Category Archives: Medicine/Health Care

Sharfstein’s Scarlet Letter

By Barry Rascovar

August 11, 2014 — For a 44-year-old, Josh Sharfstein has accomplished much: Baltimore City health commissioner, Maryland health secretary and chief deputy commissioner at the Federal Drug Administration.

Josh Sharfstein

MD Health Chief Joshua Sharfstein

Yet when Sharfstein leaves his state post at year’s end, his many achievements will be eclipsed by one giant failure: Maryland’s terribly botched health insurance exchange rollout.

This glitch-plagued rollout — the costliest debacle in Maryland state history — was a monumental disaster that should have been foreseen.

There were plenty of warning signs in the year leading up to the Oct. 1, 2013 enrollment opening. The exchange’s computer software immediately crashed — and remained dysfunctional for months.

Standing Tall

To his credit, Sharfstein shouldered the public blame for this immense fiasco. The other chief culprits, Gov. Martin O’Malley and Lt. Gov. Anthony Brown, deflected criticism to protect their political futures.

Even worse, they connived with legislative leaders to cover up the true story by avoiding an in-depth accounting of what went wrong until mid-2015. This intentional lack of transparency and accountability will remain an indelible blot on the O’Malley-Brown administration. It will haunt both of them in the years ahead.

Sharfstein took the fall at legislative hearings. He was the only one connected with this ill-fated project to apologize and take responsibility for a truly screwed-up rollout.

It is ironic this happened on Sharfstein’s watch because he’s known as a hands-on micro-manager who drives underlings crazy with his detail-oriented obsessions.

Loss of Control

This time, though, Sharfstein ran afoul of a bone-headed decision by O’Malley and Brown to set up the new Maryland health exchange as a separate, independent agency — instead of wrapping it neatly into Sharfstein’s health department.

That twist meant huge additional expenses — a separate set of backroom jobs had to be created and filled that could easily have been tacked onto existing services within the health department.

The biggest problem in giving the exchange its independence was loss of control.

MD Healthcare Connection

Sharfstein never gained direct authority over the health exchange because O’Malley set up the new agency outside the health secretary’s purview.

Yes, he co-chaired the oversight board with Brown, but that group served as a rubber-stamp for whatever Rebecca Pearce, the insurance executive hired to run the exchange, suggested. The panel didn’t challenge her assessments — a serious mistake.

Even worse, there were no traditional checks and balances to make sure the pivotal choice of technology contractors didn’t veer off-course (sadly, it did).

Nor were the health department’s seasoned computer experts in position to monitor the exchange’s faltering software development.

The department was left on the outside with no authority to intercede or blow the whistle on the prime contractor’s inept performance and failure to meet deadlines.

Righting the Ship

Sharfstein, a pediatrician whose entire career has been in government and public health, was ill-prepared to act as overseer of a highly complex information-technology project.

But as an experienced manager, and with a wealth of IT expertise available in his department, he probably could have avoided the computer crash that proved so costly.

To his credit, Sharfstein accepted responsibility for the disaster. He worked tirelessly to find a work-around and a fix (the first succeeded, the second didn’t). Now the old exchange system is being junked and a new one that is functioning well in Connecticut is being superimposed — at an enormous cost.

The health secretary will stay on to see if this latest stab at building a health insurance exchange works. He wants to walk away without leaving a health exchange headache on his successor’s desk.

That determination says a lot about Sharfstein’s commitment to righting the ship.

He can take pride in the fact that despite horrendous obstacles, over 400,000 people (mostly Medicaid recipients) signed up for health insurance through the exchange. If the Connecticut software system works in Maryland, that number should grow in Year Two.

Moving to Hopkins

We haven’t heard the last of Josh Sharfstein.

He’ll take up residency at Johns’ Hopkins’ Bloomberg School of Public Health as an associate dean with a full workload, but the urge to serve the public could lure him back, especially during a Hillary Clinton presidency.

If that’s the case, he’ll still have to explain what went wrong that led to Maryland’s costly health exchange snafu. It’s a scarlet letter he will wear, whether deserved or not.

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Cannabis, Politics & Public Health

By Barry Rascovar

May 27, 2014 — According to the mother of the man who recently crashed his stolen dump truck through the doors of WMAR-TV and stormed through the TV station claiming he was God —  her son was a heavy marijuana user and that’s what caused his latest  psychotic episode.

Psychotic man crashes dump truck into WMAR-TV

Psychotic man crashes dump truck into WMAR-TV

The near-calamity brings new focus to the marijuana legalization debate in Maryland’s June 24 gubernatorial primary.

One candidate, Democrat Heather Mizeur, champions marijuana legalization. She claims its use “is less harmful to the body than alcohol or tobacco.”

A Maryland with legalized, regulated, and taxed marijuana will mean safer communities, universal early childhood education, and fewer citizens unnecessarily exposed to our criminal justice system,” her campaign website states.

Del. Heather Mizeur

Del. Heather Mizeur

Note the one area Mizeur does not mention — the impact legalization might have on public health.

The WMAR incident is only the most glaring example of what might happen in the public health arena under cannabis legalization.

Marijuana Concerns

As luck would have it, the most recent issue of Columbia Magazine from Columbia University arrived in the mail recently with a lengthy article on pot legalization and what the university’s researchers have to say.

Writer Paul Hond raised these questions: “What are the harms to individuals from using cannabis? Will legalization lead to more use? Will the roads be less safe? And what about the kids?”

