Editorials from Oregon newspapers
Albany Democrat-Herald, March 24: Kitzhaber cleans Cover Oregon's house, but questions remain
Prompted by yet another brutal report examining the Cover Oregon debacle, Gov. John Kitzhaber last week sacked some of the key players, including a longtime political ally, but questions still surround the issue, including this one:
To what extent will voters blame Kitzhaber himself for the fiasco?
The answer to that question won't come for sure until the November election, but it's certain that Cover Oregon — and, to a lesser extent, the federal Affordable Care Act— will be front and center during the fall campaign.
By this point, you know the basic outlines of the story: Today, more than five months after the exchange was due to go live, and despite investing some $200 million, Oregon remains the only state where the public can't sign up for health insurance in one sitting. The public and Cover Oregon must still use a hybrid paper-online process.
On Thursday, Kitzhaber reacted to another independent report into the mess — the second tough report about Cover Oregon in the space of less than two weeks — by cleaning house. Among those let go: Bruce Goldberg, the director of the Oregon Health Authority and a longtime Kitzhaber ally on health care reform. Kitzhaber also asked the Cover Oregon board to remove its chief operating officer and its chief information officer.
Last week's independent report from First Data found plenty of reasons why the effort to create Oregon's health insurance exchange seemingly foundered from the start: No single person seemingly was in charge. Decision-making was too diffuse, and the state agencies charged with making the project work didn't communicate well with each other.
And there was a huge amount of misplaced faith that the state's primary vendor for the project, Oracle, would be able to pull it all together.
That didn't happen, in part because the state contract with Oracle didn't include any penalties for missed deadlines or slipshod work.
The state may need to start the process over from scratch, at a cost of who knows how many millions.
In addition to the house-cleaning, the governor last week pledged a variety of reforms, including a look at statewide information technology projects and a review of the contracting woes that in part fed the Cover Oregon disaster.
Kitzhaber also would be well-advised to take a hard look at his management style: The governor prides himself on being visionary — and tends to leave the details to others. To what extent did that tendency fuel the Cover Oregon mess? Again, that's a question voters will have to answer this November.
The (Eugene) Register-Guard, March 21: Uncovering Cover Oregon
Gov. John Kitzhaber said in a telephone interview Thursday that he's ultimately responsible for the failures of Cover Oregon, the state's online marketplace for private insurance under the Affordable Care Act. But an independent review released Thursday, he said, shows that the information he was getting about the Cover Oregon project was being filtered in ways that kept him mostly in the dark about the scope of the problems. Kitzhaber can't avoid accountability, but now the governor needs to press for more information — and, possibly, legal action.
Cover Oregon was supposed to begin online enrollment in insurance plans on Oct. 1. More than that, it was intended to connect Oregonians with other state services, providing a comprehensive portal to programs supporting public health and well-being. But nearly six months later no one-stop online insurance enrollments have been completed, and the links to other services may fall by the wayside. The state has registered nearly 50,000 people for private insurance under the Affordable Care Act, but that's despite Cover Oregon, not because of it.
It will be hard for anyone who's not an expert in information technology to figure out exactly what went so wrong with Cover Oregon. Maybe that's the problem right there: Cover Oregon's development was overseen by people who know all about health care, insurance and government — everything but software. The picture that emerges from the review, prepared by the First Data consulting group, is of a program run by people who put far too much trust in their software contractor, Oracle Corp., ignored or didn't recognize signs of trouble and couldn't fix things as Cover Oregon slid toward disaster.
The day he released First Data's report, Kitzhaber also accepted the resignation of Dr. Bruce Goldberg as director of the Oregon Health Authority. Goldberg will remain as acting director of Cover Oregon until someone new is hired. His departure means that the top three state officials in charge of Cover Oregon have quit or been fired.
Goldberg is a capable and energetic health administrator. It was he, as much as anyone, who secured $1.9 billion in federal grants to set up coordinated care organizations under Oregon's Medicaid program. But Goldberg was the wrong person to put in charge of a big information technology project.
