Despite setbacks, Gov. Peter Shumlin has remained doggedly optimistic about Vermont Health Connect’s prospects, but over the last 40 or so days faith in his administration has waned among lawmakers on the left.
Don’t expect mutiny any time soon — Democrats say now isn’t the time to point fingers — but key legislators are penciling in time next session for a post mortem on the administration’s management of the rollout of Vermont’s health care exchange.
The website’s unveiling has been riddled with problems, and enrollment numbers have been paltry. Throughout its first month, Shumlin and his administration glossed over problems — such as the still non-functioning payment processing component — as expected glitches and reassured the public that the rollout continued on track.
Shumlin won pats on the back last Thursday for announcing a postponement of the deadline for individuals and small businesses to enroll and for giving due recognition to the website’s defects. But Democratic lawmakers had quietly been prodding him to take that step earlier, and the delay hasn’t alleviated the misgivings among members of his own party.
The level of optimism ebbs and flows between different lawmakers, but very few have echoed the confidence coming from the Fifth Floor — that everything will be shipshape, if not by Jan. 1, then by March 31.
Some say CGI — the company that built the exchange — deserves the lion’s share of the blame for the website woes, but they cast the administration as an ancillary culprit for not keeping closer tabs on the company. CGI also built the federal exchange.
Public records, reported on by the Vermont Press Bureau and VTDigger, reveal that the administration had clear warnings about the website’s defects before it was launched. An assessment by outside consultants called “Operation Readiness Review” warned administration members on Sept. 11 that “critical risks” could interfere with the Oct. 1 launch date. On Sept. 27, VTDigger reported that CGI had failed to meet more than half of the “critical milestones” outlined in its contract with the state.
With little direct contact with CGI itself, lawmakers are dependent upon on the administration for answers, and not all of them have been comfortable or content with the arrangement. Behind the scenes, the top legislative brass has been peppering the Shumlin administration with questions, and, at times, admonishments.
House Speaker Shap Smith said he met weekly with administration officials in September for updates on the exchange project, and he was disappointed with the launch.
“The scenario was a little rosier than the one we ended up seeing,” Smith said. “We had an expectation based on conversations with the administration that things would be going better than they did when they rolled out.”
Smith says he encouraged the administration to announce a contingency plan last week — ahead of the Dec. 1 deadline set by Republicans in the House and Senate.
The Legislature isn’t in session, which leaves rank-and-file lawmakers out of the loop. Rep. Jim Condon, a member of the Ways and Means Committee, summarized the communications he’s had with the administration: “I received a snazzy booklet in September, but it just had some basic information about how to sign to update. We receive occasional email updates with the number of people who’ve signed up.”
But Condon wasn’t ready, in the absence of up-to-date information, to ape the administration’s upbeat outlook. “It’s been tough sledding, and I don’t see it getting better right away,” he said. “I hope everything works out, but I guess I’m not as naturally optimistic as the governor.”
At a House Health Care Committee meeting Tuesday, the mood among lawmakers was dismal. “Depressing day in House Health Care, no doubt,” tweeted Rep. Chris Pearson, P-Chittenden.
Pearson accused Mark Larson, commissioner of the Department of Vermont Health Access (DVHA), of having “sugarcoated” problems afflicting the exchange, during an earlier presentation to lawmakers in September — a charge Larson denied.
Republicans have made no secret of their skepticism that the exchange will be fully functional by Jan. 1. But anxiety has also infiltrated the highest echelon of the Democratic ranks, affecting lawmakers who have political capital invested in standing by Shumlin.
A small group of Democratic powerbrokers — House Speaker Shap Smith, Senate President Pro Tem John Campbell, the heads of the money and health committees committees — have met frequently with the administration. Every few weeks, officials including Larson, Health Care Reform director Robin Lunge, Secretary of Administration Jeb Spaulding, and, sometimes, Shumlin, have briefed them on the progress and problems with the exchange.
