When he ran for president in 1988, Michael Dukakis infused the phrase Massachusetts Miracle into stump speeches to describe the states economic transformation. That same description could apply if a costly and controversial plan to fix the states Connector exchange succeeds.
One critical checkpoint used to assess the direction of a confusing dual track strategy will be decided after June 30, which is when new software will be completed.
Massachusetts is considering defaulting to HealthCare.gov even as it pours millions of dollars into a last-ditch attempt to fix its dysfunctional HIX, a model for national health insurance reform since 2006. The Bay State joins Oregon and Nevada in seeking such a transition before the 2015 enrollment season kicks off on Nov. 15.
Considerable political pride is riding on the outcome. I think it would be a big black eye if Massachusetts, which was a kind of template for how health reform could be implemented, to then be one of the state-based exchanges that werent able to make it work, observes Vince Ashton, president and CEO of HealthPass New York, an independent commercial HIX serving small businesses and sole proprietors.
He believes Massachusetts is looking to remain in control over the marketplace to the greatest extent possible, adding that Healthcare.gov would serve as a backup plan if the state cant get hCentives new software up and running in a timely manner.
Whats unclear at this point is what the final tab will be on top of $57 million the state already has shelled out on Connector or whether the federal government will pick up that expense. This approach could total $121 million, according to The Boston Globe, which also reported that $40 million in federal grants could be repurposed to help pay for the fixes. Connector is the linchpin of former Gov. Mitt Romneys health care reform plan, which became a template for the Affordable Care Act. It has enrolled 296,686 state residents since December through paper forms and other workarounds, the same report noted.
Connector officials are relying on the consulting expertise of Optum/Quality Software Services Inc., a unit of UnitedHealth Group Inc., to oversee hCentives work. The company also helped correct HealthCare.gov glitches. Both Optum and hCentive declined to comment. Jon Gruber, an MIT economist and Connector board member who was instrumental in health care reform at both the state and federal level, also is not talking though he recently expressed doubt that Connector would be taken over by HealthCare.gov.
In some ways, fixing [Connector] is a bit of an exit strategy because they have to have some reliability before they convert to another application or suite of applications, explains Robert Booz, a health care analyst with Gartner, a leading IT research and advisory company.
He adds that switching to Healthcare.gov has actually become a palatable solution because it now provides more proven technology than state exchanges, many of which have stumbled. The experience of state exchanges has not been good, he observes. There are lots of different reasons for that. If you look at a common thread, it relates not to politics but to IT implementations.
Ashton says the trouble with Connector is that it lacked a unified vision, flexible timetable for adhering to schedules or procedures and adequate oversight over technical corrections. There also was no clear path to accountability for the systems failures. But as long as the hCentive fixes keep progressing, Ashton predicts the state will continue its dual-track strategy.
Each state exchange has its own unique set of glitches. However, Booz says there has been a common thread, which is each states challenging relationship with its IT vendor and overall project management.
There are significant policy differences between Connector and the federally facilitated marketplace exchange, he explains. The biggest example is the states subsidy isnt as wide reaching as the federal exchange subsidy, both of which reportedly will be integrated as part of the Connector fixes, while the application process was paper-based.
Shutan is a Los Angeles freelance writer.
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