the primary contractor CGI, without a final plan for how to fix it. Since we can’t change the past, the commonwealth must immediately focus on how to make the best of an exceedingly bad situation.
Massachusetts’ Health Care Connector should give up the idea of running its own website and partner with the federal exchange. The state should only keep control of what functions are unique to Massachusetts, but rely on the systems recently fixed by some of America’s brightest tech minds. This could offer a quick-ish solution and would save significant taxpayer money. The federal government certainly has a stake in making the arrangement work as the Obama administration has invested significant political capital in the ACA.
The challenge is that it would require state officials to eat a slice of humble pie after lofty rhetoric promising a “Rolls Royce” state-of-the-art exchange rather than just a functional one. But political reality should force their hand as it is likely that Republicans will control both chambers of Congress next year, and are unlikely to write a blank check to Massachusetts to fix its failed ObamaCare website.
Regardless of the path forward, one of the major Massachusetts-specific issues adding complexity to building a functional website is our Medicaid program. The commonwealth, for example, has well over 200 Medicaid eligibility rules; Connecticut has single-digits. The legislature should immediately take up the job to simplify the MassHealth rules.
The state should not just hire a new firm to replace CGI, as the commonwealth still lacks the technical expertise to prevent a second failure. Plus fresh starts are expensive — likely hundreds of millions of dollars.
While we must develop solutions to the website mess, we also have a responsibility to learn from it. The federal Health and Human Services’ inspector general is looking into shortcomings in Maryland’s website and the Government Accountability Office is investigating Oregon’s failures.
Astonishingly, a short independent report found that there had been no comprehensive testing of the site before launch.
Massachusetts’ exchange is in the worst shape in the nation. People who thought they had signed up for health insurance are being turned away by doctor’s offices and others are forced to bear the full brunt of medical bills. People have paid multiple months of premiums but have been told there is no record of these payments. Yet there is still no investigation into exactly what went wrong. Politics may be trumping people.
These mistakes will cost state taxpayers plenty. Currently $16 million is being spent over a 60 day period on “workarounds,” i.e. mainly manual data entry of applications. The state is looking to ask the federal government for upwards of $50 million for additional short-term work, before fixing the site.
As a result of the failure, more than 160,000 people have been put on Medicaid to insure that they would have some kind of coverage. Some of these individuals will end up qualify for federal reimbursement, but many will not, and state taxpayers are giving them free insurance, when they should be paying premiums. The final cost to the state is unknown for this transitional coverage, but preliminary estimates are at least $10 million a month extra. That is why a quick fix is so important.
Transparency about the workarounds has improved since Gov. Patrick hired Sarah Iselin to oversee the exchange debacle. But we still don’t know what went wrong with the site and only have snapshots of how deep the issues run.
There are rumors of a tax on all small business plans to bail out the commonwealth’s Health Care Connector. State officials have a whole lot of explaining to do before we get to that point.
Josh Archambault is a senior fellow at Pioneer Institute and the Foundation for Government Accountability.