Saturday, March 29, 2014

No Consequences for Wasting $125M in Maryland... As Usual with Democrat Voters, Good Intentions Trump Actual Results

from the Washington Post
Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.

The board of the Maryland exchange plans to vote on the change Tuesday, the day after the end of the first enrollment period for the state’s residents under the 2010 Affordable Care Act.

Marylanders will be able to use the exchange even as it is being overhauled. The first enrollment period opened Oct. 1 and closes Monday for insurance coverage that kicks in this year. A second open enrollment period starts Nov. 15.

Like Maryland, Connecticut was one of the first and most enthusiastic states to embrace the idea of building its own insurance exchange rather than using a federal site to implement the law’s sweeping changes in health-care coverage.

But unlike Maryland, where the system crashed within moments of launching and has limped along ever since, Connecticut’s exchange has worked as smoothly as any in the country.

Maryland is not alone in having deep-seated problems with its health marketplace. Technical issues also have plagued Oregon, Minnesota and Hawaii. But Maryland will be the first to walk away from its site, a particular embarrassment for Lt. Gov. Anthony G. Brown (D), who was placed in charged of implementing health-care reform in Maryland by Gov. Martin O’Malley (D).

It was not immediately clear how much more money Maryland may have to invest to get a fully functioning system, according to the two individuals, who spoke on the condition of anonymity because they were not authorized to discuss the changes.

The money the state has already spent has gone toward development and operation of the Web site and for agency operating costs. The existing Maryland system will stay operational for “a period of time” while the Connecticut version is being installed, one of the individuals said.

O’Malley told reporters Friday morning to expect an announcement on the future of the troubled exchange next week. The exchange board is scheduled to meet at 5 p.m. Tuesday.

“We still have stuck applications. We still wrestle with it every day,” O'Malley said at a news conference. “The clock was ticking, and we have been changing the flat tires on this rolling car for the last five, going on six months now. And it has gotten better with every new fix applied to it, [but it is] still not working as it was supposed to work.”

Dori Henry, a spokeswoman for the Maryland exchange, said no decision would be finalized until the board votes on it. “The official line is the same: A decision has not been made,” Henry said. “There will not be anything further coming from the state until a decision is made.”

Henry said the exchange has cost $125.5 million to develop and operate.

As of last Saturday, 49,293 Maryland residents had enrolled in a private plan through the exchange, far short of the state’s original goal of 150,000 enrollments and shy even of its revised estimate of 75,000 to 100,000.

Some of the hardware that Maryland bought for its system, such as servers, can be salvaged, but the software and coding that are the guts of its online marketplace will be replaced, said the individuals familiar with the decision.

To knit together the new system, Maryland will turn to the consulting firm Deloitte, which wrote the code for Connecticut’s exchange. Deloitte spokesman Paul Dunker declined to comment about Maryland’s plans.

Kevin Counihan, chief executive of the Connecticut exchange, Access Health CT, said his staff has been talking for months with a handful of states interested in using Connecticut’s technology. He said any announcement about Maryland’s plans would need to come from Maryland.

“A lot of states will be watching them and watching to see what they do,” Counihan said.
The broken website alone cost Maryland taxpayers $2,500 per enrollee.

Friday, March 28, 2014

America's Real House of Cards in Action

The Fix is "in" for the Medicare "Doc Fix"... once again!

Pervert Enabling Bill of 2014 Passes Maryland State Legilsature

from the Baltimore Sun
Legislation barring discrimination against transgender people passed the General Assembly on Thursday, as the House of Delegates approved the bill after an impassioned debate. The vote sends the measure to Gov. Martin O'Malley, who said he will sign it.

The bill, approved by the House 82-57, prohibits discrimination based on gender identity in housing and employment, in obtaining credit and in access to public accommodations. Five Maryland localities, including Baltimore City and Baltimore and Howard counties, have similar laws. But the measure enacted Thursday provides statewide legal protection for an estimated tens of thousands of Marylanders who say they often experience harassment, discrimination and even assaults.

When the legislation is signed into law, Maryland will join 16 other states and the District of Columbia with similar statutes.

Proponents hailed passage as the culmination of more than a decade of campaigning to extend Maryland's anti-discrimination law to cover transgender people. The campaign came after successful political battles to protect gays and lesbians and to legalize same-sex marriage.

