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On the Third Hand: Execution

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Bernie Sanders would prefer that everyone have Medicare, but he can live with the Patient Protection and Affordable Care Act (PPACA) coverage expansion programs, for now.

The other major contenders for the 2016 Democratic Party presidential nomination all support PPACA, and it makes sense that PPACA was not a particularly hot topic during the first Democratic primary candidate debate.

But one of the participants, Martin O’Malley, the former governor of Maryland, oversaw the construction of a state-based PPACA health insurance exchange, the Maryland Health Connection.

On the one hand, Maryland’s exchange board has been good about publishing information about enrollment activity, and about exchange operations. The exchange has enrolled about 124,000 people in private qualified health plan (QHP) coverage for 2015, and about 483,000 people in Medicaid coverage.

The Maryland exchange board has also been humble. From the beginning, it’s made a serious effort to reach out to agents and brokers.

On the other hand, in spite of having generous, enthusiastic state support, the Maryland exchange also faced severe startup problems. Its chief was one of the first exchange chiefs to resign.

See also: Maryland exchange head resigns

The initial poor showing of the Maryland exchange raised questions about whether — concerns about the proper role of government in the health insurance market aside — U.S. state and federal agencies are capable of starting and running the kinds of programs created by PPACA. Having a good heart is great, but what about execution?

Most Republicans won’t express any genuine concern in public about how the PPACA exchange system works. They generally want the exchange system to fail.

That means that the best people to conduct a sincere analysis of what went wrong are probably Democrats and independents who respect the goals of PPACA, but have a political incentive to find out how the exchange system is really working and what changes could make it work better. In theory, maybe O’Malley’s rivals for the 2016 nomination could be grilling him about that topic.

On the third hand, maybe the truth is that the PPACA exchange system is a political orphan, and the Democrats don’t have any more real love for it than the Republicans do. Maybe the Democratic contenders’ real thinking is, “Why give much attention to something that will have to sink or swim on its own two or three years from now? Let’s buy it a box of trail mix and move on.”


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