Tag Archives: Obamacare

Repeal Obamacare? Hogan’s Conundrum

By Barry Rascovar

July 10, 2017 – Though he’s a Republican, Maryland Gov. Larry Hogan must pray each night that his fellow Republicans in Congress fall flat on their faces in their concerted efforts to wipe out Obamacare and replace it with a vastly inferior health care safety net.

Hogan quietly voiced opposition to House and Senate “repeal and replace” bills in a statement he had issued in Annapolis while on an overseas trip.

He’s trying hard to avoid offending Maryland Republicans who support an immediate repeal of the Affordable Care Act. Yet he’s acutely aware of the harm, and human pain, such a move would have on hundreds of thousands of Marylanders.

Maryland is in a unique situation when it comes to the “repeal and replace” movement. Ending Obamacare could place this state’s entire hospital system in jeopardy. Hospitals in the Free State stand to lose a staggering $2.3 billion in Medicare and Medicaid payments if Obamacare abruptly ends.

Obamacare and Hogan

Maryland Gov. Larry Hogan

Some hospitals, especially in rural parts of the state and in poor urban neighborhoods may not survive. One national study indicated up to 50% of all rural hospitals in the United States could close under an Obamacare repeal. In Louisiana, Mississippi and Texas, up to 75% of rural hospitals could be driven out of business.

Nursing homes are under the gun, too, since two-thirds of its patients are on Medicaid, which is the primary budget-cutting target of congressional Republicans.

‘Tremendous Impact’

Passage of either the House or Senate repeal bills “could have a tremendous impact on Maryland,” according to the non-partisan Department of Legislative Services. This would “require the General Assembly [and the governor] to consider significant financial and policy decisions.”

That’s something Hogan cannot afford in 2018 as he runs for re-election. Yet the governor could find himself between the proverbial rock and a hard place next year, thanks to conservative Republicans in control of the House, Senate and White House.

The price to Maryland state government of an Obamacare repeal is in the billions. Maryland government would lose $1.3 billion in federal Medicare and Medicaid funds next year, growing to a loss of $1.5 billion in federal dollars in 2022.

If the law is repealed, Hogan and Democratic legislators in Annapolis would face a monstrous and agonizing choice.

Do they jettison Obamacare’s expansion of Medicaid that now gives health insurance to 421,000 state citizens, many of them children? Do they leave 1 million Marylanders now covered through subsidized private insurance plans or the Medicaid expansion to the tender mercies of insurance companies?

Or are Hogan and lawmakers going to jump in, swallow hard and raise taxes – in an election year – by a huge amount to cover the lost $1.35 billion next year?

That’s why deep down inside, Hogan really but really wants Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan to give up their insistent request to wipe out Obamacare and instead work with Democrats on a compromise plan that preserves the best parts of the ACA and fixes what’s not working.

Seeking a Magic Bullet

The odds of McConnell and Ryan finding a magical “repeal and replace” formula that satisfies the majority of Republicans are not good. It may yet happen but time isn’t on their side.

The more voters learn about specifics of the Republicans’ replacement proposals, the stronger the opposition. Over the July 4 holiday, GOP lawmakers who dared to venture out received heated criticism from constituents.

Part of the problem is that McConnell and Ryan are attempting to peddle a plan that calls for an unprecedented version of “income re-distribution.”

Obamacare re-distributed taxes collected from the rich, insurance companies, durable medical equipment companies and tanning salons. The ACA spent that money to help provide health insurance to the poor and lower-income families.

Now Republicans are calling for a reversal of this process – giving back all that tax money to wealthy Americans and profitable corporations while stripping from the poor and lower-class much of their health care benefits.

It’s “Robin Hood in Reverse,” in this case congressional Republicans want to take from the poor and give to the rich.

Had the GOP plans created an alternative health care safety net that protected the rights of the elderly, poor and near-poor, the furor today might have been averted. But in their haste to wipe out Obamacare, Republicans in Congress failed to develop a legitimate replacement program that would make things better, not worse.

Obamacare in Maryland

In Maryland, there have been good results from Obamacare. The state’s uninsured rate has dropped more than half, to an all-time low of 6.6%. This is a godsend for hospitals, which saved $311 million in just two years due to the shrinkage of uncompensated care cases.

