Anatomy of a national embarassment: How the first state with universal health insurance completely failed adapting to Obamacare

Ed Lyons analyzes, in great detail, the failure of the health-connector system in Massachusetts, the state that pioneered the very idea:

Yet somehow, no one was held accountable for the largest, most spectacular failure of state government in many years. On February 13, at a public Health Connector Board meeting, Executive Director Jean Yang broke down and cried about what had happened. Yet she, along with everyone else in the exchange project, never accepted responsibility, and she remains in charge to this day.



    Free tagging: 


    I'm still wondering.

    Does anyone have a good reason for why a local software company wasn't offered the gig? We have some of the best programmers in the world located right here in the Boston area.


    Because government

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    Because getting a contract from a government agency requires a LOT of upfront cost in time and effort and sometimes even prototyping. It's extremely speculative and if your are a company that doesn't have an "in" with the agency requesting the work, then you are more likely to lose the bid no matter what.

    So, nobody goes seeking government agency work unless they're a powerhouse that can bring other expert companies on board to do the actual work once the bid is actually won...if they're willing to deal with the overhead of reporting to both the powerhouse AND the government on progress/success/failures.


    I worked for a small company

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    I worked for a small company that did contracting with the government. I don't think you have to be big, but you do have to put in the extra work required, which while easy to mock it does lessen the amount of jobs that would just go to friends/political favors. Im sure it still happens, but having an thorough and formal process lessens the ability of government employees just giving it to a friends company.


    Good luck

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    The "extra work required" is up front and without compensation. You're essentially hoping to prove your value by interning and nobody makes money that way in the long run.

    In some cases, a particular service is needed from a particular company and the company works with the government employee to craft specific requirements that would only apply to that one company. However, you can't know that by looking at the dossier for the project. So you might waste your time applying figuring the one or two weak spots in your bid will be overlooked by the lower price you're willing to take to do the project...and in the end you lose the bid to another company that "fit the requirements better" because they helped craft those exact requirements for that very reason.

    And as the complexity of the problem increases, the likelihood that a small/medium sized company would be able to accommodate the entire plan within their resources decreases. So you end up with a giant in charge who then goes and finds all the necessary bits. That makes the giant money and keeps them the giant. The system perpetuates itself and innovative companies don't gain enough ground to approach a government bid on their own next time and drive any innovation or do better than we've always done.


    There are a lot of small machine shops here

    ..that mainly do gov work. Defense procurement rules spec a US origin.

    I had access to the Mass High Tech Council data base a few years ago to source leads for a marketing outfit.

    A friend of mine even worked on huge naval propellers at a Rolls Royce machine shop on the South shore.

    It depends on the scale. And many of these smaller shops are probably part of a bigger defense supply chain.

    It never hurts to toss in

    a few qualifiers with shot or two of maybe to shore up the glib.

    The database has a number of economy sectors.

    I was mining it for SaaS/Cloud firms, software, electronics and healthcare services. Firms ranged in size from fewer than 10 employees to more than a thousand with capitalization scales all over the map.

    Gov software is a subset of what a shit show the software biz is in general but even there I'll stick my neck out and speculate that the quality of effort that goes into writing trident missile algorithms for Draper and MITRE is different from slopping out a healthcare interface.

    Not really

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    Healthcare means HIPAA compliance and that is taken really seriously in pharma/healthcare because lawsuits are expensive.

    Remember, it was government rocket programming that prematurely landed a Mars mission due to mixing Imperial and metric units.

    One can't very well remember things

    if one has never heard of them.

    Not that such gaffes are implausible.

    Cardigan, the commander who oversaw the Light Brigade charge at Balaclava, was in a yacht in the harbor looking at the wrong map when he dispatched the order.

    I'll take another risk here and assume most parties to contracts involving lots of money are likely to take compliance to stipulated terms seriously whether it is a public or private sector issue.

    I could double down on the glib by also tossing in some platitude like to err is human... blah blah blah.. but it's early.

    And private sector software firms never make hugely expensive gaffes or risk lawsuits. Just look at the sterling history of Microsoft and the astonishing run of flawless executions of operating software system ship outs they are noted and acclaimed for.

    "prematurely landed"

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    That is one of the best aphorisms for "cratered" that I've heard.

    Meters are not feet, and miles are not kilometers folks.