All those concerns require careful examination before entertaining Mizeur’s desire to make pot legal in Maryland.Columbia Magazine

Hond first spoke with Margaret Haney, who has run Columbia’s Marijuana Research Laboratory for 15 years.

When chronic marijuana smokers were asked to quit as part of the lab’s studies, here’s what occurred:

“Sleep disruption is one of the most robust withdrawal symptoms,” Haney says. “The smokers had trouble falling asleep. They woke up in the night. They woke up early. Their mood, too, reflected classic drug-withdrawal symptoms: irritability, anxiety, restlessness. Food intake dropped precipitously. The first two days, they consumed up to a thousand calories less than they did under baseline conditions.”

Haney continues, “The consequences of dependence are not as severe as with alcohol, cocaine, and other things. . . . However, once you’re a daily smoker, your ability to stop becomes as poor as cocaine users’.” Haney notes that “only 15 to 17 percent are able to maintain abstinence.”

Impact on Teens

Haney is most concerned about the consequences of teens who smoke marijuana regularly. “There’s going to be a cost for teenagers doing that. . . . I do worry about the developing brain and the effect of heavy marijuana use on the brain’s cannabinoid receptors” that affect mood, memory and stress.

Herbert Kleber, director of Columbia’s Division on Substance Abuse and former deputy drug czar under President George H. W. Bush (Bush the Good), is alarmed about another aspect: Today’s tokes are loaded with much more of the potent psychoactive compound THC.Marijuana Plants

In this complex, high-pressured world, Kleber understands “a lot of people are looking for escape.” But this isn’t the marijuana of your father’s days.

Back when the Beatles’ John Lennon called marijuana’s effects “a harmless giggle,” the amount of THC in a joint was about 2 percent, Kleber says.

Enhanced Potency

“Now, the THC level of the average DEA [Drug Enforcement Agency] seizure is about 12 percent. At the dispensaries in California and Colorado, it’s 15 to 30 percent. . . It’s a very different drug. A very, very powerful drug.”

In previous interviews he has ticked off the public health hazards — “increased likelihood of cancer, impaired immune system, and increased chance of other drug problems, such as addiction to opiates. . . . Recently, substantial evidence has been published linking marijuana use to earlier onset of schizophrenia and other psychoses.”

Kleber is concerned as well about the impact pot has on the young.

Teen smoking marijuana “Marijuana does affect the brain. The younger you are when you start using it, the greater the risk that it will cause brain damage that will be with you the rest of your life.”

True, smoking weed isn’t as dangerous as a drug addiction, concedes John Mariani, director of Columbia’s Substance Treatment and Research Service. “Marijuana problems tend to be less dramatic — you’re not as ambitious, you perform less well. You probably stay home, watch TV, and eat ice cream. The disorder is about the absence of things — what doesn’t happen.”

Is that the brave, new world that awaits Maryland in a Mizeur governorship?

Pot and Driving

Another accusation is that marijuana legalization will dramatically increase highway accidents. Guohua Li, director of Columbia’s Center for Injury Epidemiology and Prevention, is studying that question. His findings indicate the alarmists are correct.

“First of all. . . the use of marijuana doubles the risk of being involved in a crash. The risk is not as great as with alcohol, which increases crash risk thirteenfold. But when a driver uses alcohol and marijuana, the risk of a fatal crash increases about twenty-four fold. So marijuana in combination with alcohol doubles the risk.”

Li’s 12-year study (1999-2010) of traffic fatalities found that marijuana involvement with car crashes tripled during that time.

Li also took on Mizeur’s main legalization thrust — that marijuana does less bodily harm than  alcohol. “If you argue that because alcohol is worse than marijuana. . . then marijuana should be legalized, that’s a race to the bottom, rather than a race to the top.”

Backlash to Legalization?

Even one of legalization’s supporters at Columbia, Carl Hart, a neuropsychopharmacologist, author and director of the Residential Studies and Methamphetamine Research Laboratories, worries these public safety and public health issues will lead to what Hond calls “a spirited backlash to legalization in the near future.”

Columbia University Prof. Carl Hart

Columbia University Prof. Carl Hart

In the past year, we’ve witnessed in Maryland a stampede among some politicians in Annapolis to give a younger generation of voters what they want — legal pot — even before they examine the possible consequences.

What we’re missing is a frank discussion of the wide-ranging ramifications legalization could have on society. The scientific results from Columbia University are not encouraging.

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Stonewalling MD Health Exchange Probe

By Barry Rascovar

April 7, 2014 – The Maryland General Assembly concludes its 2014 session Monday in good shape – except for one monumental omission: the mystery surrounding Maryland’s fatally flawed health exchange, which has squandered uncounted tens of millions of dollars.

It’s now clear both Gov. Martin O’Malley and Lt. Gov. Anthony Brown are content to stonewall and impede any detailed investigation of what went wrong in setting up the Maryland Health Benefit Exchange until well after the June 24 primary election.

Gov. Martin O'Malley

Gov. Martin O’Malley

Is there a cover-up going on?

Judge for yourself.

On Thursday, the state’s legislative auditor told lawmakers he had been thwarted in his attempt to conduct a meaningful review of the health exchange.

Because the exchange’s leaders only gave state auditors what was available to the public, “We don’t have the complete story,” said the chief auditor, Thomas Barnickel III. “There’s a lot we don’t know.”

