State makes contingency plans for technical problems in exchange

Robin Lunge, center left, the state's director of health care reform, and Richard Boes, commissioner of the Department of Information and Innovation, address a meeting of the Health and Oversight Committee at the Statehouse on Thursday, June 20, 2013. Photo by Andrew Stein/VTDigger

Robin Lunge, center left, the state’s director of health care reform, and Richard Boes, commissioner of the Department of Information and Innovation, address a meeting of the Health Care Oversight Committee at the Statehouse on Thursday. Photo by Andrew Stein/VTDigger

The Shumlin administration has fewer than 100 days to open a new Web-based health insurance market for more than 100,000 Vermonters.

With the clock ticking deep into crunch time, the state’s top officials are preparing for the worst — the possibility that the federal and state information technology systems are not ready to support the insurance exchange, called Vermont Health Connect.

“That is the contingency we’re planning for,” said Robin Lunge, Gov. Peter Shumlin’s director of health care reform. “If the Web portal is broken or isn’t usable we could continue to do a paper process. For example, we could have people sign up directly with the insurer.”

Although the exchange is slated to open for business on Oct. 1, 2013, it isn’t until Jan. 1, 2014, when Vermonters who purchase insurance individually or through businesses with 50 or fewer employees are mandated to purchase insurance on the exchange.

Vermont Health Connect will cost more than $100 million to get up and running, and most of those funds are coming from the federal government. When the market is functioning properly, the state’s IT systems should jibe automatically with other state, insurance and federal databases.

The state is planning to print out Vermonters’ information and file hard copies with insurance companies.

From October to January, however, Lunge said the state is planning to print out Vermonters’ information and file hard copies with insurance companies. The administration is asking the feds for extra funding to run this manual filing system, as the state works with various contractors to pull the entire system into place.

“Everybody should be worried about it because it’s a big IT project, but we are doing the best job we can to manage it,” Lunge told the legislative Health Care Oversight Committee on Thursday.

Richard Boes, commissioner of the Department of Information and Innovation, sits on an executive steering committee with Lunge for this project. He joined her for the committee meeting in the House Chamber, and he is confident the exchange, in some form, will be in place by Oct. 1, 2013.

Richard Boes, commissioner of the Department of Information and Innovation. VTD/Taylor Dobbs

Richard Boes, commissioner of the Department of Information and Innovation. VTD/Taylor Dobbs

“We will have an exchange up and running in October,” he told the committee. “There are significant risks and issues. They are being tracked, and they are being managed.”

The administration contracted out to Maine-based BerryDunn to review the risks and issues associated with the state’s IT systems. While the administration has a draft report in hand, Lunge and Boes did not know when the final report would be ready and did not release copies of the draft. Boes said that Oct. 1 is an easier federal deadline to meet because the marketplace doesn’t need to be as functional as it does on Jan. 1, 2014.

The deadlines are difficult to meet, Lunge said, considering that the feds released their final guidance on establishing the exchanges less than a year ago.

“We have identified, as have many other states, that the federal timelines are an issue in the technical IT sense: Something that you need to work around, and plan for and mitigate,” she said.

One of the biggest unknowns for many states is whether the feds will be able to meet the deadlines set out in the Affordable Care Act, aka Obamacare.

The U.S. Government Accountability Office issued a report last week, which found the Centers for Medicare and Medicaid Services had not completed crucial elements of the federal exchanges and data hub and were behind the curve on others.

Vermont is one of 17 states creating its own insurance exchange, but the state marketplace would still tie into a federal data hub to digitally determine a Vermonter’s eligibility for subsidies.

“If the federal hub is not ready Jan. 1, we can either have people self-declare their income, because it does get reconciled at the end of the year for the premium tax credits, or we could have people submit verification from a pay check,” Lunge said.

She said later that the Government Accountability Office report applies to the majority of states, which have opted to the federally run exchange.

If the state can get Vermont Health Connect up and running, and the feds are still scrambling to meet deadlines for federal exchanges, the Legislature and the Shumlin administration’s decision to create a state-run exchange could provide Vermonters with a level of stability other states wouldn’t enjoy.

“Part of the consideration (in making that decision) was: Do you want to be responsible for building this system yourself or put this in the hands of the federal government?” Lunge said.

Clarification: Vermont is one of 17 states creating a state-based exchange, and the District of Columbia is also creating its own exchange. 