The First Data report faulted Cover Oregon for lacking a "system integrator," for poor communications, and for weak contracting processes. Those are all different aspects of the same problem: poor management. Kitzhaber said that Oracle initially indicated that 95 percent of Cover Oregon's software could be off-the-shelf products. As the project progressed, it became clear that at least 40 percent of the software would need to be custom-made. Cover Oregon's management was unprepared to make the shift from buying software to building it.
There may be deeper problems, Kitzhaber said. Risk status reports from Oracle differed from those provided by Cover Oregon — the governor has asked Sens. Ron Wyden and Jeff Merkley to ensure that the Government Accountability Office probe now under way investigates those discrepancies. State purchase orders from Oracle were broken into smaller parts, apparently to avoid the review to which larger orders would have been subjected. These matters could indicate something worse than managerial incompetence.
In addition, Kitzhaber has asked Attorney General Ellen Rosenblum to review the First Data report and assess the possibility of legal action against Oracle and other vendors. The GAO probe should also examine Oracle's performance, the governor said.
The Legislature approved bills last month strengthening the oversight of state investments in technology, and the governor has signed them. Kitzhaber has consulted with Health and Human Services Secretary Kathleen Sebelius about alternate strategies for achieving Oregon's insurance enrollment goals. These are necessary actions to prevent a recurrence of the problems plaguing Cover Oregon, and to deal with their aftermath.
Kitzhaber noted that First Data had pointed to Cover Oregon's fractured management structure, with no single person having full authority and oversight. But there is such a person, or there ought to be — he's called the governor.
The (Bend) Bulletin, March 22: Cover Oregon was a governance failure
As the federal health care overhaul was rolled out over the last few years, Oregon was invariably the eager overachiever in the first row, waving a hand to volunteer. The governor, John Kitzhaber, a doctor who left the emergency room for politics, made health care his main issue. Fellow Democrats controlling the Legislature went along, embracing ambitious plans to extend insurance coverage and Medicaid to low-income residents.
"Yet for all that, by some measures Oregon has among the most dysfunctional online insurance exchanges in the nation. Only about 50,000 people in Oregon have signed up for a commercial insurance plan through the exchange, well below the state's goal, according to federal estimates. And almost all of those people enrolled using paper applications or with help from an insurance professional because the website had been so unreliable."
That is the beginning of a New York Times news story published Friday. We don't think we could have put it any better.
The report of the independent investigation commissioned by Kitzhaber into Cover Oregon's failures was released Thursday. It doesn't make the failures more acceptable. It makes Oregon's state government look more foolish.
Kitzhaber spun the report this way: "What happened in Oregon is not a policy failure, it's technology failure."
But it was a failure of policy. Policies the state had in place to protect the state in contracting were not followed. They were wriggled around. That is policy failure.
The report highlights the lack of central control overseeing the program. The involved agencies were competing and not cooperating. That may not be a policy failure. It is perhaps a more damning governance failure.
Oracle, the lead technology contractor, obviously also failed to deliver a working product by the launch date. And there is much more that went wrong, all detailed in a 77-page report that reads like a guidebook in misgovernance.
Kitzhaber is trying to learn from the mistakes. Top officials at Cover Oregon are leaving or being asked to leave. There will be management reforms and procurement reforms and organizational reforms.
But as was made clear in the report, one of the problems was that policies weren't followed.
Cover Oregon is a governance failure. Kitzhaber failed to do enough to ensure the interests of Oregonians were protected.
The Oregonian, March 20: Bruce Goldberg goes, but Oregon's health care challenges remain
If Bruce Goldberg's resignation as Oregon Health Authority director wasn't inevitable before this week, it certainly became so with Thursday's release of a damning outside review of Cover Oregon's technology debacle.
