WASHINGTON — With the federal
online insurance exchange running more smoothly than ever, the biggest laggards
in fixing enrollment problems are now state-run exchanges in several states
where the governors and legislative leaders have been among the strongest
supporters of President Obama’s health care law.
Republicans have seized on the
failures of homegrown exchanges in states like Maryland, Minnesota and Oregon —
all plagued by technological problems that have kept customers unhappy and
enrollment goals unmet — and promise to use the issue against Democratic
candidates for governor and legislative seats this fall.
“People see incompetence when they
look at this,” said Michael Short, a spokesman for the Republican National
Committee. “Everyone that’s associated with it is going to have to deal with the
consequences of this terrible law, including the state legislators who created
these exchanges and the governors in charge of running them.”
Last month, the Republican
National Committee filed public-records requests in Hawaii, Maryland,
Massachusetts, Minnesota and Oregon seeking information about compensation and
vacation time for the exchange directors, four of whom have resigned. All five
states have Democratic governors whose terms end this year. Three of them — Gov.
Neil Abercrombie of Hawaii, Gov. Mark Dayton of Minnesota and Gov. John
Kitzhaber of Oregon — are seeking re-election.
In Maryland, the turmoil around
the state-run exchange is dogging Lt. Gov. Anthony G. Brown, a Democrat hoping
to succeed Gov. Martin O’Malley, who is leaving office because of term limits.
Mr. O’Malley made Mr. Brown his point person on the health care law’s rollout in
Maryland, and now Mr. Brown’s opponents — both Democratic and Republican — are
bludgeoning him with the state exchange’s failures.
Addressing a legislative panel on
Jan. 14, Maryland’s top health official said the state had made the mistake of
using “off-the-shelf” software with serious defects. The official, Joshua M.
Sharfstein, said the state would stick with the current system until the
enrollment period ended on March 31, but might consider other options, such as
joining the federal exchange, after that.
All five states lean Democratic,
and many analysts believe the exchange failures will not be enough to allow
Republican upsets this fall. Still, the issue has been potent enough to hurt Mr.
Obama’s approval rating and put congressional Democrats on the defensive. If
nothing else, it will provide a continuous headache for Democratic candidates
like Mr. Dayton in Minnesota, who is hoping to cruise to a second four-year
term. The website of the state’s exchange, known as MNsure, is still plagued by
software defects, and an outside review last month found that it cannot be
completely fixed before the March 31 enrollment deadline.
“The reality is that Mark Dayton
owns the MNsure debacle — there’s no other way about it,” said Ben Golnik, a
Republican strategist and a former executive director of the Minnesota
Republican Party. “He pushed it through the Legislature, he said Minnesota is
all in, so I think it’s going to be very difficult for him to distance himself
from this.”
On the other end of the spectrum,
some of the best-performing exchanges are also run by Democratic-controlled
states, including Connecticut, New York and Rhode Island.
Mr. Dayton and Democrats in other
states with error-prone exchanges have been working in earnest to get the
problems fixed, even as some have blamed the private contractors they hired to
build the systems. Some of the worst problems are in Maryland, where insurers
have repeatedly had to extend enrollment deadlines. Mr. Brown, the lieutenant
governor, successfully pushed legislation to allow some of those stymied by the
exchange to enroll temporarily in a state-sponsored insurance program.
Last month, Mr. Brown told
legislators that the exchange staff and contractors had failed to let him know
the extent of the problems before the exchange opened for business — and
promptly crashed — on Oct. 1. He said 22,500 people had enrolled in private
health plans through the exchange as of Jan. 11, far short of the state’s goal
of 150,000 by March 31. Republicans in the state have called for an
investigation, and one of Mr. Brown’s Democratic primary opponents, Douglas F.
Gansler, Maryland’s attorney general, has repeatedly blamed him for the
problems.
In an emailed statement, the Brown
campaign said Mr. Gansler was “parroting right-wing Republican attacks” on the
health care law “while Lieutenant Governor Brown remains focused on addressing
the challenges of its implementation.”
Joe Cluster, executive director of
the state’s Republican Party, said he hoped the exchange’s problems would help
ensure a divisive, expensive Democratic primary in June. “Get your popcorn,” he
said. “I think it will play a huge role in the governor’s race.”
In Oregon, officials resorted to
processing applications by hand after the exchange, Cover Oregon, failed to work
on Oct. 1. People still cannot fully enroll through the exchange website, but
about 32,000 have signed up for private coverage using a backup process. That is
only about 14 percent of the 237,000 total that, according to the federal
Department of Health and Human Services, the state had originally hoped to
enroll by March 31.
The interim director of the
exchange told state lawmakers in a recent hearing that his staff was considering
other options in case the website was not fixed by the end of March. Governor
Kitzhaber, who has ordered an independent investigation into what went wrong, told
The Oregonian newspaper that he had been kept “entirely outside the loop”
about the exchange’s problems leading up to its debut.
In Massachusetts, 5,428 people got
private coverage through the state’s troubled exchange from October through
December, according to the Department of Health and Human Services. The problems
there are especially striking because the state’s 2006 law expanding health
coverage was a model for Mr. Obama’s law. The state had an existing insurance
exchange that worked well until this past fall, when it was overhauled to comply
with the federal law.
Attorney General Martha Coakley of
Massachusetts, a Democratic candidate for governor, has said she would consider
suing CGI, the contractor in charge of the overhaul, which also helped design
the initially problem-plagued federal exchange serving 36 states. The state
exchange has tripled its call center capacity to help people enroll and hired a
consultant to help fix the website.
In Minnesota, exchange officials
have suspended a lighthearted promotional campaign featuring a statue of an
injured Paul Bunyan and are shifting resources to the exchange call center,
where customers have experienced long waits for help. The state’s legislative
auditor is conducting an investigation into what went wrong.
After the outside review of MNsure
was released, Mr. Dayton told reporters that he “will take responsibility” for
the problems, but added that he stood by the law. “As this expands,” he said,
“thousands more Minnesotans are going to have access to affordable health care,
and that was the intent.”
Lawrence Jacobs, a political
scientist at the University of Minnesota, said it was “quite possible” that
Republicans could regain control of the state’s House of Representatives — the
only chamber whose seats are up for election this year — if problems with the
exchange persisted into the fall.
“If we’re still talking about
MNsure in October,” he said, “that’s bad news for Democrats.”