It's really quite ridiculous for the linked report to use a capital:user ratio as a meaningful metric -- it's a bit like building an auto factory, building the

It's really quite ridiculous for the linked report to use a capital:user ratio as a meaningful metric -- it's a bit like building an auto factory, building the first car, then arguing that the car cost $100m to build. Having said that, it's obvious that some states, like Hawaii, are going to fight an uphill battle to make a cost-effective case for their revenue, while states like Oregon failed spectacularly to make good on their requirements. OR's new CIO, Alex Pettit, just recommended killing the whole Oracle-belabored mess and moving the state onto the federal exchange. Pettit doesn't have any blood on his hands from the Cover Oregon debacle (he was hired away from OK after the exchange's failure), but it's still a gutsy move to kill it, since he's the one who has to deal with the politicians. (Plus he's not making any friends at Redwood Shores, and Oracle is going to outlast all the politicians.) I would take away from this the lesson that the political desire to use states as "laboratories of democracy" is sometimes the completely wrong move; one critical, massive, high-risk and poorly-managed rollout was enough, thanks. Adding fifteen more projects on the HHS dime to replicate functionality (leaving aside state-level Medicaid systems) ended up driving up costs and adding more failure points to the system. Ironically, the states that were most resistant to the ACA contributed the most to federalizing healthcare enrollment, a centralization that might be politically antithetical to those politicians but that will probably save time and money in the long run.