This report identified Rocky King, Bruce Goldberg and Carolyn Lawson as the three key decision-makers in the state's ambitious project to create a customized online health insurance exchange. King, the folksy head of Cover Oregon, and Carolyn Lawson, the hard-driving IT director imported from California, both resigned months ago. Goldberg, a respected figure in Oregon health care, was next.
This housecleaning is a necessary part of holding state leaders accountable for bungling the rollout of a key government initiative. It's a top short-term priority, second only to meeting this spring's federal enrollment deadlines. Still, the larger questions around Cover Oregon remain unanswered:
(asterisk) Does the organizational culture within the Oregon Health Authority and Cover Oregon guarantee a repeat of the same mistakes on future projects?
(asterisk) Does Cover Oregon have the right board of directors and governance structure to operate effectively?
(asterisk) And by the way, at what point will the hundreds of millions of federal and state money translate into better, more affordable health care for people in Oregon?
On Thursday, Gov. John Kitzhaber released the findings of an independent review by First Data. The report laid out in crisp, shuddering detail the multiple problems that led to Oregon's singularly poor IT performance: Feuding personalities. Poor communication. Missed deadlines. Warnings ignored. Standards circumvented.
A nonexistent chain of command and diffuse management structure raised the odds of failure. So did the state's supreme self-confidence as a health-care innovator. The problems fed on each other, despite stern advice and warnings from inside and outside state government.
Here's one example among many in First Data's report: In May 2012, the state's Legislative Fiscal Office sent this note to King, the head of Cover Oregon: "I strongly recommend that you.focus on the concerns identified by the LFO, rather than charging off on multiple iterations before there is a clear picture of what you're going to build, how it is going to operate, and what are the interrelationships between each line of business, each work package, each use case, the requirements, each iteration, and the products from Oracle that are going to be utilized to meet each business functional need."
King received the note but didn't get the message. Neither did his team, board of directors or others with authority. The inability to follow basic business advice, or react to giant red flags waved frantically by the Quality Assurance folks, helps explain why Oregon remains the only state in the nation without a fully operational online health insurance site.
Kitzhaber said Thursday that he plans to take a "very active role" in studying changes to Cover Oregon's governance model. He also plans to replace a few board members within a few months, saying the board "may not have the right mix of people" to exercise its full oversight duties. He further acknowledged his responsibility to run a functional government, noting that innovation is difficult if state agencies are unable to communicate or share turf.
Goldberg will remain acting director at Cover Oregon until the state finds a replacement. The state's focus now, correctly, is on dealing with enrollment deadlines and deciding whether to salvage or ditch its Web site. This phase will be over soon enough. The challenge of improving state government will stick around for a long time.
(Pendleton) East Oregonian, March 21: Digging at the root of the Cover Oregon problem
When U.S. House Rep. Greg Walden stopped by for a visit to the East Oregonian editorial board last week, our most important question was obvious: What happened to that Malaysian plane?
When Walden demurred on that, we went on to the second most interesting thing we could think to ask about: the audit of Cover Oregon that he requested from the U.S. Government Accountability Office.
Walden called the state health system debacle "the biggest financial failure in IT in state history."
It's hard to argue with the Congressman there: $200 million was spent on the exchange, which still cannot enroll a single Oregonian in a single visit to the website.
The state was given $304 million in federal money to create the system that remains riddled with flaws more than six months after its long-heralded debut.
Those poorly spent federal dollars are what interested the investigators from the GAO, who have a history of unbiased digging.
Walden didn't know the timeframe on the federal report, guessing it would take more than a few months.
An independent state report has already proven highly damning to many of the top executives in the Cover Oregon administration.
After its release earlier this week, Kitzhaber axed his former ally, Bruce Goldberg, director of the Oregon Health Authority and interim head of Cover Oregon since January. He also asked the Cover Oregon board to ax chief operating officer Triz DelaRosa as well as Aaron Karjala, the chief information officer.
Walden assured the editorial board that the GAO audit isn't just a political witch hunt — that his goal is to find out what happened to the dollars, not end a political career (read: a Democratic governor running for an unprecedented fourth term who just did enough axing to chop down a forest).