Heavily Redacted

The documents auditors received were heavily redacted — a sure sign things are being hidden from view.

It’s also not in line with accepted auditing practices of state government agencies.

But when the governor and lieutenant governor want to make sure no one gets to the bottom of this historic debacle any time soon, the administration knows how to obfuscate.

No Sign of Rebecca Pearce

For instance, the exchange gave auditors 600 emails to or from Health Secretary Josh Sharfstein — the administration’s spokesman on this issue — but nary a single email involving Rebecca Pearce, who ran the troubled exchange until December.

Could such an astounding omission have been accidental?

The redactions were so numerous in the 14,500 documents that auditors couldn’t determine if the controversial contract awards were done legally or appropriately.

MD Healthcare Connection

MD Healthcare Connection

Auditors also couldn’t figure out how the exchange went about selecting the vendor who screwed up the exchange’s computer program — Noridian of North
Dakota — or how in the world the exchange opted to buy off-the-shelf software — as opposed to customized software — from IBM.

This software proved incapable of doing the job.

Auditors did learn from documents there was confusion within the exchange over points of contact, meeting schedules, lack of a program manager and even a lack of details about the project plan.

They made one definitive finding: The exchange conducted no performance testing whatsoever.

Is it any wonder this lemon of a software program crashed on Day One and has yet to fully recover?

Limited Document Release 

Exchange leaders also saw to it auditors didn’t get enough information to figure out who made those horrendously poor decisions, who was really in charge and who should be held to account for this debacle.

Democratic leaders in the legislature aren’t in any hurry, either, to pin some of the blame on Brown because that would hurt his campaign for governor.

So no one was indignant when it became clear last Thursday at a hearing in Annapolis that the legislature’s own auditors had been stonewalled.

Earlier in the week,  O’Malley and Brown laid out their own line of attack: We’re not at fault because it’s the evil contractors who messed up.

And who, exactly, hired those contractors? Aren’t those the ones who ought to be fingered?

What was Brown’s role as co-chair of the exchange’s oversight committee?

Lt. Gov. Anthony Brown

Lt. Gov. Anthony Brown

Didn’t he have to approve those contracts? Or was he only a figurehead?

It’s clear now the prime contractor never should have been chosen in the first place. Is that the contractor’s fault or the O’Malley-Brown administration’s?

What genius decided to launch the state’s most complex and expensive IT project with off-the-shelf software?

Is it IBM’s fault the O’Malley-Brown administration decided to take the cheaper route  and ended up with a turkey that was never designed for the tasks assigned it by the exchange?

Bait-and-Switch Tactic

Is it Noridian’s fault the O’Malley-Brown administration pulled a bait-and-switch?

Exchange leaders signed a fixed-price contract with Noridian that included 261 requirements for the software program — and then later added 227 new requirements, changed 28 of the original requirements and dropped 73 of the mandates Noridian had bid on.

O’Malley seems content to blame IBM for what went wrong. Yes, IBM made the off-the-shelf software, but it was never tailored for the complicated interfaces envisioned by the IT gurus in Maryland government. Yet IBM is now the governor’s fall guy.

Now IBM is pushing back. The computer giant says it went the extra mile to fit a round peg into a square hole, but it couldn’t “overcome the state’s failure to properly manage the implementation of the exchange.”

We may never know if that’s true because O’Malley won’t launch an impartial investigation. Indeed, he’s not launching any investigation into how potentially hundreds of millions of tax dollars were wasted.

This is the guy who wants to run for president?

Permanent Stain?

What an unmitigated calamity. No authority figure in Maryland state government wants to get to the bottom of this disgrace. No public group is pressing for action, either.

We’re left with an appalling mess.

The lack of accountability, transparency and responsibility — if not remedied — will become a permanent stain on the record of O’Malley and Brown. History will not remember this episode kindly.

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Obamacare Accountability — Oregon, not MD, Got It Right

By Barry Rascovar

March 31, 2014–Today’s the deadline for folks in Maryland to start the application process for health insurance under the Affordable Care Act. If you miss this deadline, you face a tax penalty next year.

The good news is that tens of thousands of people have health insurance who couldn’t — or wouldn’t — obtain it before.

The bad news is that Maryland’s health exchange has been an unmitigated disaster — a painfully small number of people actually applied and paid their initial insurance bill.

MD Healthcare Connection

MD Healthcare Connection

Those responsible for this stupendously costly debacle aren’t going to be held accountable.

Those at the top of Maryland’s political food chain still stonewall this issue hoping it fades from public view.

State legislators have ordered a slow-motion assessment of the damage by their own analysts. It’s doubtful this will be a detailed, CSI-style examination of what went wrong.

By the time the report surfaces in mid-summer it will be too late: The decision on what comes next — most likely connecting Maryland to Connecticut’s software system — will be made (as early as this afternoon).

And by the time that legislative report appears, the June 24 primary will have come and gone — and with it any danger Lt. Gov. Anthony Brown’s gubernatorial campaign might be fatally damaged by the findings.

It’s also possible any legislative report will be sanitized by House and Senate leaders so as not to embarrass Brown (by then he could be planning his inaugural) and Gov. Martin O’Malley, who has national aspirations.

What a shocking lack of accountability to the public.

The Oregon Way

It stands in stark contrast to the way another liberal, Democratic state, Oregon, handled its own Obamacare calamity.

