Complaints about our national government are epidemic. It seems that everyone you know- even strangers- have stories they are bursting to share about some inept federal employee they had to deal with, a ridiculous regulation they encountered or just how dysfunctional Congress and the executive branch are right now. Public frustration and disgust abound.
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So, be glad there at least is the Government Accountability Office (GAO) the audit and investigative arm of Congress. Imagine, if you can, a government agency where employees cooperate with each other and (amazingly) taking pride in serving the public. In a 2013 survey of 13,000 people employed in the Washington, D.C., area, it was named one of the top 50 places to work- the second time in three years.
As its name implies, the GAO’s mission is to hold other parts of the government “accountable.” Its mission is to unearth waste and fraud and to test whether a government program is actually working the way it was designed. That is exactly what several members of Congress wanted to know about the hastily-created Patient Protection and Affordable Care Act (PPACA).
A key component of the law was the creation of exchanges where individuals can compare and buy different health insurance plans. In states that declined to create such exchanges, residents use the federally-run exchange healthcare.gov.
It was about this time last year that reports of mismanagement, contractor disputes, serious technology snafus and gross over-spending about the implementation of the exchanges began regularly appearing on the evening news. After interviewing top echelon bureaucrats at the Centers for Medicare and Medicaid Services (CMS), lower-level government workers involved in the launch of the program and private contractors, last week the GAO testified before a Congressional subcommittee saying that, essentially, the whole project had been a colossal, disorganized mess.
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"In summary, we found that CMS undertook the development of Healthcare.gov and its related systems without effective planning or oversight practices, despite facing a number of challenges that increased both the level of risk and the need for effective oversight…. "
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The report also found that: "CMS incurred significant cost increases, schedule slips, and delayed system functionality for the FFM and data hub systems due primarily to changing requirements that were exacerbated by inconsistent oversight. From September 2011 to February 2014, estimated costs for developing the FFM increased from an initial obligation of $56 million to more than $209 million; similarly, data hub costs increased from an obligation of $30 million to almost $85 million."
Members of the Subcommittee on Oversight not only wanted to know why and how the launch of this massive health-care plan was botched, it also wanted to know how things are working today. To that end, the GAO went undercover.
“We created 18 fictitious identities,” explains Steve Lord, managing director for forensic audits and investigations at the GAO. GAO investigators contacted various federal healthcare marketplaces- either by telephone, online or in person- and applied for benefits. “In 11 out 12 attempts we were able to get coverage,” says Lord. The only reason the twelfth application was denied is because the GAO 'applicant' did not provide a Social Security number.
One of the provisions for coverage under ACA is that applicants have “lawful status,” meaning they're either a U.S. citizen or are in this country lawfully. (This is a huge concern considering an estimated 12 million illegals are living in this country.) Furthermore, in order to get government aid to help pay the premium, applicants must document they meet income requirements. But although GAO “applicants” were instructed to provide such proof, “GAO found the document submission and review process to be inconsistent.” By July, two of the investigators were notified that their fake documentation had been verified. In addition, “GAO continues to receive subsidized coverage for the 11 applications, including 3 applications where GAO did not provide any requested supporting documents.”
Another piece of the program that the GAO tested involved the so-called ACA “navigators.” That’s the name given to employees at federal health insurance marketplaces who are supposed to provide impartial advice to the public about the various plans available and to facilitate the process of applying. GAO investigators “could not get help from 5 out of 6 people,” says Lord. “We couldn’t even get them to engage. That caught us by surprise. They were hired to help the public.”
Perhaps because he’s worked at the GAO for 31 years, Lord says he is not shocked by these results. “We do undercover testing across a number of federal programs.” Then he diplomatically adds, “This is a work in progress. CMS is still trying to fix things. The financial management module is still not in place to verify income. They’re still setting up a process to check with the IRS.”
With another open enrollment period coming up in November, let’s hope they figure it out soon. In any event, it’s at least some comfort that Lord and his colleagues will be there testing the system.