Whether an injured and staggering Cover Oregon can ever be viable in its current state is uncertain. Walden told us he isn't sure, and even Kitzhaber admitted the same. Switching to the federal website, still with its own nagging issues, is not the glimmering greener grass we'd hope it would be.
We hope the GAO does its best to find out who should be held culpable for the failure of Cover Oregon. The amount of dollars wasted is a staggering sum, an embarrassment for a state that considers itself tech-savvy and puts a hefty amount of responsibility on its state government.
Voters will have the opportunity to have their say in the matter come November's election. Will the ax swing again?
(Salem) Statesman Journal, March 18: Lessons from Cover Oregon debacle
Oregon Rep. Kurt Schrader has pointed words for Cover Oregon and the state's leadership.
Schrader was a veterinarian, not an information technology specialist, before he entered Congress nearly 5½ years ago. But while serving as a budget leader in the Legislature, he encountered some of the state's past IT troubles. And it seems as if Oregon has not learned from those experiences.
Meeting with the Statesman Journal Editorial Board on Tuesday, Schrader said the lessons from the Cover Oregon debacle include:
. Have an oversight board made up of technology experts, not people who have a vested interest in the project's success but lack technology acumen.
. Understand the limits of technology. Most people, including public officials, do not realize how complicated IT is.
. Have control over outside contractors, so they can't get paid for an incomplete, inadequate or inferior product.
. Don't continually make changes in the technology goals and standards, as happened with Cover Oregon.
To those salient points, we would add another that has been discussed in the high-tech world in recent days: Come into the 21st century of technology. The idea of hiring one contractor — in this case world-renowned Oracle — to create a big project is outdated. Open-source software is available that frees programmers from being dependent on one company. Corporate computer servers, for example, often use such open-source programs.
A February report from the federal Centers for Medicare and Medicaid Services assailed Oracle for the quality of its work and Cover Oregon for its lax oversight of that work. Schrader said that even Oracle's CEO had not realized how bad the situation was in Oregon.
But Schrader also had good advice regarding the overall Affordable Care Act: "The sad thing is a lot of people are confusing the technology with the health-care bill."
One good aspect of the ACA is the coordinated care organizations, which Oregon is pioneering as a way to improve the quality of health care while reducing the costs.
As for Oregonians who need health insurance, don't get caught up in Cover Oregon's dysfunctional website. Talk to a designated insurance agent, community organization or Cover Oregon representative who will help compare plans and prices.
As for Obamacare, as the ACA often is called, it's here to stay regardless of which political party controls Congress. We need to make it work.
Baker City Herald, March 19: Walden's forest bill has promise
Rep. Greg Walden has gotten right to the heart of the debate over managing national forests, and he only needed to write a four-page bill to do it.
Which must be some sort of record for legislative brevity.
Walden, the lone Republican in Oregon's congressional delegation, thinks residents ought to have a louder voice when the U.S. Forest Service proposes to restrict motor vehicle use on national forests.
Actually, Walden's "Forest Access in Rural Communities Act" pretty much gives county commissioners veto power over such decisions as the Wallowa-Whitman's 2012 Travel Management Plan, a decision that was quickly withdrawn after local residents balked at the proposal to ban motor vehicles from more than 3,500 miles of roads.
Walden's bill applies to counties, including Baker, Union and Wallowa, that have national forests within their boundaries, as well as to counties that border a county with national forest land.
The bill would prohibit the Forest Service from banning motor vehicles from any road until the agency does two things:
. "consult with each affected county for the purpose of incorporating the needs, uses, and input of affected counties";
. "obtains the concurrence of each affected county for implementation of the access travel management action"
The second requirement is what makes Walden's bill so significant.
Although the bill doesn't define "concurrence," Andrew Malcolm, Walden's communications director, said Tuesday that the congressman's intent is that concurrence would mean "something like a resolution voted on by the county commissioners."
