Like the nature of white-collar work itself, the concept and design of the office has evolved over more than a century, from the counting-houses of nineteenth-century clerks to the cubicles we love to hate. Author Nikil Saval joins us to explore the history of our workspaces.
After months of technical and other glitches with Maryland’s health care exchange website, state health officials this week terminated their contract with the company that built the site, echoing a move in January by the federal government. The state says the company, Noridian Healthcare Solutions, misrepresented its ability to build the site. Noridian cited complications due to the many changes the state demanded throughout the process. We explore the issues and how Maryland plans to move forward.
- Mary Pat Flaherty Reporter, Washington Post
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, a U.N. report slams North Korea for crimes against humanity. Whether the international community can act is another question. But, first, last year, Maryland's newly created health care insurance exchange was hailed as a model for the nation; that is, until the website went live on October 1. The rollout, disastrous. Echoing the federal government's troubles, the site crashed immediately, leaving Marylanders unable to sign up.
MR. KOJO NNAMDIAnd it's yet to be fully functional nearly five months later. Maryland, this week, fired the company in charge of building the exchange. Joining us to discuss this is Mary Pat Flaherty. She is a Pulitzer Prize-winning reporter with The Washington Post. She joins us from studios at The Washington Post. Mary Pat, thank you so much for joining us.
MS. MARY PAT FLAHERTYWell, thanks for having me.
NNAMDIWhat exactly went wrong with Maryland's health exchanges?
FLAHERTYWell, whether we know yet all that went wrong is unclear to me but we certainly know some things that did. As we had reported earlier -- I was working with another reporter I know you've talked to before, Aaron Davis...
FLAHERTY...but we were able to look at some of the consultant reports that were done quite early. And a year before the launch on October 2013, there were warnings that the IT backbone that was being built out was not going to be very stable. And those warnings continued. And I think that from what we were able to see by our reporting, they had both a rapid changeover in some of the top managers. They went through three project managers on the state side. And you also saw, in discussions in some of the emails that we were able to look at, a kind of disconnect between health policy people and IT people.
FLAHERTYSo you had somebody who probably should have been the mechanic on the job and somebody who was more concerned with what was this really ambitious and overarching reform of health care. And whether you had the right mesh, it would appear that you did not. And so I think those were sort of the underlying issues there.
NNAMDI(800) 433-8850 is the number if you have questions or comments about Maryland's firing its health exchange contractor. (800) 433-8850. You can send email to Kojo@WAMU.org. Have you tried to sign up for health insurance in Maryland using the state exchange? What was your experience? Our guest is Mary Pat Flaherty, a Pulitzer Prize-winning reporter with The Washington Post. Mary Pat Flaherty, Maryland has now fired the main company tasked with building the site, not unlike the federal government's move in January.
FLAHERTYYes. The firing was announced yesterday at part of a hearing in Annapolis. The transition is going to be that the firm, which is a North Dakota based firm, will stay and work, hosting some of the services through the end of March, when the open enrollment is there. This is my understanding of it. But some of the design, maintenance and operation capacities in which they were actually still building some of the site or remedying some of the site, they'll come out of that operation sooner than that March deadline.
NNAMDIDo we know how much of the blame for the, well, disastrous performance of this health insurance exchange website comes down on the company tasked with building the site, Noridian?
FLAHERTYOh, I think there will be many lawsuits addressing just that question. There already is litigation between Noridian Healthcare Solutions, which is the prime contractor Maryland hired, and a subcontractor called EngagePoint, which was the one tasked, from what we can see, with more of the technical work. And so there is a disagreement already there that's made its way into federal court as to who was responsible for what and did they meet their obligations. And I think that will only be ratcheted up now with the move at the state level to fire Noridian as well.
FLAHERTYThere's probably blame enough to go around on all sides. You had state people who took on an ambitious and complicated project. Noridian, as they pointed out yesterday, said that there were hundreds of changes and enhancements that were driven both by state requests and also changes at the federal level. Those were loaded on to what was a complex project already. And then the open question is whether the firms that were handling that had the capacity, wherewithal and resolve to take on that complex task in the beginning, absent all those additional changes that were loaded on their back as they went along.
NNAMDIWell, I mentioned that -- I mentioned state officials. Should they have been aware of the problems before the October 1 rollout? The investigation your paper did indicated that senior state officials, quoting here, "failed to heed warnings that no one was ultimately accountable for the project and that the state lacked a plausible plan for how it would be ready by the October 1 deadline."
