Earlier today, I read the single best piece of journalism to date on the genesis of Vermont’s health care exchanges. It’s an excellent reporting job by Neal Goswami of the Vermont Press Bureau; and unfortunately for non-subscribers, it’s behind the Mitchell Family Paywall. If you have access to the Times Argus or Rutland Herald, or can find a copy at a local library, it’s well worth your time.
It’s on the front page of the Sunday (March 9) Times Argus under the title “Vt.’s Health Exchange: The Inside Story.” Goswami conducted numerous interviews with key players, plus one well-positioned anonymous source, and came up with a thorough and believable account of how the launch of Vermont Health Connect went so badly wrong.
Short version: Everyone deserves some of the blame, but no one person or entity is particularly at fault.
Longer version: The whole process was severely handicapped by the court battle over the Affordable Care Act. It was signed into law in March 2010, and set a deadline of October 1, 2013 for health care exchanges to be active. But the legal challenge wasn’t resolved until summer 2012, so work on the exchanges didn’t start until a little more than a year before the deadline. As Governor Shumlin told Goswami: “…obviously no governor or president was going to spend time and a lot of money implementing this law that none of us knew if parts of it would survive a Supreme Court decision.”
And, since Obamacare was a political football in 2012, there was no chance Congress would agree to an extemsion.
The court delay meant there was little time to waste, which meant that any additional setbacks would be doubly harmful. And, of course, setbacks there were. The Administration chose Oracle as its main contractor;
But troubled by setbacks in Oregon, Shumlin dropped Oracle and signed a new deal with CGI… in December 2012. This left just nine months to complete an information technology project that would normally take at least two years, according to an official with CGI.
The Administration stands behind its decision to dump Oracle, pointing out that Oregon’s troubles have been much worse than Vermont’s.
Goswami provides two accounts of what happened from January to October 2013.
CGI says that, due to time constraints, it promised a limited but serviceable site by October 1, with more features to be added later. CGI claims the Administration initially agreed to this, but later added more requirements.
For its part, the administration puts most of the blame on CGI for, as an anonymous government official put it, promising a sportscar and delivering a clunker.
On October 1 the scope of the problem became clear, and more troubles came after the site went live. As Goswami reports,
Facing such mounting challenges, a normal IT project would have seen the launch date extended, or the budget would have gone up to allow for more resources. But the Affordable Care Act had a fixed date and the money was set.
Part of the problem within state government, according to Goswami’s anonymous official, was a division of relevant expertise. The Department of Vermont Health Access had the policy smarts to provide strategic guidance, but lacked the ground-level experience needed to make tactical decisions on business rules and IT. DVHA head Mark Larson sees it differently; he says the single biggest problem was a lack of time.
Since the first of this year, Goswami reports, the state and CGI have put their heads together, clarifying responsibilities and workflow, and renegotiating some parts of the contract. Canceling the CGI contract was considered, but the Administration decided that would cause more problems than it would solve. The two sides now appear to be working much more harmoniously.
All in all, Goswami paints a picture of an extremely complicated project jammed into a very short timeline due to the Obamacare court challenge and Vermont’s contractor switch. After that, relatively minor mistakes had huge consequences. The result was our October 1 disaster and the months of scrambling to fix the system.
No catastrophic management failure, no corruption, no scandal; just a bunch of human beings working under incredibly difficult circumstances — circumstances largely not of their own making.
Could things have been handled better? Sure. But by far the biggest problems were (a) the sheer complexity of the task, and (b) not nearly enough time.
Read Goswami’s piece if you get the chance. It probably does a better job of telling the story than any number of internal or independent investigations will.