Andrew Stein

Comments

  1. Brian McAllister :

    All this for a law that was authored by lobbyists for insurance companies that forces us to buy their product. Oh, and let us not forget how it was voted on when the majority didn’t even read it.

    I would be any amount of money that all of those that support this would have their panties in a bunch of it was the auto or gun industry that wrote a law that forced everyone to buy their products.

    • John Greenberg :

      Brian:
      The analogy you suggest is misleading. Not everyone drives (but all drivers ARE mandated to carry liability insurance), and only about 35% of the population own guns. But with exceedingly few exceptions, everyone accesses the health care system sooner or later in their lives. No one is being coerced into receiving medical care; only into paying their share of the expense.

      The Obamacare bill is not perfect,– far from it. And the gift to the private insurance industry is, as you suggest, one of its weakest elements. In a better world, I’d prefer a Medicare for all type of solution.

      But the Obamacare bill does take a giant step towards universal coverage in the US, a goal which had eluded all previous attempts at legislation for over 50 years. That’s a significant accomplishment.

  2. Craig Powers :

    More and more layers of paperwork with no promise from VT policy makers that the new system will even work.

    $100 million cost for something they do not even know will work. Incredible waste and inefficiency. Reform sure is expensive.

    • rosemarie jackowski :

      I agree. It is a field day for ‘paper churners’ and a very bad day for taxpayers and all citizens who will ever need medical care.

      This is NOT Single Payer. This is the opposite of Single Payer. This is like saying that to get to Burlington from Bennington, first drive south for 100 miles…..

  3. Kathy Callaghan :

    As Benefits Director for the State Employees Health Plans, when in 2001, my small staff and I moved 20,000+ lives from 4 health vendors to 1, I can say with confidence the following:

    IF you pay attention to every single detail in the enrollment process (you, the STATE – not the vendors); and

    IF you never take your eye off the ball – EVER; and

    IF you have a zero tolerance for error or duplication; and

    IF you have a talented staff with an incredible work ethic
    as we did,

    then you have a reasonable chance of getting this right the first time. We had to reenroll every single person, since the prior plans were going away. Anyone not reenrolled would lose coverage. One of our incredibly dedicated staff located the last few retirees in nursing homes, and made sure they were reenrolled. Now that’s commitment.

    In addition, paper enrollments were coming in right after 9/11, when there was a huge panic about lethal substances being found in envelopes. I recall asking the staff member responsible for opening and logging, if she was okay with doing this and the answer was, “Why not”?

    This worked as well as it did because we did not leave important matters to the carriers’ IT people. We oversaw every single aspect to make sure it went well. There was one slight glitch at the startup when the carrier miskeyed our Medicare supplement coverage levels and claims were mispaid, but that was quickly resolved. Just one example of a simple problem that can impact a lot of people.

    So, some words of caution – and – thanks for the opportunity to give a shout-out to the dedicated State employees in the Benefits Division of Human Resources. To those often bemoan “lazy” State employees, you should be so lucky.

  4. Andrew Naugle compares health insurance exchanges to online travel agencies. More at: http://www.healthcaretownhall.com/?p=6539

  5. Robert Rich :

    What could go wrong?….Oh wait..

    http://vtdigger.org/2012/12/13/state-fights-against-the-clock-to-complete-more-than-200-million-in-health-it-projects/

    “This past year, three IT projects have stalled or gone belly up: a new Department of Motor Vehicles system, a judiciary case management program and a Department of Children and Families system.”

  6. Kristin Sohlstrom :

    There should NEVER be a comparison between health care exchanges and Travelocity or Kayak.com. That is a dishonest comparison. Why? Because people CHOOSE to engage in Travelocity or Kayak of their own accord. You do not have a choice to use a health exchange and that information is going to be funneled to multiple federal agencies.
    http://www.cchfreedom.org/files/files/TheObamacareHub.pdf

    • Bob Zeliff :

      Just to be clear, the insurance lobby worked for an got put into law that those who did not buy insurance from some company, would have to pay a penalty.

      Obama care is 100% insurance from insurance companies…the insurance company’s determine the costs….it is only the level of benefits that is standardized so people can compare each company easily.

      • Kristin Sohlstrom :

        I suppose, but that doesn’t speak to the fact that your health data is going to the feds. Have fun with that.

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