FLAHERTYWell, I think that -- not I think, from the reporting we did and certainly we laid out a lot of the documents that anybody who would go to our website still could find both at a timeline and a -- through links at the story at washingtonpost.com that look at some of the reports that were issued by consultants, and also warning letters very early on that some of the work that was being done might not be up to what Maryland expected. And to say the other part of this, I mean, Maryland went out and really wanted to buy and produce what was a Cadillac operation.
FLAHERTYOther states, Kentucky is coming to mind, that had a more streamlined approach to this, had more success.
FLAHERTYI think Maryland decided that from the beginning and on the frontend of things, they wanted to build in an awful lot of things: redo the backbone of their Medicaid system; go in -- at one point they had suggested that they were going to have interactions that would allow state lottery winner notifications to be coming back into the system, so that you could look at people who had made money; and also maybe having interactions with state support systems, where they would get alerts and they would know that people who might have won service and also won money were showing up in their system.
FLAHERTYSo they had a lot of bells and whistles that they were going for at the beginning, when perhaps a more streamlined approach, and add on your, you know, your electronic windows and moon roof later, might have been the better way to go.
NNAMDIA top Maryland health official said that the company, Noridian Healthcare Solutions, quoting here, "severely misrepresented the maturity of the system it could build using off-the-shelf software." Do we know what that means?
FLAHERTYWhen the bid went out -- this is what I know as to what that means -- when the bid went out, Noridian was chosen as the contractor from the documents that came out because one of the options they said they could do would be to assemble from off-the-shelf software, a system that would meet Maryland's needs. The state now is saying that that task of stitching together all of those pieces was not one for which Noridian was well suited.
FLAHERTYNoridian, without speaking for Noridian, clearly is going to push back and said that they -- is -- go -- were in that position to be able to do what they had promised and that the complexity of the job, rather than their presentation, probably was the overwhelming factor.
FLAHERTYBut that is what that off-the-shelf means -- that rather than doing wholesale design from the ground up in which they were going to do every kind of piece of software and every change that would bring you Medicaid systems, verification of identities, connections to the federal website, information to push out to insurance companies -- that they would take packaged software, which would enable them to move more quickly, assemble that into something that would be distinctive, but the components would have been something that were precast.
NNAMDIWe're talking with Mary Pat Flaherty. She's a Pulitzer Prize-winning reporter with The Washington Post. We're discussing Maryland's firing of its health exchange contractor and inviting your calls at (800) 433-8850. Who do you think is responsible for issues with Maryland's botched health exchange rollout? You can also send us a Tweet at KojoShow or email to Kojo@WAMU.org. I will start with -- on the phone with A. C. in Brentwood, Md. A. C., you're on the air. Go ahead, please.
A. C.Thank you so much, Kojo. And I love your show. I never call in, but this issue is really important to me.
C.I'm self employed and I live in the Gateway Arts District. There are a lot of artists who live here. And I think some of them may have gone through the same experience I went through. I did successfully get a plan. But I did a timeline recently and I first got on the site on October 4, managed to set up an account, which -- there's so many different permutations on the site, you can't really tell what you're actually doing -- but anyway, I set up the account on October 4. I managed to actually get my first confirmation from CareFirst, which was the provider that I ended up using, on January 10.
C.And in between that time, I got a lot of misinformation from navigators, from those at the main number in Maryland. And not because it was their fault, but because nobody knew what was going on. I finally selected a plan on November 26. Then somebody at the main number said, you're eligible for Medicare. I'm not. My income is too great for that. They didn't know what was going on. And finally someone from the main Maryland health connection -- I had to call every time. Nobody ever contacted me. And somebody finally looked at my application and went, Oh, well, you're self-employed, therefore you've filled this out wrong.
C.And there was no indication on the site as to how you would do your annual income, if you knew your income from your 2012 tax forms, but not later. And it was just very confusing.
NNAMDIWell, I do have to say, A. C., I admire your diligence and your patience. It took you three months to get signed up. Mary Pat Flaherty, how common is that story that we just heard?
FLAHERTYThat's a -- that is not an uncommon story, and particularly in that window that she -- that A. C.'s talking about with -- get -- trying to go in it a couple days after the site came up and, you know, persisting and being tenacious through the beginning of January. A lot of people, even on October 4, were still getting blank screens. The process she talked about, by which you would have to have had a lot of information at your hands before you even typed in, that was not one that was well known, so that people were sitting there and trying to scramble and getting the income information that they needed.
FLAHERTYWe had in our story, in fact, that in the first couple of days, there were a few people who did manage to get in that October 1, 2, 3, window, I forget the exact cutoff -- apologies on that...
NNAMDIOh, don't worry about it.