Big problems remain in the current system. Large premium increases are pending before Al Redmer, the state insurance commissioner (and a likely Republican candidate for Baltimore County Executive next year).

If Redmer approves large rate hikes, many of those currently insured may be priced out of the market. The state’s uninsured rate could soar and hospitals could run deficits.

But if Redmer rejects those big rate hikes, private insurers may have no choice but to drop out of the Maryland marketplace, as Cigna recently did.

Regardless of what happens in Washington and what Redmer decides, Maryland’s health-care safety net is in danger of tearing apart – unless Hogan and state legislators are willing to intervene.

That’s a tough call in an election year, especially for a governor who made a no-new-taxes pledge.

But the Republican governor and Democratic leaders in the General Assembly may have no choice.

Fixing the existing system is far easier than wiping out Obamacare and starting from scratch. Either way, though, State House politicians likely will have some heavy lifting to do early next year. ##

Hogan’s Worst Nightmare: Trumpcare

By Barry Rascovar

May 8, 2017 – Maryland Gov. Larry Hogan’s worst nightmare is starting to come true. Trumpcare has passed the U.S. House of Representatives. If the Senate finds a way to give President Trump what he wants, it could spell a heap of trouble for Hogan in 2018’s general election.

The Republican Party’s mania with obliterating Barack Obama’s massive health insurance law has led the majority party in Washington to ignore common sense.

“Repeal and replace” is a GOP obsession – though an estimated 24 million people could lose their insurance, tens of millions more could be out of luck due to pre-existing conditions and medical programs for the poor could be cut 25%.

It also would damage the nation’s economy. That’s especially true in Maryland, where healthcare is one of the state’s biggest employers.Hogan's Worst NightmareIt is almost certain to be the No. 1 issue in the 2018 mid-term elections, even if the Senate approves a diluted Trumpcare bill.

What a devastating state of affairs for Republican Hogan. Until the House vote last week, he appeared in excellent shape to win a second term.

Now he has to figure out how to tiptoe around this explosive issue that already is proving highly unpopular.

Unfavorable Poll Numbers

A Washington Post-ABC poll last month found 61% of Americans opposed Trumpcare. A Quinnipiac poll the month before found Trumpcare support stood at just 17%.

Most Americans, it appears, would rather stick with the existing – though seriously flawed – Obamacare medical insurance program and fix parts that aren’t working well (“keep and improve” as opposed to the GOP’s “repeal and replace”).

Wait until the Congressional Budget Office issues its cost and impact analysis of the House-passed version of Trumpcare. It could expose the bill’s soft underbelly. Public resistance could grow louder.

For Hogan, House passage of Trumpcare might be the beginning of bad news.

He could be trapped in a nearly untenable position: A Republican who might have to disavow his own party leaders in Washington to survive.

Hogan won election in 2014 by promising “no new taxes.” Does that mean he will let Trumpcare’s 25% cut in federal Medicaid funds lay waste to Maryland’s health programs for the poor and near-poor? Where would he find hundreds of millions in state dollars to cover those unfunded programs?

How does he run for reelection with Trumpcare hanging over his head?

Justifying Republican Plan

How does Hogan justify to voters his party’s plan to let insurance companies charge outrageously high premiums – or deny coverage entirely – for people with “pre-existing conditions”? This could be anyone with acne, anxiety, depression, diabetes, obesity, cancer, pulmonary problems, asthma or even allergies.

How does he tell older working Marylanders that under his party’s plan their insurance premiums could jump an unaffordable 500%?

How does he explain a cut of $600 billion in taxes that supported Obamacare – a massive windfall for wealthy Americans, insurance companies and medical device companies?

How does he justify $880 billion in healthcare cuts to Medical Assistance for the poor?

Hogan & Company should be praying that the Senate junks the House bill and takes a few years to figure out what to do next.

Otherwise, the GOP across the country – including here in Maryland – could take a shellacking for its all-out effort to appease its conservative base.

Gift to Democrats

There’s no doubt Democratic candidates for Maryland governor will tie Hogan to Trumpcare.

