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Many differences between Mass., federal rollouts

The Mass. rollout process may not offer a clear comparison with the federal law, said economist Jonathan Gruber.
The Mass. rollout process may not offer a clear comparison with the federal law, said economist Jonathan Gruber.Bill Greene/Globe Staff/Boston Globe

President Obama is expected to make the case for the beleaguered federal health insurance law Wednesday from Faneuil Hall by drawing parallels with the Massachusetts health care program, which after a slow start came to be seen as a major success.

But significant differences between the state’s 2006 health law and the federal Affordable Care Act, the political context in which the programs were launched, and the websites created to implement them make the comparison a tricky one.

The state site got off to a relatively smooth start compared with the launch of the much larger federal website. The online marketplace where consumers can shop for insurance plans is used by more than 30 states and must interact with many more insurers than the Massachusetts site.


Beyond that, the federal law is far more prescriptive than the state law, requiring creation of a complicated federal data hub that draws on tax records, homeland security filings, and other databases to verify consumers’ identity and income.

The federal government had more than three years to launch the website, but that time was compressed by political and legal challenges. Development was divvied up between numerous contractors and led from within the Department of Health and Human Services.

“Our website was a lot simpler, frankly, than what the feds were doing,” said Jon Kingsdale, founding executive director of the Massachusetts Health Connector, the agency created in 2006 to launch the state’s online insurance marketplace.

The implementation process in Massachusetts may not offer a clear comparison, said Jonathan Gruber, an MIT economist who was an adviser to then- Governor Mitt Romney and Obama on the health laws. But, he said, the state provides a clear example of what others could gain when the federal law is fully implemented.

He pointed to better access to preventive care, a growth in employer-sponsored coverage, and less expensive insurance plans for individuals and families who buy on their own. The Massachusetts law today has broad public support.


Nationally, Gruber said, “we need to be patient, and measure the outcomes in months and years, not days and weeks.”

When the Connector was created, Kingsdale was hired away from Tufts Health Plan, where he was a senior vice president. He used his industry connections to staff the office and build relationships with insurers that would be selling plans on the website.

The Connector hired one principal contractor, Computer Sciences Corp., to develop the website. From the start, the focus was on giving people a good online shopping experience, said Greg DeBor, then a partner with the company who is now a consultant with Manatt Health Solutions.

The site allowed people to see what plans were available without requiring them to submit personal information first. The late-game decision to require people using HealthCare.gov to create an account and enter financial data before shopping for plans has been blamed for some of the failures of the federal site.

“It’s a bad shopping experience, I would say, akin to turning over your life story before you can walk through the door at Walmart,” DeBor said.

Under the 2006 state law, Medicaid remained a separate program, with its own application process. And the process for verifying whether a person qualified for subsidized insurance through the Connector, based on income, was farmed out to Medicaid. Much of the communications between the Connector and insurers was handled offline by a subcontractor, DeBor said.


The federal law requires much more to be done online, including the verification of income through a data hub.

The Connector launched its website incrementally over 15 months, delaying the enrollment period for some who received subsidies because the website wasn’t ready yet.

Meanwhile, the Legislature passed three bills in 2006 and 2007 to make technical changes to the law, correcting oversights or fixing problems found as the site was developed.

“Things could evolve as it went along,” said James Roosevelt Jr., chief executive of Tufts Health Plan, which sells plans through the exchange. When those changes were made, “nobody said, ‘Oh, that shows that Romneycare is a total disaster.’ ”

It’s hard to overstate how different the political climate was in Massachusetts during the Connector’s launch from what it is in Washington today.

“When conservatives attacked the law, Mitt Romney stood up and defended it,” said John McDonough, a Harvard health policy professor and Boston.com blogger who had a hand in crafting both the state and national laws.

The political rancor in Washington has made tweaking the program nearly impossible and has magnified every misstep. The near-failure of the national website, however, is more than a misstep. It has stalled enrollment efforts and fueled public frustration.

Montreal-based CGI, one of the developers questioned over trouble with the website, is the same company that has overhauled the Connector’s website to comply with the federal law.


The state site has had some technical problems, but it is running more smoothly than the federal portal. As of Tuesday morning, nearly 32,000 Massachusetts residents had begun applications. Of those, 11,147 were completed.

The new Connector website is more complex. The program is more integrated with Medicaid, and the state has provided some additional subsidies not included in the Affordable Care Act to maintain the level of assistance from the state law.

Building out the program here, where a functional exchange existed, and helping insurers adapt to changes was a challenge, said Connector chief information officer Scott Devonshire. Starting fresh across more than 30 states “is not a task that I would envy,” he said.

Chelsea Conaboy can be reached at cconaboy@ boston.com.