Massachusetts: The Health Connector Autopsy Report

Contributor ArcticStones forwarded this to me. I'm not in a position to either confirm or debunk many points in this article, but a quick search of this site for "Massachusetts Limbo" will bring up a number of references made in it. The author is a quite open Republican activist. However, if his claims are correct--and the bulk of them certainly seem to be--then those in charge of the first version of Massachusetts' ACA exchange should be held accountable for some rather appallingly bad decisions before, during and after the 2014 open enrollment period.

I generally support the Affordable Care Act, and states like Kentucky, Connecticut and (for the most part) Washington State, New York, Rhode Island and Colorado have proven that when the technology, budget, personnel and other project aspects are handled properly, it can be extremely successful. However, that also means not turning a blind eye or blaming the wrong source when things go wrong...and in the case of states like Oregon and Massachusetts, things did indeed go very, very wrong.

Oregon still has one hell of a legal, financial and technical mess to clean up, but at least they mitigated some of the damage by manually processing almost half a million people through their exchange system. Massachusetts, on the other hand...

The following is a summary of the full report, which was published at Medium.com on August 26th, 2014. Again, I can't state for certain that everything here is accurate, but lord knows something went terribly wrong in Massachusetts, and this is the most comprehensive attempt I know of to explain what that was...and "comprehensive" is an understatement (it'd be a novella if printed out in paperback form):

Summary of Health Connector Autopsy Report

This 31,000 word report covers the entire story of the troubled Massachusetts Health Exchange project, and provides expert commentary from an IT expert. It was created to help the public fully understand what happened, and why.

The bulk of the report is a timeline. This was done to show the difference between what was known internally, and what the public was aware of. It shows that severe problems with the exchange were hidden from the public all the way to the launch. Afterwards, the problems continued to be hidden, or were minimized. Worse, the government consistently put out false information about the project before, during, and after the launch. The report also aggregates newspaper stories about people who were harmed by problems renewing their health insurance, and points to previously unreported evidence that there are customer service logs at the health connector documenting how serious many of the problems were. The report comes to the following conclusion:

Our government was so proud of its health policies, and so worried about the image of the policy-makers, that it decided nothing else mattered as much: not good government, not sound management, not telling the truth, and not even the people who needed health care.

What's new in this report

There have been many stories in the newspapers about episodes in this story, but these are items previously unreported:

• An analysis of unreported weekly and monthly audit showing that the project was in trouble from the very beginning, long before July of 2013, which the press discovered in January.
• A series of misleading and false claims in public documents from the Health Connector about the state of the exchange. These documents were published after they knew the failure of the exchange was "likely" yet they say that everything was fine, and that people would be getting features that the Connector leadership knew they would not be getting. The most absurd is the Health Connector annual report, which comes out weeks after the collapse, and says everything went great.
• A strong link to Governor Patrick's cabinet. The Executive Director of the Health Connector, Glen Shor, leaves to becomes Chairman of the Board in January of 2013, and also joins Governor Patrick's cabinet. Glen Shor is the previously unnoticed link between problems in the Connector to the Governor's cabinet, making it hard to believe Patrick didn't know about problems with the exchange.
• Numerous false or misleading statements to the public by Health Connector Excutive Director Jean Yang.
• Strong evidence that it was the government who was primarily at fault for the failure of the exchange.This is in contrast to the government's repeated claim that it was almost entirely the fault of the primary vendor, CGI.
• Evidence that Governor Patrick's statements about the exchange in January and February are at odds with what he was in a position to know. For example, he claims that the government didn't know how bad the condition of the exchange was until late November. This is untrue.
• Evidence and commentary showing that the technical management of the exchange project was in violation of many standard practices and features utterly irresponsible decisions, such as launching a complex web application without any testing done by the users.

This report was written by Ed Lyons. He is a writer and seasoned technical architect with many years of IT experience, and has assisted on large, troubled projects. He has a close friend who went through the exchange enrollment in 2013 and had great difficulties with the process. Disappointed with the scattered coverage by the media, he wanted to tell the entire story with commentary that revealed what happened and why. He is on twitter as @mysteriousrook.