Oregon, like Maryland, has a two-term Democratic governor, John Kitzhaber. It has Democratic majorities in both houses of its Legislative Assembly.

But unlike Maryland, Oregon has a strong second party. Republicans hold 26 of 60 House seats and 14 of 30 Senate seats.

With such a potent countervailing force, it’s no wonder Governor Kitzhaber wasted little time launching an independent probe of his state’s dysfunctional health exchange, known as Cover Oregon.

Oregon Gov. John Kitzhaber

Oregon Gov. John Kitzhaber

Its Oracle-based software crashed so badly on Day One that all applications were done by hand. Yet Oregon still signed up more people for health insurance than Maryland.

What the independent review in Oregon found is likely to be mirrored in Maryland — if there’s ever a similar third-party critique.

Among the Oregon findings:

–“There was no single point of authority on the project.”

–The governance structure “was not effective.”

–There were “competing priorities and conflicts between [state] agencies.”

–Cover Oregon failed to hire a prime contractor or a system integrator.

–The governor and others were repeatedly warned by Cover Oregon’s quality assurance firm, Maximus, that the project was seriously off-track. These warnings started years ago and were ignored.

–In 2011, Maximus wrote that the state was acting as its own prime contractor and thus was assuming “more of the overall project risk.” How true.

–There was no Plan B as required by federal law — but there was a backup plan in case the lights went out.

–Cover Oregon picked off-the-shelf software; Oracle claimed it required only 5 percent customization. The actual number was 40 percent.

–The selected software “was not stable” and to this day “more items are breaking than are being repaired.”

–Top state officials “did not understand or acknowledge the significance of the website issues” until it was too late.

–There was a lack of “a consistent, cohesive enterprise approach to management of the project.”

–There was “no authoritative direction.”

–There was “Ineffective and at times contentious” communications and a “lack of transparency.”

Cover Oregon

The Oregon report is highly critical of the Executive Steering Committee leading the project — similar to Maryland’s oversight panel co-chaired by Brown and Health Secretary Joshua Sharfstein:

–“Oversight authority was inconsistent and at times confusing or misinterpreted.” This led to “unclear or incorrect understanding about the true state of the project approaching the Oct. 1, 2013 deadline.”

–The steering group lacked “formal meeting notes and decision tracking and documentation.”

–Perhaps worst of all, the Oregon project did not have “a single enterprise decision-tracking tool to document and manage decisions across entities.”

When Kitzhaber received the damning 77-page report in March, he cleaned house.

He fired the state’s top health official — a longtime friend and ally — who had been running the exchange since January. The chief operating officer and chief information officer of Cover Oregon also got the heave-ho. (The exchange’s original leader had been forced out in December.)

The Maryland Way

Don’t expect such drastic action in Maryland. It doesn’t fit the image O’Malley and Brown want to project going forward. Accountability is giving way to practical political considerations.

Still, the Oregon autopsy rings many familiar bells in Maryland. What happened in Oregon seems to have happened here.

Here’s what a forensic analysis of Maryland’s failed healthcare sign-up effort is likely to show:

*O’Malley and Brown created the exchange as an independent agency unshackled from the state’s formal procurement process. Support services and the normal chain of command within state government were lacking.

*Brown and Sharfstein never gave the project the intense oversight and strong, authoritative leadership it needed.

*They hired the wrong contractor — a minor-league player in the world of healthcare IT — who then quarreled bitterly with the sub-contractor it hired to do the IT project’s heavy lifting.

*No one was riding herd on the contractor.

*The state’s IT gurus picked off-the-shelf software to save money and time, software that never had been used in this way.

*There was no back-up plan in case Plan A failed (as it did).

Quality assurance and system integration were lacking. There was no general manager and no effective tracking system.

*There was no exhaustive trial period built into the schedule. 

*There was a lack of clear and honest communication up and down the line. Transparency continues to be a problem.

What Citizens Deserve

That pretty much sums up what went wrong in Maryland — even without an impartial investigation by outside experts.

But it is worth considering whether Maryland citizens deserve the same type of no-holds barred forensic autopsy Oregon conducted into its health insurance debacle.

In a lopsided one-party state like Maryland, that may prove far too embarrassing for those in power to let it happen.

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Is a Higher Minimum Wage Counter-Productive?

By Barry Rascovar

March 24, 2014 — Since it’s an election year, Democratic politicians in Annapolis are eager to pass an increase in the minimum wage. Gov. Martin O’Malley is poised to promote a higher minimum wage law in Maryland as part of his incipient campaign for national office.

But is it a good idea? Will there be unintended consequences in the form of job reductions?

That could well be the case, based on a recent Texas A&M economic study. It’s also the findings of a February study by the Congressional Budget Office.

Minimum Wage Increases

Minimum Wage Increases

Bottom Line: A jump in the minimum wage by 10 percent (Maryland’s proposal is 13 percent in Year One and a cumulative 39 percent over three years) will have a significant negative impact on future job hiring.

The non-partisan CBO forecasts that a federal hike in the minimum wage from $7.25 an hour to $10.10 an hour could mean a likely loss of 500,000 jobs nationwide, although there’s a chance the job loss could top one million.

The Texas A&M study may be more relevant in that it looked at new job creation in the year following previous minimum wage hikes. “Net job growth falls in response to an increase in the minimum wage,” it concludes.

