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Bungling mars health care deadline in some states

Tuesday - 3/25/2014, 8:14pm  ET

FILE - In this Dec 10, 2013 file photo, Lt. Gov. Anthony Brown, center, talks about problems with Maryland’s health care exchange in Baltimore. Joshua Sharfstein, Maryland’s health secretary, is standing to the right, and Carolyn Quattrocki, the interim director of the exchange, is standing to the left. With the open enrollment deadline approaching, some states running their own health insurance exchanges are focused less on getting robust sign-ups than on avoiding total disaster. Nevada, Massachusetts, Vermont, Maryland and Oregon are among the states facing severe technical and administrative problems, which have led to firings of top officials and contract cancellations for key software companies. (AP Photo/Brian Witte)

SANDRA CHEREB
Associated Press

CARSON CITY, Nev. (AP) -- As supporters of the federal health care reforms push for final signups, a handful of states are trying to press the reset button.

They have botched their handling of the process so badly that they already are looking beyond Monday's enrollment deadline to the next enrollment period starting in the fall.

Many states and the federal government experienced technical problems with the enrollment websites, but implementation of the federal Affordable Care Act has been a relative disaster in Maryland, Massachusetts, Nevada, Oregon and Vermont.

Rather than focusing on meeting enrollment targets, officials in those states find themselves consumed with replacing top officials, cancelling contracts with software companies, dealing with state or federal investigations, and spending tens of millions of dollars on fixes and new contractors. The core of the problem has been the difficulty in building an online health insurance marketplace that syncs up with myriad state and federal databases.

Early projections for those five states were to sign up a combined 800,000 Americans for private health insurance coverage by March 31, 11 percent of the Obama administration's original target for national enrollment. Yet with just days to go before the six-month enrollment period ends, achieving 25 percent of that target would be considered a success.

Overseers of Nevada Health Link have called that state's program a "full failure" and a "catastrophe." Some officials have suggested dumping Xerox, which was awarded a $75 million contract to develop the system.

While Xerox remains on the job, a state board earlier this month approved up to $1.5 million to hire another tech firm, Deloitte Consulting, to assess the Xerox system and recommend fixes.

Last month Nevada officials cut their target enrollment from 118,000 to 50,000 and conceded that meeting even the lower goal would be a challenge. That drew the ire of board members, who lashed out about the thousands of people who will remain uninsured after Monday's deadline.

"These are not numbers. These are people throughout the state who don't have health insurance," said Lynn Etkins, an attorney and vice chairwoman of the board overseeing the Silver State Health Insurance Exchange.

A week later, Nevada exchange executive director Jon Hager announced his resignation to pursue "new opportunities."

It is a similar story in Oregon, where the exchange's executive director and two officials who oversaw the early technology development resigned. As of last week, 47,000 Oregonians had signed up for private insurance, less than a quarter of initial projections for the full enrollment period.

The exchange's website was so badly bungled that applications at the beginning had to be processed manually, a process that remains partially in use. Cover Oregon has withheld $26 million of the $160 million billed by Oracle, which designed the website.

The federal Government Accountability Office has announced an investigation, and a state-funded audit released last week found a failure by the exchange's managers to heed reports of problems, poor communication and what it described as "unrealistic optimism." In announcing results of the audit, Democratic Gov. John Kitzhaber said he was angry and disappointed in a process that had caused so much confusion and uncertainty among consumers.

Maryland's exchange crashed at the start of open enrollment on Oct. 1 and has been rocky ever since. The exchange's initial executive director, Rebecca Pearce, quit two months into open enrollment, and last month Maryland fired the state's prime information technology contractor, Noridian Healthcare Solutions, after paying it $65 million.

U.S. Rep. Andy Harris, the only Republican in Maryland's congressional delegation, called for a review by the U.S. Department of Health and Human Services into how $250 million in federal money was used in the botched exchange. The department's inspector general informed Harris that it will conduct the review.

"I mean, this is an immense amount of money on a project that I think in the end, if I were betting right now, I would bet that they will abandon the Maryland exchange and either import another state exchange like Connecticut's that works or go to the federal exchange," Harris said.

In addition to making major fixes, Maryland officials are considering whether to adopt technology developed by another state, join a consortium of other states running their own exchanges or partner with the federal exchange.

In Massachusetts, where health care reform implemented under then-Gov. Mitt Romney was used as a model for President Barack Obama's Affordable Care Act, officials announced earlier this month that they were cutting ties with CGI Group Inc. The Montreal-based firm also was the lead contractor on the troubled federal health care website that operates in 36 states.

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