Massachusetts’ star-crossed effort to set up an Obamacare-compliant health care exchange has been an expensive embarrassment — all the more so since Massachusetts’s previous universal-health care program was the model for the federal Affordable Care Act. Just how expensive is a matter of debate, in part because the corrective process has been so complex. But the public, state lawmakers, and the next governor will all benefit from a true accounting of how much the website fiasco cost.
The conservative Pioneer Institute recently released a report saying the state’s efforts to set up its own website could end up costing as much as $1 billion in federal and state dollars when all related costs — including temporary coverage for those whose Medicaid or subsidy eligibility couldn’t be determined because of the malfunctioning site — are factored in.
Governor Patrick has called that report inaccurate, and some of its assumptions are indeed wrong. Yet it raises an important point: A credible analysis of the website mess will provide a useful cautionary tale for policy makers in the future. Citizens also need to know not just how many tens of millions were wasted by management and IT failures along the way, but also the extent to which the website failure created a cascade of costs for Medicaid and other programs.
Massachusetts residents whose eligibility for Medicaid or subsidized insurance couldn’t be determined because of the malfunctioning state website received temporary coverage that, Pioneer calculates, will end up costing an estimated $400 million. The think tank reasons that since Massachusetts already had near-universal health coverage under Romneycare, many of those put on temporary coverage probably weren’t eligible, while others should have paid at least some of their own costs. On the other hand, if most were eligible — something the Patrick administration believes is true but can’t say with certainty at this point — state and federal dollars would still have been spent on them, though with the federal government likely picking up more of the cost.
The Patrick administration’s estimates are significantly lower; the temporary medical care program has cost the state $259 million so far, most of which is to be reimbursed by the federal government. In any case, it’s clear that the website mess created unanticipated costs.
For public officials, it might be tempting to let the episode drop. But the episode revealed some flaws in state government: The Massachusetts Health Connector board hasn’t always distinguished itself by asking persistent, probing, timely questions. The state’s overall supervision of information technology has been weak.
Auditor Suzanne Bump says her office plans to start an audit of the Connector within a year, though she won’t say specifically when. Bump, who is up for re-election, should speed up that schedule, making a detailed audit of the state’s website effort and the related health care programs a top priority. A thorough outside scrub may be the only way citizens will get the accurate information they deserve.