There's absolutely no question that the Affordable Care Act is helping Americans. But here in Maryland, we have a technical nightmare. The state exchange website is a full-fledged fail, there might be north of 500,000 uninsured here, and the exchange has just signed up about 38,000. If there's a bright side, it's that expanded Medicaid has done somewhat better.
Now, the whole thing has become a political issue. A very complicated political issue. It pits different wings of the Maryland Dem Machine against one another, it pits Republicans against Democrats.
So far the O'Malley administration is successfully dodging responsibility. Worse, it turns out that transparency has apparently been the last consideration of the nine-member Maryland Health Benefit Exchange board.
Martin O'Malley put Lt. Gov. Anthony Brown "in charge" back in 2009-2010 -- or so say some people. (I'll try to offer a possible interpretation of that in a future diary).
The failure opens Brown to attacks from Doug Gansler and Heather Mizeur, who are running against him in the June primary for governor. So far, he's been ducking rather than taking charge or taking responsibility. I have a personal theory that the "Brown in charge" meme was nothing more than PR from the outset. The whole mess doesn't make the state's Democratic party establishment look very good, in my opinion. That includes our Democrat-dominated General Assembly, which has been treading carefully on tiptoe.
So what's the "underbelly"?
It's the fact that Maryland's program was out of control for months and it was all kept under wraps. The people who are footing the bill - taxpayers - the people who are supposed to benefit - Maryland residents - can't get information about what was going on with the Maryland Health Benefit Exchange, a quasi-public corporation set up to carry out the state's ACA efforts.
The latest estimate of the bill for the broken exchange website is $261 million.
Meanwhile, the MHBE says it has lost legally required meeting documentation from 2012 and 2013 and, it appears, has been violating the Open Meetings Act regularly for two years by conducting everything related to the contractors behind closed doors. Here's the tip of the iceberg.
The Maryland Health Benefit Exchange is in charge of implementing the Affordable Care Act in the state. It runs the dilapidated Maryland Health Connection website for health insurance signups. A nine-member board is in charge of all decisions.More below the spaghetti code:
... it seems clear they violated the Open Meetings Act when they voted in secret to cancel a contract with Noridian Health Services. They voted – also in secret – to extend and amend a contract with Optum/QSSI, which was hired in December to fix the website’s software. Optum’s contract may have been approved in secret, as well.
The Open Meetings Act does not allow contractual approval, amendment or cancellation behind closed doors. It does not allow “ceremonial” approval after everything’s been worked out in secret, beyond public view.
Since the Sunday night meeting was a teleconference, the public was effectively barred from the meeting.
The Baltimore SUN (here) suspects the administration is playing games with Maryland's weak Public Information Act, or FOIA law. They're trying to pin down how much involvement Anthony Brown had. After all, it does matter if the guy is running for governor.
But they don't see his name on any emails. Someone else whose name isn't on emails has been very much in the news in recent months. Identifying that person is an exercise left to the reader.
I'm not so interested in whether Brown was driving the bus off the cliff or not, though from the docs I've been able to look over, it seems he never did attend any meeting of the Maryland Health Benefit Exchange board of directors in 2012 or 2013.
Fallout: It's given Andy Harris, Maryland's 1st District Congressman, an opportunity to grandstand and demand a federal audit of the $200-million-plus website build. An audit's coming, which is good. But no one will know the results until 2015.
Andy seems more concerned about the abstract "waste and abuse" than about the estimated 47,000 uninsured people in the nine, largely rural Eastern Shore counties that form part of his district.
More fallout. Peter Bielenson's new model for health care, Evergreen, has nearly sunk because of the dysfunctional exchange website.
The Maryland Health Connection lead contractor and subcontractor, who both belong to the private sector that can always do things better, are suing each other.
Meanwhile, if the state hits 50,000 private plans through the exchange by March 31, it will be a near-miracle.