Navigating the health insurance morass


A story published in The Times this week by Nelson Sigelman, “State’s shift to Obama care is far from smooth,” highlights the unfortunate trickle down effect of the bungled federal effort to implement sweeping national health care reform — reform pushed through Congress without meaningful bipartisan or popular support and without paying attention to the details. If one can call the multi-million dollar website that still does not work properly a detail. Depending on the media source, and the politics, the cost of the website, which continues to increase with every effort to wring out its many glitches, is between $70 million and $634 million. Quite a disparity.

Bloomberg Politics found some middle ground in a report published December 10, titled, “Hidden Obamacare website costs show lack of transparency.” The site reported that President Obama’s health agency said it has spent $319 million through October building an online health insurance marketplace. But what the estimates do not include, said the Bloomberg report, is the cost of the around-the-clock effort to repair the website, which hundreds of thousands of Americans found unusable after its October 1 debut.

CGI Federal, a subsidiary of Montreal-based CGI Group, built the website. It is the same company contracted to build the new Massachusetts website.

Before there was Obamacare there was Romneycare. Enacted in 2006, the Massachusetts Health Care Reform Law marked the first time any state required nearly all of its residents to have health insurance coverage. And it worked pretty well.

Now, Massachusetts is required to offer plans that comply with the federal Affordable Care Act (ACA). The Massachusetts Health Connector, the agency that administers the state health plan, hired CGI to modify and upgrade its working site, at a cost of $69 million, that would lead residents, many of whom had managed to find their way through the existing website, into the new health portal. The problem is, the new portal lead to a maze.

Earlier this month, the Obama administration announced it was firing CGI. Massachusetts Governor Deval Patrick is checking his legal options.

Visitors to still cannot use the website to determine their eligibility or select a plan; application data that is submitted through the website is not storing correctly; and small businesses are still using the old web based system to shop for plans, the State House News Service reported last week.

“We still have an incomplete and inadequate IT functionality as a result of an underperforming vendor that has made it difficult for users to complete the application process,” said Roni Mansur, deputy executive director and chief operating officer at the Connector.

Frustrated Health Connector officials have called in a “rapid assessment team” led by experts from MITRE, a non-profit research and development center, to assess the situation. The MITRE group, which is being paid by the federal government — that would be taxpayers — is expected to complete its review this week.

The Connector and the Patrick administration are also considering ways to hold CGI responsible for its failure to deliver the $69 million website. So far, the state has paid only $11 million of the contract, the State House News Service reported.

Secretary of Administration and Finance Glen Shor, chairman of the Connector Board, said every option to hold CGI accountable for its failures is “on the table,” including a lawsuit. It is a frustrating and costly mess.

Caught in the middle, as the report in today’s Times highlights, are the Martha’s Vineyard Hospital and Island patients who are attempting to navigate the changes wrought by health insurance reform, a confusing journey even in the best circumstances when there is a functioning website.

For Martha’s Vineyard Hospital chief executive Tim Walsh, “continuity of care” is the biggest concern.

Mr. Walsh said there has been much confusion and many disconnects. Hospital administrators and those on the front lines, he said, are doing their best “to let patients know what they need to do to maintain their coverage, and in many cases, lead them through the process of switching plans so they will have coverage.”

In some cases, the hospital is continuing to bill insurance providers with whom it no longer holds contracts. In such a situation, payment for services rendered is no sure thing, but it is the right thing.