The state of the state ObamaCare exchanges

Most national media attention has been focused on the federal ObamaCare exchange, which serves 36 states.  The remaining state exchanges get less news coverage, although occasionally an ObamaCare apologist will claim they’re doing much better than the federal train wreck.

Our first hint that this claim might not be entirely accurate comes from Maryland – the very heart of the federal Leviathan, whose nightmarish state exchange was once held up as the model for the entire system.  (I guess it actually is the model, but not in a good way.)  The director of the state exchange just resigned amid voter outrage that she jetted off to the Caribbean for a fun-filled vacation during the launch of her system, sipping umbrella-festooned adult beverages on those sun-kissed beaches – unreachable by phone, email, or text message – while the Maryland incarnation of the ObamaCare disaster collapsed into an almost completely non-functional pile of error messages.

Who in the world would schedule a vacation during the launch of the system they were responsible for, especially given the dire warnings of impending doom that were percolating through the bureaucracy, carefully hidden from the ears of the public?  Wait, it gets better: the Minnesota director did the same thing.  She took a vacation to Costa Rica in November, far from the anguished cries of frustrated Minnesotans who spent hours trying to access her busted system.  Not only that, but the director of the state Medicaid program reportedly went with her, even though official documents described him as “instrumental” for the ObamaCare launch.  State authorities in Minnesota tried to keep it all quiet, but sussed out the truth, leading to the director’s sudden resignation.

Let’s have a round of applause for our “best and brightest” in government!  The funny thing is how the Ruling Class keeps thanking these people for all their hard work, even as public outrage forces them to take permanent unpaid vacations.  The Ruling Class never gets tires of congratulating itself for failure, or insulting its serfs.

The situation is still tense in Maryland, as the Baltimore Sun reports there have been calls to abandon the state exchange entirely and jump aboard the federal system, despite recent claims from Governor Martin O’Malley that everything works now:

“Color me skeptical,” said Del. Justin Ready, a Republican from Carroll County, said. “I’ve been getting lots of complaints from people.”

O’Malley’s office did not go into detail about the technical obstacles that remain for the site, but said that the state would step up its marketing efforts to get more users on board before the end of March, when Americans without health insurance face a tax penalty.

The state exchange, with its feuding contractors and prolonged technical problems, could become a political liability if still does not work, political observers said. For most top Maryland Democrats, widespread praise of the effort shifted into silence and quiet disappointment as the exchange struggled after its launch.

“If this continues, at some point for their own political survival, they will have to speak out against it,” said Todd Eberly, a political science professor at St. Mary’s College.

Some in the party have begun sharpening criticism of the troubled online marketplace. On Friday, two Maryland congressmen urged the state to consider any means necessary to speed progress, including using the federal exchange to reach an estimated 800,000 uninsured residents.

In fact, the Baltimore Sun went on to endorse these concerns in an editorial, suggesting that Maryland should strongly consider abandoning the state exchange, at least in part:

If the exchange is able to replicate its best weekday and weekend performance during every one of the 104 days between now and the end of the open enrollment period on March 31, Maryland will still only achieve about three-quarters of its goal of signing up 150,000 people with private coverage. The site may be better, but better isn???t good enough.

Under those circumstances, the question raised by Rep. John Delaney, a Montgomery County Democrat, about whether it would be better for Maryland to scrap its effort to build its own exchange and instead join the federal one has merit. Indeed, Gov. Martin O’Malley acknowledged on Monday that the option ??? and all others ??? remain on the table.

That’s a hard possibility for Governor O’Malley to acknowledge. Under his leadership, Maryland was one of the most aggressive states in the effort to build out its own exchange ??? a strategic decision that appears in retrospect to have involved no small amount of hubris and political ambition. Walking away now from all that effort and tens of millions in expenditures would be particularly embarrassing.

It would also have policy implications. Maryland decided to build the kind of exchange it did because officials wanted to create something of a one-stop portal that would integrate shopping for private plans and enrolling in Medicaid. Theoretically, that would make the system much easier to navigate for families in which, for example, the children are eligible for Medicaid and the parents for private plans. The state also had designs on eventually integrating enrollment for other social services ??? like food stamps and energy assistance ??? into one system. Scrapping the state exchange altogether would ensure that none of that would be possible, at least not anytime soon.

Oh, cheer up, fellas.  The dream of one-click enrollment in cradle-to-grave state welfare may remain elusive, but the federal ObamaCare exchange is plenty good at shuffling people into the hell of Medicaid.

Massachusetts, which we were often told was the cradle of ObamaCare because of its similarities to Romneycare, seems close to bailing on the state exchange too, having just dumped its error-plagued system for transmitting applicant information to insurance companies.  The Boston Herald says the state has “plans to roll out an alternate method this week to connect consumers to insurance companies,” but I don’t see anything in the article describing what Plan B might look like:

The Bay State Health Connector has ditched the 834 transaction forms system with just eight days until the Dec. 23 deadline to enroll patients for new insurance starting Jan. 1, and is looking for a new system to connect consumers with their newly selected insurance companies for enrollment.

???Because the IT vendor was unable to complete enrollment functions in the automated system, the Health Connector worked with carriers to create an alternative pathway to enrolling customers,??? Commonwealth Health Connector spokesman Jason Lefferts told the Herald yesterday. ???The carriers have been flexible and patient through this process, and we will be able to ensure Jan. 1 enrollments are completed. The first enrollments through this alternative process are expected to be sent on Tuesday.???

