Critics of the Hawaii Health Connector have identified multiple problems with the setup and management of the online health-insurance marketplace, and the fact that all these severe flaws existed concurrently made the current crisis all but inevitable. Example: In a state already notorious for its information technology shortcomings, the work of getting the exchange running was not handled properly.
But most important among the failings was that many of the key discussions in the formative stages were made out of the public eye, which meant the taxpayer had no warning about the dysfunction.
The bottom line is that the state must see health-care reform implemented effectively, and its elected leaders have a key role in seeing that this happens. In the run-up to the coming legislative session, lawmakers have to seek ways to restructure the organization to make it much more accountable for the millions of federal dollars invested in its establishment.
The latest blow to the embattled private nonprofit was last week’s announcement that Coral Andrews was stepping down as executive director after Dec. 6. It is the worst timing possible for such a transition, given that enrollment is due Dec. 15 for coverage starting Jan. 1. The marketplace had enrolled only a few hundred insurance customers in its initial weeks, owing partly to the technical problems with the website that delayed the scheduled Oct. 1 launch.
The Connector’s governing board should focus its postmortem, of course, on finding a capable successor — but also on being candid in rooting out problems and directing solutions that regain public trust in this project. Andrews plainly was unable to finish the job of getting the marketplace up and running; the fact of her resignation at this crucial juncture for the state’s Affordable Care Act rollout was a wrenching outcome, to say the least.
But Job No. 1 is for the interim chief — Tom Matsuda, the state’s ACA implementation manager — to accelerate the pace of community outreach to new enrollees. Given the technical challenges of the site, the face-to-face enrollment push, which also has lagged terribly behind schedule, is all the more essential now.
Of course, a permanent executive director must be found to keep the primary objective in sight: enrolling enough people to keep the marketplace sustainable and to achieve broader health-care access for the public. Officials say there are 100,000 uninsured people in Hawaii.
However, the Connector clearly cannot be allowed to continue without revisions to its current form. Judging by the lack of public disclosure about all the problems in the weeks leading up to the launch, transparency must be improved.
Act 205 created the Connector as a private nonprofit in 2011; it was passed to ensure that Hawaii had its own insurance exchange rather than rely on the federal marketplace — which has famously suffered from its own set of flaws. The reason: Hawaii wanted to ensure that its own Prepaid Health Care Act, which remains in effect even with the ACA, was upheld in the health plans that would be offered.
It was the correct decision for the state to have its own marketplace, but two implementation failings must be corrected. One, the Connector should be fully subject to the state Sunshine Law. It might be a private nonprofit, but so far it’s operating with public funds, and with no clear financial plan for a self-sufficient future. So the public has a right to know how business is being conducted.
Two, the Legislature should reconsider its decision to allow insurance carrier representatives to be voting board members. Their professional advice is essential, but decisions must be made by those whose primary interest is the success of the exchange, not of individual companies.
The current leadership void is a tumultuous development for an enterprise already hobbled by a rocky launch, but the crisis at least lights a fire beneath state and health-exchange leaders who must move quickly to correct past mistakes.