"It is remarkable how far we've come in such a short period of time," said Sen. Richard Madaleno, chief sponsor of the Senate version of the bill and one of the Assembly's openly gay members. "I think it sends [a message] that Maryland is a welcoming place for everybody. No matter who you are, you have the opportunity to live your life, to have a job, to have a place to live, to be able to go out and enjoy a meal."

Opponents said the legislation will endanger women and children by making it easier for sexual predators to gain access to women's restrooms or locker rooms.

"I think this really sets Marylanders back as far as our right to privacy when we go to different bathrooms," said Del. Neil Parrott, a Washington County Republican. "Certainly it's very concerning for children that when an adult parent lets his child go into the bathroom, and now there could be a man or a woman in the bathroom legally."

Parrott, who was instrumental in petitioning same-sex marriage and two other laws to referendum in 2012, said he had not decided whether to try to put this legislation on the ballot.

But Carrie Evans, executive director of Equality Maryland, said she wasn't worried, noting that voters had upheld all three laws in that referendum. She predicted Parrott and other opponents of transgender rights would face "an uphill battle" getting voters to overturn the transgender rights law.

"This is about discrimination," Evans said. "It's about people getting jobs and having apartments." She said she doubted Marylanders would vote to deny anyone such rights.

Most of the lengthy, and at times heated, House debate focused on bathrooms. Delegates questioned how sexual predators could be kept out of women's restrooms and dressing rooms if the bill becomes law. Critics proffered a string of amendments aimed at that issue, arguing that men wanting to assault women or molest children would dress up in women's clothing or simply claim they "felt" like a woman to justify their presence if challenged.

"Please make sure women and little girls are in areas free of people who will do them harm," said Del. Kathy Szeliga, a Republican representing Harford and Baltimore counties.

Del. Joseline A. Pena-Melnyk, floor leader for the bill, countered those and other arguments to change or defeat the bill. She pointed out that the legislation would not apply to bathrooms or locker rooms in schools. Proprietors could exclude transgender people from women's or men's facilities by offering separate bathrooms or shower stalls curtained off for them, she said.

To other critics who mentioned news reports of women and children being raped in public restrooms, Pena-Melnyk countered that there was no evidence that transgender people have a propensity to commit crimes.

Del. Luke Clippinger, an assistant state's attorney and chief sponsor of the House version of the bill, said there are already criminal laws on the books to prosecute anyone who might enter a women's restroom or dressing room for prurient reasons or to assault anyone. The Baltimore Democrat reminded lawmakers that the legislation would provide legal protection to a group of people now denied it.

Advocates for transgender rights estimate the legislation may affect 30,000 or more Marylanders. In a nationwide survey of transgender people, more than two-thirds of the 132 Marylanders questioned said they had experienced harassment or discrimination on the job, while 81 percent of those who'd expressed their gender identity in school said they'd been hassled.

A few delegates made clear they were philosophically opposed to the legislation or unwilling to accept changing gender identity as normal.

"We can pass all the bills we want, but we can't change nature," said Del. Emmett Burns, a Baltimore County Democrat who is a minister. He added, "My constituents think we have lost our minds."

Del. Michael McDermott, a Republican representing the lower Eastern Shore, said mores are different in rural areas. He said those supporting the bill were "voting for confused legislation on behalf of some very confused people."

But Del. Maggie McIntosh, a Baltimore Democrat, recalled that similar arguments had been raised against legislation according protection against discrimination for homosexuals, which ultimately passed in 2001.

"This is an important group of people who, frankly, we left out" of the earlier law, said McIntosh, who is gay. "They're beat up, ridiculed, suffering, and they need to hold their heads up high, just like I do today."

Others invoked the civil rights struggles of the 1960s and '70s. Del. Rudolph Cane, an Eastern Shore Democrat and an African-American, recalled how in his youth, his family was excluded from dining in many restaurants when visiting Annapolis. Transgender people "aren't the ones causing problems," he said. "We need to support equal accommodations so people can enjoy a decent life."

Friday, March 21, 2014

Annapolis First Pushed Gambling, Now Drugs

from the Baltimore Sun
As state lawmakers try to get Maryland's medical marijuana program off the ground, the focus has turned to the practical matter of establishing an industry to provide the drug — and the details are proving daunting.

While there is broad agreement in Annapolis that marijuana should be widely available for patients who need it, there's no consensus about how best to accomplish that end.

Legislators are hearing from frustrated patients and their families who still can't get marijuana legally to treat intractable pain, seizures and other medical problems. They're also being buttonholed by lobbyists representing people hoping to get in on the ground floor of what has proven in other states to be an extremely lucrative market.

