Best in Governance
Maryland Health Benefit Exchange Board
In October of last year, Maryland was poised to roll out its health insurance exchange as part of the implementation of the 2010 Affordable Care Act (ACA). Hopes were high that the state would be able to serve the almost 800,000 uninsured residents in the state.
But Maryland’s new system landed with the thud. Barely more than 1,000 people registered on the website in the first week, and the state’s exchange was hounded by management turnover, internal feuding, lawsuits, and a poorly designed website. To add insult to injury, the website crashed within minutes of premiering. Like more than a few other states, the government’s technical failures dominated the story of healthcare reform in Maryland.
What a difference a year makes. Since Maryland’s disastrous first stab at implementing a health insurance exchange as part of the ACA, it has changed tack by looking to other states for successful strategies. During the first week this year, enrollments in the Maryland Health Connection topped 25,000. Best of all, the exchange was running so smoothly, it opened a day early.
This time around, Maryland looked to Connecticut and the successful rollout of its insurance marketplace. The Maryland Health Benefit Exchange Board used some of the same code and technology as Connecticut’s system, but it learned more than just computing shortcuts. Maryland’s team spoke frequently with the health exchange leadership in Connecticut and also visited in person several times to glean what worked and what didn’t for the Connecticut system.
Maryland’s Maryland Health Benefit Exchange Board also created linkages to outside agencies like Medicaid, Medicaid, and private health insurers and conducted thorough testing to ensure the website would be able to handle the volume of service expected when the sign-up deadline approached, a critical failure of the first health insurance exchange.
A collaborative tone for the Maryland Health Connection was set by Maryland’s data-driven governor, Martin O’Malley, who has encouraged state agencies to seek solutions based on what has worked elsewhere. So far, Maryland appears to be the only state using another state’s technology for the state-wide health insurance exchange, but based on its success, sharing best practices for healthcare reform is a lesson more states should be heeding.