By Matt Murphy
STATE HOUSE NEWS SERVICE
STATE HOUSE -- Gov. Deval Patrick's new special assistant in charge of overseeing the repair of the Health Connector's troubled enrollment website told lawmakers on Wednesday that the state was seeking a six-month extension from the federal government to keep subscribers enrolled in current coverage plans beyond the March 31 deadline to give ample time to repair the faulty site.
Sarah Iselin, on leave from her job at Blue Cross Blue Shield of Massachusetts, testified before the Joint Committee on Health Care Financing, offering frustrated and at times angry legislators assurances that health officials recognize the turmoil that has been created by the botched rollout and are working to provide access to coverage.
"I don't care what is promised, because we've heard that before," said Rep. Jay Barrows, a Mansfield Republican. "There is no way you can deliver by March 31."
Iselin, who acknowledged it would be difficult to right the ship in the next two months, traveled to Washington D.C. last Friday, the day after she was named by Gov. Patrick to oversee the Connector website fix with Health Connector Executive Director Jean Yang and Medicaid Director Kristen Thorn.
The trio met with Centers for Medicare and Medicaid Services Administrator Marilyn Taverner to ask for federal approval to extend current coverage plans and some temporary health plans through Sept. 30 to provide time to fix the website, which was supposed to be the principal portal for consumers to sign up for health care coverage.
Iselin said she was "optimistic" that CMS would grant an extension through at least June 30, and reassess the progress made over the second quarter of the year before deciding on a further extension.
"While clearly there were things that did not go right here in implementation, they get it. It didn't go right for them either," Iselin said, adding, "The signals they sent us in the meeting were very positive."
Iselin, Yang and Thorn faced more than three-and-a-half hours of questioning on Wednesday as House and Senate members of the Health Care Financing Committee grilled the officials on steps being taken to fix the website, how those involved in failure to deliver a functioning website on time are being held accountable and how their constituents struggling to enroll will be helped.
"We spent a lot of money. Some of it may be federal, but it's all taxpayer money however it's collected. We spent a lot of money for something that doesn't work," said Sen. Richard Moore. "It's a wonder we don't have as series of mental health crises because of people's frustration."
Iselin said she was working with a new technology vendor Optum, the existing vendor CGI and Connector and MassHealth officials to immediately develop a short-term plan to improve the "workaround" systems that have been developed to enroll consumers in new plans without the help of a functioning website.
"We are managing this vendor on an extremely short leash and articulating expectations on a day-by-day basis," Iselin said, detailing the 9 a.m. and 5 p.m. daily meetings at a new Quincy command center to go over goals for the day and assess whether those expectations are being met.
Suggesting many in Massachusetts may have "underestimated how complex" the transition to the ACA would be because the state had experience with health reform in 2006, Iselin said she is also aware of the need to be transparent with the public and lawmakers on progress being made, and plans weekly updates with measurable benchmarks.
"I want to be very honest that this process needs improvement and we are working day and night," Yang said.
While Iselin just arrived on the job and said she was there to focus on the future and the steps being taken to improve the enrollment experience, many lawmakers expressed their frustration that no senior members of the Patrick administration, or the governor himself, appeared before the committee to explain why the rollout went so badly.
Even after it was explained that Administration and Finance Secretary Glen Shor had his second child on Tuesday and Health and Human Service Secretary John Polanowitz was dealing with a family illness, lawmakers said they were disappointed the secretaries were not in attendance.
"So the guys ducked and covered and sent the women to do the house work," said Rep. Ruth Balser (D-Newton).
Though the committee never directly questioned Yang, who was part of the steering committee overseeing CGI and implementation of the website from the beginning, on what went wrong over the past year, Yang in her testimony did point to problems with the management structure that have been outlined in an independent report produced by Bedford-based MITRE.
Yang noted deadlines and expectations were repeatedly scaled back as it became clear that CGI, which has taken much of the blame for the website, could not meet its targets, and said that as deadlines grew nearer the collaborative nature of the oversight steering committee made rapid decision-making difficult. The steering committee, which included MassHealth, the Connector and UMass Medical School, was disbanded when Iselin was appointed.