The challenge is to devise a plan that would encourage entrepreneurs to become growers and distributors — while allowing enough competition to keep prices down for the consumer.

Last year, the General Assembly made it legal for the state's academic medical centers to dispense medical marijuana. But the hospitals have not moved to do so, prompting lawmakers to consider authorizing physicians on staff or affiliated with hospitals to, in effect, prescribe it.

Legislation passed by the House of Delegates would do that. But it has raised other concerns about creating a cartel of sorts, with a relatively small clutch of businesses holding exclusive rights to grow and sell the drug throughout the state. The House bill calls for awarding 10 licenses to cultivate and dispense marijuana. The licenses would run for five years initially, with an option renew them for another decade.

Some say that's a prescription for trouble. They worry that limiting the number of growers could restrict the supply and boost the price of the drug, making it hard to get in some places and unaffordable to poor patients.

"The poor guy in the city with HIV is not going to be able to avail himself of the drug because he can't afford it," predicted Sen. Bobby A. Zirkin, a Baltimore County Democrat. "I do not think we should be setting up a monopoly, whether it's five, 10 or 25 [growers]," he told colleagues on the Judicial Proceedings Committee on Thursday.

"Let the market decide," Zirkin said, urging panel members to authorize an unlimited number of growers and dispensers.

Some also worry that awarding lengthy licenses would handicap regulators dealing with any problems that may surface with startup operations.

"Doctors have to be relicensed every two years," noted Dr. Paul Davies, chairman of the state Medical Marijuana Commission and head of an Annapolis pain management practice. Having a shorter license term would enable regulators to keep closer tabs on growers and distributors, he said.

Twelve of the 20 states plus the District of Columbia that have allowed for medical use of marijuana require growers to be licensed every year or two, according to state health officials.

Advocates of the House plan say limiting the number of growers would help ensure there would be demand for their product.

"When people throw out the term 'monopoly,' I think that's not fair," said Del. Dan K. Morhaim, a Baltimore County Democrat and one of the architects of the House bill. The state needs to give new businesses stability if it wants them to take a risk on a brand-new industry that is at odds with federal drug laws, he said.

Having the growers act as distributors would prevent another layer of bureaucracy, Morhaim said

"The legislation can always be adjusted," said Morhaim, a physician. "People can make decisions informed by fact, not by speculation. In a year or two, we're all flexible."

But others worry that if the state's not careful, it could be making a small number of business owners very rich while not ensuring that everyone who needs medical marijuana in Maryland can get it.

"Overnight we're going to create millionaires," predicted Sen. Christopher B. Shank, a Washington County Republican. He said capping the number of licenses would make them extremely valuable.

"There's big money in marijuana," said Sen. Lisa A. Gladden, a Baltimore Democrat, who said there are lobbyists in Annapolis representing growers in Colorado interested in getting into the Maryland industry.

"I'm just amazed that they would come here," she added.

Sen. Jamie Raskin, sponsor of the Senate legislation, said he's not surprised the medical marijuana program has also attracted a grower's lobby.

"This is America, and people want to make money however they can," said Raskin, a Montgomery County Democrat.

Lobbyist J. Darrell Carrington said he's representing a local firm looking to get into the business.

"This is a brand-new industry, and you're creating it from scratch," Carrington said. He urged lawmakers not to fret about the length of licenses, saying regulators can always revoke them at any time for cause. The reason to start small, he said, is to ensure a smooth startup.

Friday, March 7, 2014

Just Blame the Weather....

from the Baltimore Sun
Maryland faces a revenue shortfall of $238 million over the next 15 months, state officials warned Thursday, necessitating tough choices in balancing the state’s budget in the final weeks of the General Assembly.

The Board of Revenue Estimates adjusted downward what it had projected in December the state would collect in fiscal 2014 and 2015 from taxes, gambling proceeds and other sources. Revenue for the remainder of this budget year was expected to be $127 million short, while the shortfall for the next year was projected to be $111 million.

The board is made up of Comptroller Peter Franchot, Treasurer Nancy Kopp and Eloise Foster, state secretary of budget and management.

Board members blamed weaker-than-expected economic activity in the final months of 2013, including the federal shutdown and other budget cuts, plus severe weather in recent months, for much of the shortfall.

“There’s just no glossing over the economic challenges we face,” said Franchot. But both he and Kopp said they are “cautiously optimistic” that the state’s revenues will gradually improve as the months wear on.