In other words, unless two of the three Baker County commissioners endorsed a Forest Service proposal to limit motorized access, the agency would have to scrap the plan.
This is precisely what a lot of local residents have advocated for. After all, it's all but guaranteed that county commissioners would be less likely to agree to motor vehicle restrictions than Forest Service officials would be.
Walden's bill, though, faces long odds.
We're skeptical that he can convince enough members of Congress to, in effect, hand over to county commissioners the longstanding federal authority to manage motorized access on national forests. And we doubt President Obama would sign the bill anyway.
Even Malcolm acknowledged that "it won't be easy to get this done."
But even if Walden's bill doesn't become law, it can — and it should — influence Forest Service policy.
The agency's boasting of its plethora of public meetings and comment periods sounds to many local residents like empty posturing. The withdrawn 2012 travel management plan is the most noteworthy recent example. The Wallowa-Whitman received thousands of comments, most of them from people opposed to motorized restrictions, and agency officials said those comments would be incorporated into the final decision.
Yet when that decision was announced, and it called for banning motor vehicles from more than 3,500 miles of road, it's hardly surprising that many commenters felt their opinions had been ignored.
Malcolm said the outcry over the travel management plan was the latest in a series of similar cases that prompted Walden to introduce the bill.
"It's frustrating that it's come to this, that it takes this to get the Forest Service to pay attention," Malcolm said.
But if Walden's legislative brinkmanship persuades the Forest Service to give more credence to residents' comments, then he will have succeeded even if he doesn't change the law.
The (Roseburg) News-Review, March 21: Impose pot dispensary moratorium, but lift it early
It's possible no one's happy with the Oregon Legislature's decisions on medical marijuana dispensaries.
Medical marijuana cardholders and the entrepreneurs who want to serve them feel like they've been misled.
And now city and county governments are being accused of trying to restrict residents from obtaining their medicine.
What everyone needs is a little patience.
Last August, it appeared medical marijuana advocates got a breakthrough. They convinced the Legislature to pass a bill allowing medical marijuana dispensaries. For the first time since medical marijuana was legalized in Oregon in 1998, patients would be able to buy the drug at a dispensary. Previously, they had to grow it themselves or find a caregiver who would grow it for them — apparently that can be challenging for those without green thumbs.
Even though applications for dispensaries would not be taken in March, those who'd been waiting for this opportunity began preparing to open shops.
But cities and county governments said, "Not so fast." They wanted to have some direction from the state on where these shops could be located, besides the restriction limiting them to more than 1,000 feet from a school or 1,000 feet from each other.
Last week, Gov. John Kitzhaber signed the bill that gives cities and counties until May 1 to institute a one-year ban on dispensaries, buying each some time to decide what they want to allow in their jurisdictions.
Ideally, the legislation passed last August would have had more clarity, so we could have avoided this confusion.
Now cities have to decide how long they will leave would-be dispensary operators in limbo.
he Roseburg City Council on Monday night will decide if a moratorium will go into effect in Douglas County's largest city. Myrtle Creek, Winston, Sutherlin, Oakland and the Douglas County commissioners will follow.
Because cities have just learned in recent weeks of the number of applications in their boundaries, it makes sense that they need time to hear from their residents before making a decision.
They need to balance their interests in being business-friendly with keeping all of their residents safe. They have a right to be cautious because medical marijuana-growing operations have attracted criminal activity in the past. That's likely one reason dispensaries are required to have extensive security systems.
We respect the city of Roseburg's right to impose the moratorium while councilors learn of the many regulations placed upon dispensaries by the Oregon Health Authority, and decide if they want to impose more.
If councilors want to appease those who thought they'd be opening for business any day, they could agree to a shorter time frame for developing regulations and then lift the moratorium long before May 1, 2015. Until then, medical marijuana cardholders should be able to get their marijuana the same way they did before the dispensary legislation passed.
Would-be entrepreneurs have learned a lesson — starting a new business often seems to be affected by more costs and rules than anyone expects.