Tom Firey of the Maryland Public Policy Institute figures this could mean the loss of 25 percent of all newly created jobs in Maryland if the General Assembly ups the minimum wage.

His adds: “In this miserable economy, the last thing we need is to further handicap job growth and business start-ups.”

All this is fascinating data and under normal circumstances the facts and figures should prove persuasive.

Not for politicians in an election year, though. Not when labor unions and liberal advocacy groups are going overboard promoting a higher minimum wage as the Second Coming.

Minimum Wage protester

But beware of the side effects: Higher consumer prices, a contraction of small retail businesses and unemployment for many now employed at the minimum wage rate.

The trade-off: help for the lowest salaried workers, who would see their pay (before taxes) go up by 3 percent.

Yet raising the minimum wage amounts to a shotgun approach: Only 19 percent of those who would receive this raise come from households below the poverty threshold of $15,730 for a family of two and $23,850 for a family of four.

Indeed, 29 percent of those benefiting from a $10.10 minimum hourly wage would come from households earning three times the poverty level ($46,190 for a family of two, $68,450 for a family of four).

An Alternative Route

A far better way to deliver financial support to the lowest-paid workers is increasing the federal and state earned income tax credit. One hundred percent of that money winds up in the hands of a low-wage worker earning less than $15,000 annually (the cap is $54,000 for a couple with three children). It’s a highly effective income supplement for low-wage workers.

That’s not going to happen in Maryland because a more generous EITC means a big hit to the governor’s budget, whereas raising the minimum wage socks it to small businesses primarily, not the government.

Yet given Maryland’s shaky economic recovery, lawmakers in the Senate are beginning to have second thoughts about sharply raising the state’s minimum wage. After all, Maryland lost nearly 10,000 jobs in January. Passage of the governor’s bill might accelerate those job losses.

It’s a Catch-22 for liberal Democratic lawmakers. Advocates standing on the sidelines promote this bill as a huge boost to the economy. Yet no impartial economic study comes to that conclusion.

Middleton’s Demand

Now a key senator, Thomas McLain (Mac) Middleton from Charles County, has thrown a new issue on the table. The governor’s bill ignores the plight of workers who care from the state’s developmentally disabled. They’d end up earning less than the new minimum wage.

Middleton won’t move the governor’s bill until this oversight is addressed. Developmental workers — 18,000 in community settings — deserve far more in wages than they’re paid ($9.82). They perform some of the most emotionally trying work in society tending to 25,000 developmentally disabled people in Maryland.

Even more egregious, the state pays its own developmental workers in rural state residential facilities much more. That fundamental inequity makes no sense except in terms of saving money when the state budget is formulated.

O’Malley’s minions are negotiating with Middleton and likely will find a way to satisfy the senator. Yet this problem is just the tip of the iceberg.

How many other job categories within state and local governments will have to be adjusted because of a $10.10 minimum wage? Is it affordable?

Passage Coming

There’s no doubt a modified version of O’Malley’s bill will be approved.

It may not have all the bells and whistles far-left advocates and the governor desire, such as an automatic cost of living increase and a big boost in salaries for tipped workers.

The path to $10.10 might be phased in more slowly. More exemptions might be added to cover college students working the summer beach season in Ocean City.

In the end, though, Maryland lawmakers will put a higher minimum wage on the books — even though it may not make sound economic sense and might prove the wrong way to address this dilemma.

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MD’s Obamacare Fiasco Continues

By Barry Rascovar

March 3, 2014 – HOW HIGH will it go? How much more will it cost the O’Malley-Brown administration to fix or totally replace the dysfunctional online health insurance system that it bragged about until it crashed on Day One?

It already is the most costly debacle in state history.

MD Healthcare Connection

MD Healthcare Connection

None of the state’s options are appetizing.  Meanwhile, the problems keep mounting, the latest being $30 million in extra taxpayer expenses due to the computer software’s inability to identify recipients no longer eligible for free Medicaid insurance.

Just fixing this deeply flawed software will cost untold tens of millions of dollars. Moving to a new, proven software system used in another state could send new spending into the stratosphere. Converting to the federal system has heavy costs as well as severe limitations and the potential for more breakdowns.

Frantic Scramble

“It seems like we’re shooting in the dark,” said an exasperated Del. Addie Eckardt, an Eastern Shore Republican at a hearing last week. She’s right.

State officials have been frantically scrambling ever since the administration’s highly touted online system froze and refused to work as promised on Oct. 1.

Officials are still grasping for straws, hoping the new prime contractor can make lemonade out of this lemon of an IT jalopy.

As for the next step once insurance enrollment closes on March 31, it’s another shot in the dark. Whatever the choice, it will be very expensive.

But will it work? There’s no guarantee that it will.

What a mess.

Loss of Federal Funds

Complicating matters is the looming end of federal largesse. Come 2015, the state is supposed to foot the entire bill for its health insurance exchange.

Maryland has expended $182 million in federal funds with little to show for it.  How much the state will be on the hook after Jan. 1 is another unknown, but we do know it will no longer by Martin O’Malley’s problem.

Gov. Martin O'Malley

Gov. Martin O’Malley on the air

What a distasteful present he’s leaving on his successor’s desk.

It’s baffling that no one running the legislator or the administration is insisting on an immediate and thorough investigation of this historic screw-up. This won’t be viewed favorably by future historians.

Not only is accountability lacking but the O’Malley-Brown administration is running away from this question as fast as it can.

Where’s Anthony Brown?