Every candidate will be running ads with tales of how middle-class and working-class Marylanders would be hurt, how lives hang in the balance.

It is a gift from heaven for Democrats.

One Republican pollster called the GOP’s insistent quest to wipe out Obamacare “political malpractice.”

Until recently the notion of Democrats regaining control of the House by picking up 24-plus seats next year appeared wishful thinking. Thanks to House Speaker Paul Ryan’s determination to pass a draconian Trumpcare bill, that’s no longer the case.

Little wonder Democratic House leader Nancy Pelosi – the former Nancy D’Alesandro from Baltimore’s Little Italy – was practically giddy.

Every Republican will be vulnerable, unless he or she disowns the GOP’s No. 1 issue and risks losing support from Trump’s supporters. “This vote will be tattooed to them,” Pelosi vowed.

That includes Republican Hogan, who has made an extensive effort to distance himself from Donald Trump and his controversial comments and proposals.

That may not be enough to give him immunity from this highly contagious political disease.

When virtually every healthcare group – from the American Medical Association to the American Hospital Association to AARP – as well as virtually every insurance group vehemently opposes the Republicans’ “repeal and replace” crusade, smart politicians should pay attention.

Failure by the GOP to “listen and learn” could prove fatal come November 2018 – both in Maryland and nationwide.

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Giving Frosh His Independence

 

By Barry Rascovar

Feb. 20, 2017—You can’t blame Gov. Larry Hogan, Jr., for getting irritated over the Maryland attorney general’s new authority – granted by the General Assembly – to sue the federal government without the governor’s permission.

This strips Hogan of a smidgen of his enormous powers. Yet if the Republican chief executive truly wished to stop this slight weakening of his powers all he had to do was pick up the phone and negotiate a compromise.

Instead, Hogan gave Attorney General Brian Frosh, one of the mildest mannered men in politics, the cold shoulder when Frosh requested the go-ahead to object in court to President Trump’s temporary ban on refugees and immigrants from seven Muslim nations.

Giving Frosh His Independence

Maryland Attorney General Brian Frosh

Hogan called the delegation of power to Frosh “crazy” and “horrible” – but the real nuttiness lies in Hogan’s refusal to talk through his objections with Frosh and come to a reasonable arrangement each could live with.

Political Divide

Sure, Hogan is a conservative Republican to the core and Frosh is a down-the-line Montgomery County liberal Democrat.

Still, Frosh almost never picks a fight. His 20 years in the legislature were marked by quiet persuasion based on facts, open dialogue and finding middle ground.

Only when Frosh asked for permission to sue, provided back-up documentation to the governor and was met by silence did he opt to make an un-Frosh-like aggressive move.

Democrats in the House and Senate were happy to help him, since they were alarmed by Trump’s executive order against Muslim refugees and immigrants.

Numerous state attorneys general sued to stop the president’s executive order and temporarily succeeded in blocking it. Frosh wanted authorization from Hogan to do the same thing.

He said he was concerned by clear indications the new administration will wipe out the Affordable Care Act that gives health insurance to 430,000 Marylanders and anti-environmental steps that could damage the health of the Chesapeake Bay. He wanted the tools to speak out on Maryland’s behalf in court.

Weak A.G.

Maryland is one of a handful of states that didn’t –until last week – give its attorney general the independence to sue the federal government without getting an okay from the governor.

Indeed, this state has one of the weakest attorney general offices in the country. Only on rare occasions can Frosh’s office conduct a criminal investigation and try the case—the state’s constitution handed over those broad powers to the local state’s attorneys in 1851.

Maryland’s attorney general primarily staffs the law offices of state agencies, gives legal advice to the governor, General Assembly and judiciary, handles consumer protection issues, defends the state in court litigation and files lawsuits on behalf of state agencies.

Yet this is a statewide office just like the governor and state comptroller. All three are elected by Maryland voters every four years. Their authority is spelled out in the Maryland constitution. Yet Frosh’s office is unusually dependent on the governor for permission to act.

That’s never been a healthy situation.

Why create a constitutional law office without giving that office the freedom to carry out the full range of legal responsibilities normally handled by an attorney general in other states?

Why make the Maryland attorney general such a weak reed, unable to speak for the state on legal matters without first coming on bended knee to the governor for consent?

