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A contest with Uncle Sam?

Maryland’s health insurance exchange made good progress last month, but not everyone is satisfied.

After Maryland Health Connection officials released updated enrollment numbers on Friday, Rep. John K. Delaney, a freshman Democrat who represents Western Maryland and Montgomery County, put out a public statement decrying that Maryland is “still lagging behind the national numbers.”

Delaney recognized the progress made in December with overall enrollment on Maryland’s exchange, but took issue with the fact that, as I noted on this blog last week, Medicaid enrollment accounted for the the vast majority of total enrollment, with a smaller number of people signing up for private insurance plans. That’s an important detail, he said.

The federal exchange website has been stepping up its game since its own disastrous roll-out on Oct. 1. Since then, 2.1 million people nationally have signed up for private insurance, which is about 30 percent of the feds’ goal of 7 million people. Maryland’s exchange had signed up 18,257 people in private insurance (as of Dec. 28), representing only 12 percent of state officials’ goal of 150,000 people.

(At times, state officials have made it seem like that number was their total enrollment goal and other times that it was the private-insurance enrollment goal.)

Delaney’s main point was that the federal exchange is supposedly performing better — after having made greater progress in overcoming technical glitches —than Maryland’s exchange. His comments on Friday compared the nationwide “30 percent of the goal” figure to the state’s “12 percent of the goal” figure. But that’s not an apples-to-apples comparison.

Of the 2.1 million people who signed up for insurance, only about 1.1 million of them did so via the federal exchange. The rest are new enrollees who signed up via state exchanges.

So, a more truthful comparison of the Maryland exchange’s performance and the federal exchange’s performance would look at the 1.1 million people who signed up at versus the 18,257 people who signed up at Maryland Health Connection.

But it’s also not accurate to use the federal 7-billion enrollment goal to evaluate the federal site’s progress, because that number includes all Americans, including those using state-run exchanges. So, without a specific enrollment goal for the federal site alone, it’s tough to say which site is closer to meeting its mark.

Regardless, Delaney continued to mull over those numbers over the weekend, because today, he sent a letter to state health Secretary Joshua Sharfstein asking for more information about the feasibility of switching to the federal exchange, an idea he and other officials have already floated.

Here’s the first paragraph: “Perhaps too forward, but I write today to formally request a specific assessment of the idea I first raised almost a month ago of switching in whole, in part, or on a temporary basis to the federal health exchange while the Maryland Health Connection website is being repaired. I write this as an open letter so that you can respond openly as well, because transparency benefits everyone.”

Delaney said he agreed with the state’s original decision to create its own website and that he remains open to mending and continuing to use the site, if that’s the best option.  He suggested switching to the site as a temporary measure until Maryland Health Connection was fully functional “so that peak volume of enrollees could be handled in advance of looming deadlines.” State officials have said they are evaluating that option, and that everything is on the table.

In his letter to Sharfstein, Delaney said he understands that transitioning to might pose “challenges that I am underestimating” that would make the move impracticable.

“For this reason,” he wrote, “I am asking for a specific analysis from you as to the ‘pros and cons’ of switching to the federal exchange for all or part of the Maryland interface. This analysis can be very brief, but should cover a high level overview of the technological feasibility, cost and timing considerations, and should be described in comparison to …  repairing the Maryland Health Connection.”

Other local politicians are also weighing in on how to proceed with the rest of the open enrollment period, which lasts through March 31. Harford County Executive and Republican gubernatorial candidate David Craig, along with his running mate Del. Jeannie Haddaway, have called for a shift in how the state promotes residents’ enrollment options.