Despite the problems faced by the Health Connector in signing people up for health insurance, he said there has been no postponement of the deadlines they face to obtain coverage.

How bad are things looking in the Bay State?

Health Connector staff said last week failures to automate parts of the enrollment system has forced them to manually transfer data necessary to determine if people are eligible for insurance subsidies. And rather than being notified online, applicants are being contacted by mail. Of nearly 35,000 applications they said have been received as of Thursday, only 1,993 people have been able to actually select their insurance plans.

Good thing the communications technology of the 18th century stands ready to pick up the slack when ObamaCare’s high-tech bells and whistles blow up in the faces of the commissars!

Given that the federal system has supposedly made great strides in reducing the error rate of these 834 transmissions, there’s probably a lot of pressure in Massachusetts to use it, instead of the state system they spent so much money to develop… unless, of course, they’re receiving quiet words from federal officials that vary considerably from the happy talk the Department of Heath and Human Services has been giving the media.  USA Today notes that frightened and frustrated ObamaCare victims are actually giving up their federal subsidies and paying out-of-pocket to buy reliable coverage directly from insurers… and relates that insurance companies are quietly calling B.S. on the claims of nearly perfect data transmission from the overhauled federal site.

Washington State and New York have also reported large-scale errors in the data transmitted to insurance companies.  Kentucky and Nevada appear to be the only state exchanges that haven’t faced big problems along these lines, although Politico relates an ominous quote from a Blue Cross / Blue Shield spokesman in Kentucky: “As far as the quality of the data that’s coming in, I can’t say that everything has been completely accurate, nor has everything been completely accurate.”  Well, that clears things up.  The Politico article goes on to note that state exchange officials have been generally more successful at refusing to answer detailed questions about their insurance data quality than their federal counterparts.

In Connecticut, the ObamaCare state exchange defrauded over 2,400 customers by giving them wildly inaccurate information about the cost of their health care plans.  The local commissars treated themselves to $79,000 in fancy wall murals for their offices while their system was busy rooking users in a way that would get them sued into oblivion, if they were a private-sector operation.

Vermont authorities were given repeated warnings about staff issues and technical problems with its exchange before launch, leading to some tough what-did-you-know-and-when-did-you-know-it questions for Governor Peter Shumlin.  “Starting on April 24, and continuing through Sep. 29, every report contained a page asserting that the entire health care exchange project should be considered ‘HIGH RISK’ or “RED status’ due to unresolved risks for meeting the October 1 deadline,” reports Vermont Public Radio.  This led to a series of post-launch crashes and an electronic payment system that still wasn’t working, as of last week.  The state is holding back some $5 million from its IT contractor – CGI, the same company that brought you the federal train wreck.  The company is said to be slow-walking the release of documents requested by the auditing firm hired by the state.

The Vermont exchange is hailed for overcoming the worst of these problems and enrolling a higher percentage of its small population than any other state, but as Megan McArdle at Bloomberg News observes, they also had a higher bar to clear than most others, because there is no alternative to using the state exchange system:

Per Kaiser, 5 percent of Vermont???s population, or about 31,000 people, bought individual policies before Obamacare. Eight percent, or 50,000 people, are uninsured; some of those will be expected to move onto the exchange. And this source says that ???An estimated 118,000 individuals and employees from the small group market will be served by the health benefits exchange in the first year.???

In other words, Vermont is supposed to sign up 20 percent of its population through the exchanges, 12 percent of whom must have had some other form of insurance. And unlike in other states, the law offered no way for those people to buy insurance outside of the exchanges.

[…] For the state of Vermont, 2.5 percent of its population signed up represents a disastrous failure, not a roaring success. That figure means the state hasn???t even managed to sign up the people who already had insurance, much less cover anyone new. And if it can???t get things working better by March, when those temporary renewals expire, then Green Mountain Care will have resulted in a net loss of insurance coverage for the state.

Oregon is also falling back to good old dead-tree paperwork and snail mail, although they haven’t broken out candlelight and quill pens yet.  The state exchange website was, you guessed it, an absolute disaster, to the point where reports the state is holding back $20 million from its IT contractor, and might be considering a lawsuit.  They had to hire an extra 400 people to process all the paperwork, and since half of the 30,000 existing applications are said to contain errors, they canceled the state’s massive $21 million ad campaign to lure young suckers into signing up.

According to the Department of Health and Human Services, Oregon wrapped up a smashing November enrollment period by spending $300 million on a system that only signed up 44 people.  You probably won’t hear so many complaints about its performance in December, though… because state officials have been using gag orders to keep their Little Partners in private industry from saying anything negative about ObamaCare, under pain of losing their grant money.  They promised to discontinue this practice after the non-disclosure agreements were brought to the public’s attention.

Every state is different, and much of ObamaCare is still hidden behind veils of obfuscation and misinformation at every level, so it’s difficult to make blanket statements about whether the state exchanges are collectively in “better” or “worse” shape than the federal system.  It’s undeniably a long stretch to claim the states are doing just fine.  And when all hell breaks loose in January, it may not be much of a comfort to know that an extra layer of state bureaucracy lies between consumers and their doctors, as they try to figure out whether their health insurance is valid.