FLAHERTY...but the -- that the state actually even went out and asked, and we saw that in the emails -- are these real people? -- because they were so taken aback that someone had managed to get through. And in our polling, even earlier this year, we saw people who still had exactly the process that the caller, A. C., just described. You know, it's hard on everybody, but there were some obstacles that made this even harder.
NNAMDIA. C., thank you very much for your call. I get the impression that Sandy in Silver Spring may have had a slightly different experience -- or that Sandy's son may have slightly had a different experience. Sandy, you're on the air. Go ahead, please.
SANDYThank you, Kojo. I just wanted to share that my son, who had, is 29 and had no health insurance and didn't qualify to be under his father's or mine, went on in early January and he decided just to register and not select a primary-care physician, because that was kind of too complicated. And he figured, Well, if I just register, that's a good step. So he did and he got his card. And the good news is that he did get sick this last week, and he actually could go to a clinic that was really close by. They ran tests on him and he was fine. You know, he had a cold and sore throat, but, you know, it wasn't strep or staph.
SANDYThey gave him, you know, great treatment. He came back home. He was, you know, fine. And he had a great experience. And I'm going to retire in June as a teacher before I'm 65, so I'm hoping they get all the bugs out. But he successfully, now, has health insurance, which is terrific.
NNAMDIThank you for your call, Sandy. Mary Pat Flaherty, is this a case where timing is everything, the fact that Sandy's son signed up in January as opposed to October last year?
FLAHERTYI think things were moving more smoothly in January and they're certainly moving more smoothly now. And the understanding I have is that a lot of the improvements that have been made are on that sort of front end where the customer or the consumer's coming in, and that some of the problems that are actually more deep seated and still need to be resolved which is underlying this firing of the contractor. And a change on the system are now more concentrated at the back end where the verifications go to the insurance company that this person has selected your company. Let's push out the information so you can start the billing and do everything.
FLAHERTYSo I think that's, my understanding again, is where the bulk of the remaining problems are so that the kind of like dial-in that most people are going to see is operating a little more smoothly. Having said that, they're still very reliant on call centers when things get complicated, when it's things where you have multiple family members, children that are on one system perhaps qualifying for a subsidy on their health insurance, parents who might be in a different position.
FLAHERTYSo when you get into those nuances which are not all that uncommon that's where there are still glitches, even at the front end, though for many people they're going to have a smoother beginning experience. And they just need to keep an eye on what is happening with the paperwork that should be getting them squared up with their insurance carrier at the end.
NNAMDISandy, thank you very much for your call. You mentioned that there were two companies, Noridian and Exchange -- and EngagePoint that were suing one another as a result of this. But it's my understanding that the state officials say they did not know that there were actually two companies involved in building the health insurance exchange. How credible is that?
FLAHERTYIt's -- certainly at some point there were EngagePoint people at the table. There were EngagePoint people on emails at EngagePoint.com. And so they were a presence that was known. I think the question becomes for what the state is saying that they eventually became aware they did not know that the person -- that EngagePoint had been brought in as a subcontractor. The companies dispute that. So I think that's another question of who knew -- how did they exactly know who was talking to whom and did that get relayed?
FLAHERTYAnd I would expect that that issue also might show up in something that's going to be litigated as to whether there was a handoff of work capacity and responsibility that the state wasn't aware of.
FLAHERTYBut there is no doubt that there were EngagePoint people in this -- in an obvious presence at certain points. So again, without being inside someone's head or having sat at a meeting, why that was not more fully known and had high levels is not something I could answer for you right now.
NNAMDIFinal question, so what is happening now between Noridian and the State of Maryland? Do we know who will support the website built by the terminated company?
FLAHERTYWell, that's what I was saying. I think that the hosting services, from what my understanding is, are going to go forward through the open enrollment. And then I think the broader question is coming up here too, that Maryland has talked about, as you said in the opening, about whether they need to offload some of the site while they can do really some deep seated repairs on what they have. And I think those questions are not yet resolved. So there is enough understanding that the state and Noridian are ensuring people that for the open enrollment period they can still get through. That enrollment period right now, anyway, is set to end at March 31 whether it gets extended or not.
FLAHERTYAnd then I think Maryland is looking at what it's going to do with the company it has since named to take over the prime work and whether that repair -- whether you can be driving the car and repairing it or whether they're going to have to park part of the car at another state exchange with the federal capacity while they fix what they had on the ground in Maryland, and see if they can make it run again.
NNAMDIMary Pat Flaherty, thank you so much for joining us.
NNAMDIMary Pat Flaherty is a Pulitzer Prize-winning reporter with the Washington Post. We're going to take a short break. When we come back, a UN report slams North Korea for crimes against humanity. Whether the International Community can act is another question. That's the question we'll be asking when we come back. I'm Kojo Nnamdi.
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