Note that Lt. Gov. Anthony Brown, the widely promoted point man on healthcare reform, continues to be missing in action. Yet he owes the Maryland public a full and frank explanation of his central role in this debacle.

How this affects Brown’s candidacy for governor remains of pivotal importance.

Lt. Gov. Brown testifies on healthcare bill

Lt. Gov. Brown testifies on healthcare bill

Does his “deer caught in headlights” performance disqualify him from serious consideration?

Is this the type of evasiveness on vital issues we can expect from him if he’s elected governor?

Do we want a governor who takes cover when controversies rage and lets underlings take the heat for him?

As Desi Arnaz famously said to Lucy, Brown has got “some ‘splainin’ to do.”

More Sinkholes Ahead?

Meanwhile, legislative committees continue to treat this disgraceful public embarrassment with kid gloves. History will not look kindly on their performance, either.

Digging out of this enormous sinkhole hasn’t been easy. The road ahead looks susceptible to similar perils.

What’s lacking is responsible, accountable leadership. That could become a dominant bone of contention as the June 24 primary approaches.

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Read other columns by Barry Rascovar at www.politicalmaryland.com

Cooking MD’s Obamacare Books?

By Barry Rascovar

Feb. 25, 2014 — UNBELIEVABLE. Maryland’s healthcare exchange debacle has entered the realm of the absurd.

On Friday, the exchange announced it had signed up a mere 3,000 subscribers for private insurance over the past week, bringing the total to a pathetic 33,000. The initial private insurance goal: 150,000.

MD Healthcare Connection

MD Healthcare Connection

Yet on Sunday we learned the exchange had magically surpassed its six-month goals — thanks to a too-convenient mistake by a economic research consulting group connected to a state  university.

Instead of an overall sign-up goal of 260,000 (Medicaid plus private insurance), the number was slashed to 160,000.

How handy: So far 190,000 people have signed up, thanks to 90,000 recipients who were previously on Medicaid and were shifted automatically to the new program.

What a bizarre way to declare victory!

More Bad News

We also learned on Sunday all work on a $19 million small business healthcare exchange ground to a halt three weeks ago, dismaying private insurers.

On Monday, the exchange belatedly announced it had fired — finally — the online sign-up system’s prime contractor at a closed-door meeting Sunday night.

The contractor, Noridian Healthcare Solutions of North Dakota (yes, North Dakota), already has been paid $67 million for producing a deeply flawed computer contraption (1,538 identified “defects” so far) that crashed on Day One. The hits keep coming.

O’Malley’s Response

To give Gov. Martin O’Malley his due, he had Health Secretary Josh Sharfstein tell a legislative committee on Monday the administration will not use those conveniently revised numbers but instead would stick with the original figures that actually were two-year, not one-year, goals.

Good for him.

But where was Lt. Gov. Anthony Brown, the designated point man on healthcare reform? The campaigning candidate once again wasn’t around to answer the hard questions from lawmakers.

And once again there was no indication anyone in the administration wants to launch a thorough investigation to pinpoint accountability for this historic screw-up any time soon.

Not only is it likely the state wasted at least $200 million in taxpayer dollars, but thousands of citizens in need of health insurance were denied that opportunity due to government incompetence — or worse.

It’s the biggest fiasco in recent Maryland history, yet no one in elective or appointed office seems to care enough to take action to find out who’s act fault until after the June 24 primary election.

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MD’s Quarter-Billion Dollar Healthcare Fiasco

By Barry Rascovar

Feb. 16, 2014 — ACCOUNTABILITY is sorely lacking when it comes to Maryland’s botched rollout of Obamacare. Lt. Gov. Anthony Brown  is nowhere to be found when tough questions are asked. Gov. Martin O’Malley deflects “who’s at fault” inquiries, focusing instead on getting the deeply flawed software partly operable.

The computer system’s main contractor, Noridian Healthcare Solutions, blames its prime subcontractor, who in turn accuses Noridian — a healthcare services company, not an IT firm — of incompetence and conning the state. Given that Noridian has received $65 million to construct a failed system, the subcontractor may have a point.

No Probe Planned

Perhaps Health Secretary Josh Sharfstein will decide in April or May to pull the plug on this IT horror show and start all over with a proven system from another state or join the federal healthcare sign-up exchange. That will cost a pretty penny.

But no one seems in a hurry to find out who screwed up.

Governor O'Malley explains IT fixes to Maryland's healthcare rollout.

Governor O’Malley explains IT fixes to Maryland’s healthcare computer rollout.

Democratic state lawmakers have put off till the summer a Department of Legislative Services analysis of what went wrong. That fits nicely with their support of Brown’s campaign to succeed O’Malley. It will be a long time after the June 24 primary before that DLS report surfaces.

Lt. Gov. Anthony Brown

Lt. Gov. Anthony Brown

Those same lawmakers tried to ignore the ongoing scandal during the current General Assembly session, but public pressure led to a series of hearings that deal with fixing the system rather than assessing blame. This helps Brown immensely, since he’s most likely to be fingered as the state official who was asleep at the switch.

First District Rep. Andy Harris wants the Department of Health and Human Services to probe Maryland’s waste of a quarter-billion federal dollars on a nearly inoperable system but that’s a political stunt by a tea party Republican who is becoming a nattering nabob of negativism.