Calling the projected shortfall “quite concerning,” House Minority Leader Nic Kipke called on Democrat-led budget committees in House and Senate to “exercise true fiscal responsibility” as they put together the state spending plan for fiscal 2015.

On the other hand, Benjamin Orr, executive director of the Maryland Center on Economic Policy, argued that the shortfall should persuade lawmakers to abandon proposals cut estate or corporate income taxes.

Sunday, March 2, 2014

Does Maryland Reward Political Incompetence?

from the Baltimore Sun
Maryland must spend as much as $30.5 million more to provide Medicaid coverage to Marylanders because the state's glitch-riddled health exchange website can't tell whether they are still eligible.

It's another problem exacerbated by the software that has been causing headaches since the exchange website launched on Oct. 1 for those trying to get into the expanded Medicaid program or buy private insurance with subsidies.

This issue identified in a legislative report only applies to people already in Medicaid, the federal-state program for the poor. State officials say they had planned all along to delay determining Medicaid eligibility, but acknowledged the exchange made the problem worse.

"It was a deliberate decision to keep people in coverage while system issues were getting resolved," said Charles Milligan, a state deputy health secretary in charge of the Medicaid program. "We recognize by blocking normal attrition from Medicaid that there would be a state cost."

The eligibility issue will add to the costs of the state's Medicaid program and won't be counted toward the total cost of the exchange, which is now expected to reach $261 million by the end of 2015. About 80 percent of those funds will be federal.

But critics were further infuriated by any additional money spent because of the exchange and seized on the issue to heap more scorn on the program and its advocates and intensify calls for an investigation.

Minority Leader David R. Brinkley of Frederick County took a swipe at Democratic gubernatorial candidate Anthony G. Brown, the state's point man on health care reform, and said the state is spending millions on "this malpractice by the lieutenant governor."

He said, "We need outside counsel. This thing keeps getting bigger and bigger."

Brown, who could not be reached for comment, has said that he supports investigating what went wrong, but that the state is focusing on fixing problems to get people enrolled in health plans.

Milligan said he expects the issue will cost the state less than $30 million because income limits are now higher and fewer people will be removed from the ranks. The estimate is based on the program's attrition rate before the increase in income limits. The federal government also agreed to pick up an equal share of the cost.

The more than a million Marylanders in Medicaid must reapply for the program each year. About 5,000 a month are typically pushed out of the program because of a change in income or family status.

State officials — along with those in 30 other states and Washington, D.C. — feared they couldn't handle all those re-applications under new Affordable Care Act rules at the same time the exchanges were launching and new people were being added to Medicaid, Milligan said.

All those states were given permission to keep Medicaid recipients on the rolls longer than one year. Most states requested longer extensions than Maryland, which initially asked for its extension before problems with its exchange website surfaced.

Milligan said they figured that the Medicaid enrollees had coverage and it was better to focus everyone's attention on enrolling new people. So far, more than 150,000 people have been added to Maryland's Medicaid rolls since state officials chose to expand the program, exceeding expectations.

State officials had hoped to redetermine the eligibility of current enrollees through the new health exchange website by December. But it crashed the day it launched Oct. 1. Exchange officials have since focused on fixing the major problems, putting off the Medicaid issue.

Milligan said the state asked for and was given another extension by the federal Centers for Medicare & Medicaid Services until June.

The problem and its costs were included in a report from the state Department of Legislative Services presented to lawmakers Wednesday.

The report came out just days after exchange officials terminated the contract of Noridian Healthcare Solutions, the prime contractor charged with developing and operating the state exchange.

They are reviewing their options for the next open enrollment period in the fall, which includes moving to the federal exchange website, using another state's system, entering a consortium with other states or fixing their own site.

Milligan said most states are not enrolling people in Medicaid on their exchange websites, so that will be a consideration for Maryland. He said officials likely won't ask for another extension and will need to either adjust their existing system to handle new Medicaid eligibility rules or use other new technology.

Sen. Thomas M. "Mac" Middleton, a Charles County Democrat who chairs the Finance Committee and is co-chair of the newly formed joint committee overseeing the exchange, said officials may be able to go after some of the costs of this newly identified failure in litigation with contractors.

"We all know this is a system that isn't working," Middleton said. "If you pay for a system that was supposed to work and it doesn't work, you go after them for damages."

Noridian officials have said they complied with contractual obligations even under pressure and facing constant changes requested by the state.
We'll certainly find out after the next election.