    Slanted article by a nonjournalist with an agenda

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    Why is this being reported? It's a slander article with a slant and a personal motive written by someone who is not a journalist and has no experience or knowlege of the healthcare field and the complexities involved. The story about his friend may be sad, but lacks and real details and he doesn't even acknowledge the people this system has helped. Anyone with an axe to grind and technical knowledge to set up a website is supposed to be taken as legitimate? Nope. Not buying what he's selling.

    True, he's not a reporter

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    But he is an IT professional, which possibly is more helpful in figuring out an IT debacle like this one (I speak as someone who also got caught in the whole Health Connector mess, although fortunately, in our case it was strictly an issue of wasted time online and on the phone - we never lost health coverage).


    First of all, did you even

    First of all, did you even read the report beyond the first few paragraphs? He actually cites pretty much every piece of information he uses direct from the source whether it be a presentation by UMass Medical or code audits by tech consultants.

    I bleed blue, but even I can understand the MA Health Connector was a disaster for all parties involved. This was a failure of our state government (that I always have supported in all other aspects of politics) to take appropriate action. It's easy to blame CGI for being incompetent (because they were), but it's not so easy to admit the reasons why you continued to pay them and not fire them after all of these issues started coming to light. The report details the reddest of red flags you can imagine:

    The code CGI is writing during the death march is awful: from the September 30 audit report:
    The following coding violation statistics are based on the ACR Report submitted by IV&V on 9/30/2013:
    - Coding violations increased by 53% during the past month
    - The # of Critical violations increased from 785 to 1,619 during the past month
    - The # of Major violations increased from 13,023 to 21,133 during the past month
    Now do you see why the exchange could not be fixed? They were inserting more and more problems as they were trying to finish their work.

    Because there is no higher-level testing, the auditor says they will go live based on the strengths of lower-level component testing instead of higher-level testing or user testing. (I simply don’t have words to condemn this level of malpractice.) This is like saying that a car is safe because the individual components worked in a laboratory. Nobody has tested an actual car that uses them. No one has ever driven the car, either. But 250,000 people are going to start driving this model tomorrow morning

    Or how about this...

    The author is a Republican, but I failed to see instances where his political affiliation effects this report. He writes it essentially from the perspective as a frustrated programmer, which he is. He even says that he would have gladly helped out, had he been asked. He also says that he supports healthcare reform.

    Let me finish by saying my husband has also been effected by this debacle because he still does not have dental insurance which was not part of CommonwealthCare, but is part of the ACA.


    Well the title is pretty

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    Well the title is pretty slanted, instead of saying, like you did, CGI was incompetent and the state did a terrible job managing them, the article title implies CGI is not to blame:
    "It was pride, not CGI, that doomed the Massachusetts Health Exchange"
    I would say that is where his politics first come out.


    I thought it was remarkably

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    I thought it was remarkably unbiased (wouldn't have guessed he was a Republican, necessarily) and very interesting to read. Very well done.

    Even if you skip over the

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    Even if you skip over the side story about his ill friend, like I did, the most damning part of the essay points to the failure in governance and in IT management by the state. Even when things didn't work and were behind schedule in 2012, 2013, and 2014, the higher ups pretended that things were okay.

    But Ed...

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    Ed...Jean Yang cried about not being able to sleep nights while hundreds of millions of tax dollars were wasted. That makes it ok.

    Do you think maybe she actually cared?

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    I'm not sure crying made it OK but crying almost always gets mocked as someone appearing "weak".
    I can certainly understand why she was upset.

    How dare this person show emotion? She was one person in an organization/project which I can only assume involved hundreds of people. It's a real shame the older system wasn't allowed to continue
    to be used until the new one was actually up and running correctly.

    Of course, if we had a single payer health payer system using the already established Medicare program and it was rolled out in an orderly fashion

    I don't think there would have been these kind of issues but that's another topic that's already been
    argued forever.

    C'mon, you're old enough to remember the last time ...

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    A Democrat tried to get comprehensive health-care reform done. But just in case you forgot, two words: Hillary Clinton.

    That Obama was able to get what he did - a scheme dreamed up by Republicans as an alternative to Hillarycare - is at least a step in the right direction.

    Last year I needed a month of

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    Last year I needed a month of gap insurance coverage, which luckily was during September, the last of the pre-Obamacare-Connector days. It was seamless: five minutes to sign up, relatively reasonable rates, and relatively easy to cancel (which I was able to do in October after forgetting for a while). I didn't actually use healthcare that month, but I was covered. And this year I got a $3 check because they hadn't spent enough on care.

    From the stories I heard, I was glad that it had been September, and not October, that I was uncovered.