U.S. Rep. Andy Harris

U.S. Rep. Andy Harris

Meanwhile, the O’Malley-Brown healthcare exchange continues to limp along with 29,000 Marylanders enrolled in private health plans — just one-sixth of the way to Brown’s previously stated goal of 180,000 and one-fifth of the way toward O’Malley’s 150,000 sign-up goal.

It’s a mess, the worst waste of taxpayer dollars in memory. Yet no one is launching a probe. It’s all being handled with kid gloves and diplomacy so as not to hurt Brown’s election bid or O’Malley’s longshot run for the White House.

Impartial Report

What’s needed is the equivalent of the Preston Report. Back in 1985, Maryland suffered a calamitous collapse of its privately insured savings and loan industry. It cost the state and S&L depositors hundreds of millions of dollars.

Gov. Harry Hughes and lawmakers created the Office of Special Counsel to probe “all aspects of the events” leading up to the S&L crisis. A prestigious Baltimore attorney, Wilbur (Woody) Preston, and a small team of his associates produced a package of legislative reforms and a 450-page report that detailed what went wrong and why. It was a honest and thorough assessment.

Special Counsel Wilbur Preston delivers his S&L report in 1986 (Baltimore Sun)

Special Counsel Wilbur Preston delivers his S&L report in 1986 (Baltimore Sun)

That’s what’s required now — an impartial dissection of this costly embarrassment by someone willing to lay out the facts without worrying about whether the blame falls on the lieutenant governor, the governor, the health secretary or the IT vendors.

How much of the blame belongs to O’Malley, who ultimately is responsible for what goes on in his administration? This was, after all, the most important initiative the state has undertaken in ages.

How much of the blame for this healthcare fiasco sits on Brown’s shoulders?

e’s made a big deal of his leadership on this reform, though he’s recently tried to weasel out by claiming he was only in charge of the legislation (also severely flawed) setting up the exchange.

Brown clearly was a figurehead leader — a general who showed up for the public meetings but left everything to his underlings. Even when he said he learned of the computer snafus, he apparently failed to sound the alarm.

Bleak Outlook  

Since Democratic lawmakers aren’t willing to ask the tough questions before the gubernatorial primary, and the governor has shown no eagerness to create a special panel to probe this scandal, we may never learn enough to reach a conclusion.

Even the DLS report is likely to be scrubbed of any finger-pointing at state leaders. That’s especially true if Brown wins the June 24 Democratic primary. Top Democrats in the legislature will circle the protective wagons around the presumptive governor.

What a mess.

We will glean quite a bit about the exchange’s IT failures from the competing lawsuits filed by Noridian and its prime subcontractor, EngagePoint. But that won’t lift the fog surrounding actions of healthcare exchange leaders, the governor and the lieutenant governor.

Sadly, this is one mystery that may never be solved.

 

 

 

 

 

Brown’s Healthcare Albatross

By Barry Rascovar for MarylandReporter.com

January 20, 2014 — MARYLAND’S LIEUTENANT GOVERNOR, Anthony Brown, has a problem that won’t go away — his still unexplained leadership role in the state’s disastrous Obamacare rollout.

This is the biggest sticking point in Brown’s run for governor. It could become an insurmountable obstacle if public attention remains focused on those computer glitches and poor sign-up results.

Week One of the General Assembly session brought no relief.

Brown testified before two panels on a Band-Aid measure to rescue perhaps thousands of Marylanders who couldn’t sign up for health insurance because of the state’s horribly dysfunctional software product.

Lt. Gov. Brown testifies on healthcare bill

Lt. Gov. Brown testifies on health care bill

Reading from a prepared text is one of his strong points. Answering questions isn’t. Brown ducked the few hard queries tossed his way and headed for the door without fully admitting his responsibility for Maryland’s $170 million embarrassment.

He left Health Secretary Josh Sharfstein behind to make a heartfelt apology, give an explanation of what went wrong and take the heat.

What Wasn’t Asked

This left a number of key questions hanging:

  • Was Brown a figurehead leader of the health care insurance rollout?
  • What did Brown know about the behind-the-scenes fiasco that was building over the past year?
  • When did he know it?
  • Why didn’t he roll up his sleeves and get fully engaged in the administration’s most important project for which he was the designated point man?
  • Why was he left out of the loop?

We may never get complete answers.

While a few legislative committees will poke around in the state’s Obamacare closet, this won’t be a Watergate-style investigation.

Too many Democrats already have endorsed Brown for governor. They will take care not to make the lieutenant governor look bad.

Questions Won’t Go Away

Yet unless the sign-up numbers improve dramatically — not likely — the public will receive constant reminders of Maryland’s health care belly-flop during the General Assembly session.

And once the legislature goes home, the governor’s race will heat up, with Brown the center of attention.

Attorney General Doug Gansler, his chief rival, will spend most of his $6.3 million treasury reminding voters of Brown’s leadership role in the state’s biggest disaster since the savings and loan collapse in the 1980s.

Televised debates between the gubernatorial candidates could provide a flashpoint. It may be the only time Gansler gets to directly point a finger at Brown for his culpability in the health care disaster and demand an answer.

Thanks to the Washington Post, we have a picture of the chaos and astounding incompetence that surrounded Maryland’s ill-fated launch of its health insurance exchange. (A grand total of four people signed up that first day.)

