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Rebecca Pearce’s resignation as director of the still-broken Maryland health exchange last week makes her the third blue-state exchange director to leave such a position after Hawaii’s director resigned and Oregon’s took a leave of absence. But Pearce went out in style after spending $107 million on a site that still doesn’t work. In the Caymans, baby! The director of Maryland’s troubled health insurance exchange resigned Friday amid ongoing technical problems and questions about a Caribbean vacation she took while the online marketplace faltered. The board of the Maryland Heath Benefit Exchange accepted Pearce’s resignation during an emergency session Friday night. In a statement, Joshua Sharfstein, the state health secretary and board chairman, said Pearce “worked tirelessly and with tremendous dedication.” … As state lawmakers grilled Sharfstein on Nov. 26 on why the health exchange was still broken, Pearce was on a week’s vacation in the Cayman Islands. During the trip, she could not be reached by phone, email or text, the health department said Friday. Brown said in an interview Friday that he did not know Pearce planned to leave town until she was already gone. He called her absence during the week of Thanksgiving a “very” big problem. “We just launched a staff surge and we needed all hands on deck,” he said. “Now is not the time to take a vacation.”Did you catch that? It’s not like she had a vacation planned for right after the exchange launched assuming things would go fine, which would have been irresponsible enough. She waited until it failed, the heat got turned up on her staff, and then peaced out and claimed she had not e-mail or phone access. Because the Caribbean is so famously remote.Flashback to when hopes were high before the site launched and enrolled some 3,700 residents in three months. They were shooting for 150,000. “It’s not very often you get a chance to change history.” She said that enrolling thousands of the state’s 800,000 uninsured residents for coverage starting in 2014 was the final step in implementing President Obama’s signature legislation: “We’ve built the present, wrapped it, and now we’re trying to put the bow on it.” As I’ve reported before, if there was a state that was going to get the exchange right, it was Maryland. They jumped in with both feet, they have many experienced health bureaucrats in a smallish state, and they funded this thing out the wazoo from the get-go. I attended meetings of the Maryland heath exchange board with Pearce and Sharfstein over the course of two years and no one seemed to have any inkling it would go down in flames. In fact, they boasted at each meeting of added functionality and promised the exchange would do things no other exchange would be able to do. That may have been its undoing: Laszewski said he and others believed that Maryland was going to be an example of a well-run exchange because it had a supportive state government that started early. The state was also transparent about the setup process and was reporting doing testing during the summer, he said. “And then they launched and fell flat on their face,” he said of the website’s October rollout… Joel Ario, who oversaw initial planning for the insurance marketplaces in the Obama administration and is now a top consultant with Manatt Health Solutions, knows the former leaders of both the Maryland and Oregon exchanges and said he doesn’t believe either was the problem. But Ario said that when things don’t go well “the people at the top have some accountability.” He said part of the trouble with the Maryland exchange may be that the state had a more elaborate plan for its website when it could have started with a slimmed-down plan that just met the basic requirements.This will all be fun when Gov. Martin O’Malley and Hillary Clinton are arguing over who had least to do with Obamacare.Exit quotation: “All right, let me just wrap up by saying this: Like any law, like any big product launch, there are going to be some glitches as this thing unfolds. Folks in different parts of the country will have different experiences. It’s going to be smoother in places like Maryland where governors are working to implement it rather than fight it.”