One of the ironies of the Affordable Care Act is that many of the governors who zealously supported the bill failed spectacularly in its implementation. Oregon, Maryland, and Minnesota are among the most prominent failures. The Massachusetts exchange, the primary inspiration for the ACA exchanges, collapsed entirely, and state officials lack a plan for fixing it in time for this fall’s enrollments.
After the passage of the ACA, the Centers for Medicare & Medicaid Services (CMS) instituted a management process to ensure accountability among states that chose to build their own exchanges instead of participating in HealthCare.gov. It involved “gate reviews,” a periodic assessment of progress in seven areas; CMS designed the process to ensure that continued federal funding would lead to secure and functional exchanges.
Several of the seven areas for the gate reviews required a state official to make critically important representations about the readiness of the state exchange. Those representations allowed CMS to determine whether an exchange should continue to receive massive amounts of federal funding. Law enforcement officials in Oregon and Maryland are asking whether state officials misrepresented their progress in order to keep the funding spigot open, and that is a question which needs to be asked in other states as well.