And thanks to the Baltimore Sun, we have a reminder of how screwed up the health care debacle remains. (Inadvertently directing people trying to sign up to call a Seattle pottery shop. The snafu continued for four months. A day after The Sun alerted state officials, the poor Seattle shop owner was still getting calls from frustrated Marylanders.)

Then today, the Post and  The Sun reported another screw-up. Up to 1,078 informational packets, containing the new Medicaid sign-up’s name, date of birth and Medicaid ID number, were mailed by the state to the wrong addresses — exposing those people to possible identity theft and delays in receiving medical care. The state blamed it on a “programming error.”

If people’s health weren’t at risk, these human absurdities would make a hilarious “Seinfeld” episode.

Brown’s Dilemma

The self-identified leader of this healthcare reform, Anthony Brown, remains all but invisible as the situation unravels.

How is he going to explain all of this?

At last week’s legislative hearings, he refused to apologize for what happened. He pretty much pointed an accusatory finger at everyone else for hiding the cold, hard truth from him.

Still, Brown appears well positioned to capture the governorship.

He’s got the establishment’s political endorsements. He’s got Gov. Martin O’Malley doing everything he can to ease his path to victory. He’s got more money to spend on his campaign than Gansler.

Yet it might not be enough if Anthony Brown continues to wear that conspicuous health care albatross around his neck.Albatross hung around his neck

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You can read Barry Rascovar’s other columns at www.politicalmaryland.com

 

 

 

 

 

MD Healthcare Leader? It’s Not Anthony Brown

By Barry Rascovar

For MarylandReporter.com

Dec. 23, 2013 – Who’s in charge of Maryland’s computerized Obamacare rollout? Until recently, Lt. Gov. Anthony Brown wanted you to believe he was the man.

For years, he’s been describing himself as Gov. Martin O’Malley’s “point man” on this crucial health insurance program. The governor’s press staff dutifully gives Brown co-authorship and quotable lines every time there’s a press release.

Yet it has become painfully clear Brown is not the “point man” on Obamacare, Maryland-style.

What Webster Says

By every dictionary definition, Brown fails that test.

Point man: “a person in the forefront of an economic or political issue” (Webster’s College Dictionary).

Not so. Brown is in his usual position – in the background as the governor’s second banana. At media events, he talks only when the governor directs him to do so.

Point man: “A man who has a crucial, often hazardous role in the forefront of an enterprise” (American Heritage Dictionary).

This doesn’t describe Brown’s role, either. His healthcare designation is symbolic, not substantive.

He co-chairs an oversight panel on healthcare reforms but it is Maryland’s health secretary, not Brown, who’s done the crucial, heavy lifting and taken the brunt of criticisms from legislators.

Point man: “the leader or spokesperson of a campaign or organization” (Collins English Dictionary).

Brown is neither leading the pack on Obamacare nor acting as spokesman for the computerized rollout – except when the governor is out of the country.

O’Malley Takes the Lead

More often than not Brown has had little to add to what more informed officials have to say about this terribly botched IT programming that continues to plague Obamacare in Maryland.

He’s avoided tough-questioning reporters and responded only in a few choreographed situations.

 

Anthony Brown brushes off healthcare questions from WBAL's Jayne Miller.

Lt. Gov. Anthony Brown brushes off healthcare questions from WBAL’s Jayne Miller.

Once the governor returned this month from his business development trip to Latin America, he stepped forward to answer the difficult questions about the healthcare insurance rollout. Brown has been relegated to a cheerleading role:

  • O’Malley is the one who ordered emergency IT fixes by mid-December.
  • O’Malley is the one who turned day-to-day authority for the exchange over to his top healthcare adviser.
  • O’Malley is the one who dispatched his information technology guru to figure out how to fix this deeply flawed project.
  • O’Malley is the one who announced hiring a Columbia-based computer management company to end this software nightmare.
  • O’Malley is the one holding a flurry of media events to discuss the rollout, both pro and con.
Governor O'Malley explains IT fixes to Maryland's healthcare rollout.

Governor O’Malley explains IT fixes to Maryland’s healthcare computer rollout.

Other than comments to back up the governor’s remarks, Brown has contributed little to the discussion.

Death-Watch Job

None of this is surprising.

Lieutenant governors in Maryland are pitifully neutered. They hold office for a single constitutional purpose – to replace the governor if the state’s leader dies or is incapacitated.

Brown has spent the vast majority of the past seven years in campaign mode, delivering prepared speeches at every conceivable event around the state.

He’s not deeply involved in policy decisions – no lieutenant governor is. The governor’s tight-knit inner circle of aides and advisors makes sure of it.

How Brown explains all this to voters is his biggest problem now that his lack of real responsibility has been laid bare.

Evaluating Anthony Brown

The lieutenant governor may be O’Malley’s heir apparent, but does this heir deserve that title?

His track record is slim. Until the botched healthcare rollout put Brown in an embarrassing spotlight, he was an unknown to most voters.

His future depends in large measure on O’Malley’s ability to find a way out of this healthcare debacle.

If enough IT patches make the Maryland Health Connection reliable and usable for both applicants and insurers, public ire may die down by the June 24 primary – D-Day for Brown.

But if computer glitches and foul-ups persist and tens of thousands of Marylanders are denied enrollment, if the state can’t provide insurers with accurate customer data and if public fury increases by early summer, Brown’s chances of winning could tumble.

The Obamacare debacle in Maryland has exposed Brown’s vulnerabilities. It could mark an inflection point in the nascent 2014 gubernatorial campaign.

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