The current conflict over separation of powers never surfaced when Democrats occupied both offices. Usually the two elected officers were on the same political wave length and agreed on occasional litigation to protest federal actions.

Cover for Hogan

Under Hogan and at times under Republican Gov. Bob Ehrlich disagreements have surfaced. Yet this need not have reached a point of separation if Hogan had ordered his skilled legal counsel, Robert Scholz, to work out an accommodation.

Frosh may have been close to the truth when he suggested this new arrangement actually gives Hogan the best of both worlds – despite the governor’s public protests.

Hogan doesn’t want to go on record opposing the new Republican president. He’s trying hard to ignore anything and everything Trump says that provokes controversy.

Yet it’s no secret radicals in the new administration want to deep-six Obamacare and purge all sorts of environmental regulations that could set back efforts to clean up the Chesapeake Bay.

Someone has to speak out and protest in court at the appropriate time. Hogan doesn’t want to alienate his Republican core base, yet extreme actions in Washington may require pushback from Maryland to avert harm to citizens and the “Land of Pleasant Living.”

The new delegation of authority by the legislature to Frosh solves that dilemma quite neatly for Hogan. He can continue to ignore Trumpian broadsides and dangerous executive orders while Frosh, on his own volition, tries to block Trump’s moves in court.

The governor’s hands are clean. He hasn’t forsaken the Republican president.

(He also can try to dissuade Frosh through well-reasoned arguments. The power granted Frosh requires that he notify Hogan of the attorney general’s intention to sue, wait 10 days so the governor can put any concerns he has in writing, and then Frosh must “consider the Governor’s  objection before commencing the suit or action.”)

Re-election Battle?

The real danger for Hogan could lie in the next six to 12 months if Trump takes such extreme steps affecting Marylanders, the state’s social programs and its natural resources that Frosh becomes the hero of the day – filing lawsuits repeatedly to stop or reverse Trump’s moves.

Should Hogan continue to remain mum during that time, ignoring the human toll of Trump’s actions, it might hurt the governor’s re-election chances.

Thus, Brian Frosh might place himself at the head of the pack of candidates running for the Democratic nomination for governor.

Could Hogan then face off against the attorney general in November 2018 just as Frosh’s popularity in vote-heavy Central Maryland soars due to his role as Maryland’s defender against heavy-handed actions from Washington?

It’s not far-fetched.

That possibility gains credence with Frosh’s request for a future annual budget of $1 million to create a five-person legal staff to sue the Trump administration when the public interest or welfare of Maryland citizens is threatened – be it their health, public safety, civil liberties, economic security, environment, natural resources or travel restrictions.

If Hogan, for political reasons, won’t oppose Trump and radicals in the administration, Frosh is the logical person to fill that void.

Giving him the power to act isn’t wild and crazy. It’s in line with the way things work in most other states. It ensures that Maryland’s interests will be defended by at least one statewide, constitutional officer elected by the people.

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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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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

 

 

 

 

 

Gansler, Cardin, Obamacare and More

Odds and Ends

By Barry Rascovar

October 31 — THESE ARE THE the times that try Doug Gansler’s soul. Has anyone ever had a bumpier stretch in recent Maryland political history?

The attorney general has been mocked, frequently, on national TV programs for his lame explanation of his appearance at, and hands-off attitude toward, a raucous high school graduation beach blowout this summer.

That followed his argumentative responses to State Police complaints that Gansler is a reckless, back-seat driver oblivious to traffic laws and speeding tickets.

Well, here’s some good news: Gansler’s lack of identity with most Maryland voters (72 percent either didn’t recognize his name or were neutral toward him in the latest Gonzales poll) is a thing of the past.

EVERYONE knows Doug Gansler today.

Jay Leno jokes about him. Local radio talk shows conducted saturation bombing. The story’s gone international.

Gansler explaining himself

Gansler explaining himself

Of course this means Gansler’s negatives have soared, too. Only four percent in the Gonzales poll said they had an unfavorable impression of Gansler. That number is sure to skyrocket.

Here’s the really good news for Maryland’s twice-elected attorney general: Believe it or not, we are still eight long months from the Democratic primary. That’s a couple of lifetimes in politics.

