Congressman John Delaney

Representing the 6th District of Maryland
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Delaney Asks for Clarification on Feasibility of Switching to Federal Exchange in Letter to Maryland Health Secretary

Jan 6, 2014
Press Release

WASHINGTON – Monday, Congressman John K. Delaney (MD-6) wrote to Maryland Secretary of Health Joshua Sharfstein seeking additional clarification regarding the feasibility of switching to the federal health care exchange. Through December 28, 18,257 Marylanders have enrolled in private coverage via the state’s exchange, representing 12% of the state’s enrollment goal of 150,000. Nationwide, 2.1 million have enrolled in private coverage, 30% of the White House goal of 7 million.

In December, Delaney suggested the option of using the federal exchange in light of problems with Maryland’s exchange website.

The text of Congressman Delaney’s letter is below:



Joshua M. Sharfstein, M.D.

Secretary of Health & Mental Hygiene

Office of the Secretary

201 West Preston St.

Baltimore, MD 21201-2399


Dear Secretary Sharfstein:


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.


The White House recently released data that indicates that 2.1 million Americans have signed up for private insurance nationally, including over 1 million via the federal marketplace at Nationwide, this means that we have achieved 30% of the original goal of enrolling 7 million Americans this year. However, only 18,257 Marylanders have been able to enroll thus far, which is only 12% of our state’s goal of 150,000. We have fallen quite far behind the national average and we’re running out of time.


As we both know, there are real people behind these numbers. Our “enrollment gap” means that roughly 26,000 Marylanders, including approximately 4,000 that I represent in the Sixth District, are still lacking coverage because of Maryland's troubled health exchange (these numbers are estimates based on the difference between performance at 30% vs. 12%). Frustrated and concerned Marylanders from Montgomery to Garrett County have contacted my office on this issue since October. I continue to press this question out of concern for my constituents. 


Since I raised the idea of switching to the federal exchange on a temporary basis, your office has responded to say that you are evaluating that option.  I understand that my idea of transitioning to the federal website may contain challenges that I am underestimating and it may not, in fact, be feasible. For this reason, 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 the same considerations with respect to the base case of repairing the Maryland Health Connection.


You and I share a commitment to the success of the Affordable Care Act (ACA). The ACA can accomplish two very important things: ensuring all Americans have access to health care and bending the cost curve on health care expenditures. For the ACA to accomplish these objectives, however, it must be implemented correctly. Effective implementation includes a large number of Americans successfully enrolling in private health care coverage.


More is at stake than just this mission; ACA implementation goes to the heart of government's ability to execute. At the center of a progressive agenda is the notion that government can and should engage in transformative policies to help the American people. At the center of that center must be the belief that government can successfully manage these initiatives. Otherwise, no one will trust government to attempt to make a difference in people's lives. At some point, we must collectively and critically evaluate the process associated with building the Maryland Health Connection and the original federal site, but our first priority must be ensuring access to health care for all Marylanders.


I agree with Maryland's decision to build its own website and I remain open to the view that having our own website is still our best option. I suggested a switch to the federal site - as perhaps even a temporary matter until our site is ready - so that peak volume of enrollees could be handled in advance of looming deadlines.  I was hoping the suggestion might have avoided the numbers we saw for the January 1st deadline.


With less than three months remaining in the open enrollment period, each day is critical. Given how fundamental health care is to the lives of my constituents, I feel that further discussion of the options available to the State is essential. It is important to understand if we have viable alternatives or if the best course of action remains a reboot of the existing product.   


I thank you and the Governor for your efforts to make this work, truly. The legislative fixes being proposed by the Governor are very constructive and the personal attention both you and he are giving this issue will lead us in the right direction. Your collective commitment to the well-being of all Marylanders can never be questioned.


I look forward to your response.


With my deepest respect and appreciation,   



John K. Delaney