'Epic fail': Where four state exchanges went wrong

Maryland, Massachusetts, Minnesota, and Oregon still struggle

ProPublica's Charles Ornstein details why the health care exchanges in Maryland, Massachusetts, Minnesota, and Oregon failed during their Oct. 1 launch, and why they are still struggling to find their footing months later.

Lessons from the Obamacare exchanges' glitchy debut


According to a recent Washington Post article, Maryland Health Connection senior officials "failed to heed warnings that no one was ultimately accountable" and that the state "lacked a plausible plan for how it would be ready by Oct. 1."

While state officials were claiming that the Maryland exchange would serve as a "national model," fighting between the state and contractors hired to build the exchange turned into lawsuits, the top IT official quit, and the state rotated through three different project managers, Ornstein writes.

As a result, the site crashed within moments of its Oct. 1 launch, and the exchange's director ultimately resigned in December. In January, Gov. Martin O'Malley (D) approved a law to provide a second option for residents trying to sign up for coverage if they can prove that they unsuccessfully tried to gain coverage through the exchange.


Ornstein writes that blame is being spread around as to why the state's exchange—MNsure—is unable to keep up with demand.

"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," according to a Jan. 8 MinnPost article.

MinnPost subsequently revealed that state officials took over responsibility for the website's technical infrastructure from its lead contractor in May, complicating questions over the vendor's role.

Dayton has said he was unsure if MNsure staff had kept him in the loop and MNsure's director has resigned.


Although the state should have had a clear advantage with its early adoption of universal health care, the Massachusetts Health Connector website that launched Oct. 1 was "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," Ornstein writes.

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," according to a Boston Globe article.

State officials knew as early as February 2013 that website's launch would likely be delayed, according to records obtained by the Boston Herald. And in July, officials—including the director of the exchange Jean Yang—were made aware that the contractor building the site was behind schedule and that there was "likely risk" it would not be ready, the Boston Globe reported. Yang did not tell the exchange's board, according to meeting minutes, Ornstein writes.


The website for Cover Oregon failed to launch in October and is still unable to accept electronic applications for coverage. Then-director of the exchange Rocky King resigned last month, pledging that the website would be functional soon and stressing that Cover Oregon has enrolled 14,000 state residents in private plans and 24,000 in Medicaid through the paper-based process.

How Obamacare already has cut Oregon's uninsured rate by 10%

According to The Oregonian, a technology expert at the state's Department of Administrative Services warned the top IT analyst for the state's legislature that exchange managers were being "intellectually dishonest" in claiming that the site would be ready by October. The expert revealed that flaws in the site had been well-documented since November 2011. Gov. John Kitzhaber's (D) office took heed of the warnings, but were apparently convinced "the project was on track," Ornstein writes.

As a result, Cover Oregon leaders "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," Ornstein writes (Ornstein, ProPublica, 2/6; Conaboy, Boston Globe, 1/25; Conaboy, "White Coat Notes," Boston Globe, 1/31; Boston Herald, 1/23; Davis/Flaherty, Washington Post, 1/11; Goodnough, New York Times, 2/1; Budnick, The Oregonian, 1/31; Nord, MinnPost, 1/8; Nord, MinnPost, 1/9; Monahan, Worcester Telegram & Gazette, 2/2).

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