If Gansler can regain his equilibrium and develop a cogent and sensible response to his recent gaffes, we may yet have a closely contested election for governor next year.

*     *     *     *     *

IT WON’T BE easy, though, for Gansler to put this controversy behind him. The media is in a feeding frenzy.

 It’s “get Gansler” time.

The Baltimore Sun delivered a hatchet job on Sunday that sought to compare Gansler’s moments of poor judgment with criminality by other elected officials.

In its print edition, the front-page headline read, “Weathering a political storm.” It was an even-handed account of how officials recover from political gaffes. But the comparisons made in the article, and especially the photos placed next to the front-page text, equated the attorney general’s modest mishaps to far more serious misdeeds that sent Marvin Mandel, Marion Barry and Dale Anderson to prison and Bill Clinton to the brink of impeachment.

Since when is failure to break up a high school graduation beach party a criminal offense?

How does violating traffic laws equate with Mandel’s criminal corruption conviction, Barry’s drug conviction or Anderson’s jail time for corrupt activities while in office?

None of them ever ran for higher office after their scandals, as Gansler is now doing. That’s another unfair comparison.

Clinton’s sex scandal does raise troubling character issues, but comparing that national moment of political angst to Gansler’s situation is ludicrous — and laughable.

Still, the damage has been done.

Just to rub it in, Sunday Sun editors also ran a 1,400-word critique on the way visual television imagery is responsible for Gansler’s pounding.

It was an interesting but way-too-long essay. And, of course, the editors couldn’t resist re-running that condemnatory photo of Gansler at the teen beach party. Another Sun “gotcha” moment.

Lost in the editors’ haste to pile on was The Sun’s October 24 editorial on the Gansler brouhaha — a measured, carefully nuanced analysis about difficult choices parents have to make while raising teenagers. It was a far cry from the tabloid journalism the newspaper’s editors presented to its readers on Sunday.

*     *     *     *     *

QUICK QUIZ: Who is leading the race for Maryland attorney general?

According to the latest Gonzales poll, the winner, by a mile, is that old, reliable favorite — “Undecided”.

Gonzales Polling CompanyThe results show that few voters even know who’s running for A.G.

The only reason Del. Jon Cardin polled 25 percent was due to his well-known uncle, the U.S. Senator from Maryland. Still, “Undecided” beat Jon Cardin in the poll by nearly 2-to-1.

It’s a good thing the office in question isn’t much more than a glorified law firm serving state agencies.

Voters aren’t likely to learn a lot about the candidates running for attorney general by the June 24 primary. It’s not a pressing matter for them. Besides, the gubernatorial candidates will dominate media attention and saturate the state with commercials.

Thus voters could end up picking an attorney general based on “the name’s the same” or the candidate who appears on the most local endorsement tickets.

It’s unlikely the outcome will be decided by deep voter knowledge of the A.G. candidates.

*     *     *     *     *

AN INSURANCE FRIEND reminds me that all the buzz about the number of Obamacare sign-ups since October 1 is highly misleading and meaningless.

As anyone in the insurance game will tell you, a new client doesn’t count until that individual writes a check to cover the first month’s invoice.

This won’t occur until close to the sign-up deadlines under the Affordable Care Act — late December and late March.

Until then, ignore the sign-up propaganda emanating from the White House, the State House and Republicans saboteurs. Two months from now we’ll know a lot more about the success or failure of this dreadfully managed rollout.

*     *     *     *     *

ISN’T IT IRONIC that no one is protesting as Baltimore City is about to spend at least $83 million on “smart” meters to help the city accurately bill residents for water usage?

When BGE and PEPCO sought to install similar “smart” meters to measure precise, real-time electric use, alarmist groups protested before the Public Service Commission about alleged health hazards from the meters’ wireless signals.

Smart Meter Protest in California

Smart Meter Protest in California

Those strident protests persuaded the PSC — despite the lack of scientific evidence — to impose needless smart-meter restraints on the utilities that will cost tens of millions of dollars.

As the Tea Party and smart-meter protesters have learned, it pays to yell at the top of your lungs.

Baltimore City officials are getting off lucky.

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