Rep. Jennifer Benson (D-Lunenburg), the vice-chair and ranking House member on the committee, said she found it "concerning" that the Patrick administration would send Iselin to appear before the committee given her inability to address what has happened to reach this point of dysfunction, and questioned how involved the governor has been prior to last week when he named Iselin to the job.
"His public comments on this have been almost dismissive of the depth of the situation we are facing," Benson said.
Sen. James Welch, the Senate chair of the committee, also questioned Iselin on whether the state had anyone with the technical knowledge to properly oversee CGI and Optum moving forward.
Iselin said final accountability rests with her, and said she does not need the technical know-how to properly oversee the work on the site. In addition to Optum, who helped turn around the federal health enrollment site, the state's new Chief Information Officer Bill Oates and the chief information officer at MassHealth are lending assistance.
Iselin said that of the approximately 259,000 people who get health coverage through the Connector, 130,000 were successfully transitioned to MassHealth under the Affordable Care Act's expansion of Medicaid. Yang said another 31,000 new subscribers have been able to access temporary subsidized coverage and 7,000 have been enrolled in non-subsidized health plans.
Consumers, however, to continue to struggle to use the website. Many continue to face long wait times when they call by telephone for help and some have shared stories with their representatives of making payments and having checks cashed by the Connector only to find their insurance has not kicked in, their ID cards have not arrived in the mail, or their doctors can't access their insurance.
"The governor keeps saying no one will fall through the cracks, but we see constituents every day who are falling through the cracks," Welch said.
Connector officials said anyone who started the application process before Dec. 31 will have coverage retroactive to Jan. 1 regardless of when officials finally process their applications. Those who started the enrollment process after Jan. 1 will have coverage in place retroactively to Feb. 1. The remaining population of Connector subscribers have either been transitioned to MassHealth, enrolled in temporary coverage or had their existing plans extended through March 31.
"We don't want to say it's not working, because we don't want people to give up," Yang said.
Yang said the most worrisome population is those previously uninsured seeking coverage or those trying to access subsidized coverage for the first time under the new ACA guidelines, and she encouraged lawmakers to put constituents in touch with the Connector for assistance.
Balser encouraged the administration to be more upfront and apologetic with the public. She suggested that Patrick record a message that consumers can listen to while they wait on the phone for a call-center representative that takes responsibility for state's failures, apologizes and lets them know exactly what they can expect moving forward.
Iselin said Optum had 50 people on the ground in Boston working through the technical problems with the website and would be bringing in 300 people to assist with improvement to call-center performance and the workaround solutions being employed to enroll people without the benefit of fully functional technology.
Iselin has also hired former Patrick press secretary and communications director for the Health Policy Commission Kim Haberlin to assist her in her new role.
To the concern of many on the committee, Iselin said that the website would very likely not be fully functional after four months when she is scheduled to return in May to her job at Blue Cross Blue Shield, but said she would leave with a plan in place that accounts for a smooth transition to whatever comes next.
Some lawmakers left the hearing feeling let down by what they heard, or didn't hear.
"I'm not leaving this hearing feeling any more comforted than when I came in," said Rep. Majorie Decker, a Cambridge Democrat.
Decker said she was concerned Iselin would not see the project through and felt questions went unanswered about the overall cost of the fixes, who will be held accountable and how the state will protect those residents who need care but can't access coverage.
Iselin told the committee that before she took the job she had consulted with the Ethics Commission about potential issues with her role at Blue Cross Blue Shield and had been upfront with Patrick that she could not commit to more than four months.
Rep. Sean Garballey, of Arlington, also articulated the concerns of many on the committee that CGI continues to work on the project after missing repeated deadlines and failing to deliver the website it promised.
Iselin said CGI hasn't been paid since October, and won't be paid for anything it doesn't deliver. However, Iselin repeated what Gov. Patrick said last week - that severing ties now with CGI would create problems involving the proprietary nature of the computer code already written by CGI and their understanding of the program that a new vendor would be unfamiliar with.
"I don't see how you can be successful with CGI involved," Garballey said.
Welch said he anticipated additional committee meetings in the future to receive progress reports from Iselin and others and to invite testimony from other affected parties such as the insurers and providers.