Gloria C Christie (US) - Where Technology and Politics Meet

Politics can make a big difference to the technology landscape. In this post, Gloria Christie from The Christie Group explores the control that governments have over technology programs and discusses how this is affecting different parts of the United States.

Does politics make a difference to technology? The answer is unequivocally yes!  And how is politics different from government? Our various governments make the decisions, but politics displays significant influence over those decisions. That means politics holds control over how the money gets spent.  And in turn technology depends upon that money for research and development, grants, loans and contracts. Politics has the ability to create a grand design that all of us can buy into, like the Space Program. Politics can also keep technology static and/or unreliable. Then when that situation comes to light, both politics and technology look bad.

The new federal Affordable Health Care reform act requires that states set up a competitive insurance exchange by 2014 or the federal government will set it up for them.  The law’s intent is to allow states to provide individuals and small businesses an opportunity to band together at one location to compare and choose quality affordable private insurance health care plans similar to that provided to members of Congress.

In February 2011, Early Innovator Grants were awarded to six states and one consortium of New England states to develop an IT system infrastructure supporting exchange operations with the understanding that systems become models accessible to other states.

But in August, Kansas Governor Sam Brownback returned his state’s $31.5 million Early Innovator Grant.  This is ironic because implementation of the Affordable Health Care Reform Act falls under Secretary of Health and Human Services (HHS), Kathleen Sebelius, former Governor of Kansas.  Brownback’s administration has indicated it felt there were too many strings attached to the grant.

Kansas was not the first to reject these funds. After praising the initiative, Oklahoma’s Governor Mary Fallin returned $54.6 million.  Her reported goal was to prevent the implementation of the President’s federal healthcare exchange. In Florida with the second highest rate of uninsured and a $3.7 billion budget shortfall, Governor Rick Scott, former hospital company executive, has been rejecting multi-million dollar Affordable Care Act grants. This is a disturbing trend with clear signs of continuing.

As we know, implementing a major computer system is no small task. In 1980 I worked for a major medical center when it purchased its first order-entry system.  The early 80s were exciting pioneer years for medical computing, because no rules had yet been written.  Under the auspices of my Sr. Vice-president, I sat on the implementation committee and undertook the roles of system trouble-shooter, implementation and change expert and liaison between nursing, IT and ancillary departments.  There was no user documentation or training materials.  Most users had never sat at a computer, and very few even knew the difference between hardware and software.

The medical center, like many today, had an excellent paper system, so users were not excited about the idea.  That means states face a heavy burden of change in the next few years.  Like a train, it is no small task to stop and turn a new direction.  So time is of the essence.

Thus far 49 states and the District of Columbia have planning grants of up to $1 million.  As of November 2011, HHS awarded nearly $220 million in Levels One and Two Affordable Exchange Grants to 12 states, one multi-state consortium.  One-year Level One grants are for states developing exchange policy and operational elements.  Multi-year Level Two grants move states to significant implementation.  This gives them more flexibility and resources for implementation and six more months to apply for Level One grants.  Rhode Island received the first Level Two Grant.  Two states have systems exceeding the Affordable Health Care Reform Act, Vermont and Oregon.

By November 2011, 45 states consulted with consumer advocates and insurance companies, and 39 states and the District of Columbia have introduced some legislation. Thirteen states passed legislation to create state Exchanges.  Even as these states move at their different rates through the design and implementation phases, 20 states have failed to pass legislation.   And 10 states failed to introduce legislation.

Time is short to implement an IT platform to collect and manage information integrated across numerous state and federal agencies and medical centers’ human network to create an Exchange.  And money will go to the quickest states in line.

By Gloria C Christie, MS MPA The Christie Group