But conference calls and in-person meetings haven’t left even the most in-the-know lawmakers breathing easy. They may not have been kept in the dark — a complaint from other lawmakers — but several are similarly critical of what’s described as an overabundance of optimism within the administration.
Rep. Janet Ancel, D-Calais, who chairs the House Ways and Means Committee, said, “I do think the administration was overly optimistic prior to the launch, and in the first couple of weeks, and I do think that certainly added to the challenges we are facing.”
“It sounds easy to say in hindsight,” Ancel said, “but I think the administration could have done a better job talking about realistic expectations.”
Senate Finance Committee chair Sen. Tim Ashe, D-Chittenden, echoed Ancel and added a second concern: a lack of technological literacy.
“Government is not typically in the business of large complicated website development,” Ashe said. “I believe the lack of technical expertise in these fields compromised their ability to know exactly how things were going and to communicate that to the Legislature.”
Ashe’s own attempts to get answers from CGI have been fruitless. Three weeks ago, he met with two CGI employees and asked about their internal testing protocol — a tool used to determine whether the systems they’ve built are operational. The PowerPoint they provided him with was “dizzyingly nonsensical” in Ashe’s estimation. The five-slide presentation includes bullet points describing things like the “Smoke Test” in which “Belton Test Center runs baseline scenarios to look for early results.”
Campbell, a Windsor Democrat, said he sympathized with the administration.
“I know a little about computers and I could certainly carry on a conversation about a few things,” he said, “but if someone started talking to me about the technical issues involved with something like this, they would be speaking Greek to me.”
But in his mind, it’s the responsibility of the administration’s own technical experts — likely staff within the Department of Information and Innovation — to keep people like Larson and Lunge informed.
“What we need to focus on finding out is, did we have individuals who were supposedly representing our interests and were they aware that certain problems did exist that were going to be indicative of major problems,” he said.
The concerns among Democrats extend beyond IT ignorance and blunders in communication.
Ashe worries that a fixation on the exchange’s technical glitches within the administration may be detracting attention from a larger problem: People aren’t signing up.
“There’s been a lot of focus on the technological problems with this website and almost an obsession among some, where there’s a ‘punch list’ of 100 things wrong and everyone’s focused on how many have been corrected,” Ashe said. Meanwhile, he noted, of the roughly 100,000 Vermonters who are required to enroll in the exchange, only 3,075 had picked a plan as of Nov. 6.
Ancel shares that concern. “I have a family member who will be purchasing insurance on the exchange and he hasn’t even gone out and tried it,” she said. “I think that’s true of a lot of people.”
Legislators from each of the three major parties have questioned the state’s prudence in how it has spent federal money allocated for outreach about the exchange and, most notably, the decision to enter into a $3 million contract for marketing and earned media to help promote the exchange.
Rep. Mike Fisher, D-Lincoln, chairs the House Health Care Committee. “My perspective on it is that Mark [Larson] believed and indicated to us that the contractors could get more done than clearly they were able to. It was clearly a mistake that he believed they could get it done,” Fisher said.
But that’s of lesser importance than getting people into the exchange, a challenge tied up in the technical glitches, from his point of view. “I believe our main focus needs to be overcoming the technical difficulties, and I have a great deal of concern about making sure Vermonters don’t have a lapse of coverage,” he said.
There’s also a mounting fear that Vermont Health Connect’s problems could imperil the state’s transition to a publicly financed health care system, slated for 2017.
“Many people who have a desire to reform our health care system never believed in a million years that a stupid website would make or break that reform,” Ashe said. “But people have to be confident in the ability of the state to carry out that reform. This hasn’t helped. It’s not fatal, but it hasn’t helped.”
Some lawmakers blame excessive optimism within the administration for undermining people’s trust in the state’s ability to orchestrate that transition.
Sen. Anthony Pollina, P-Washington, a longtime proponent of single payer health care and member of the Senate Health and Welfare Committee, said, “That to me is the essence of what went wrong — not the computer glitches, but the erosion of trust. It’s going to take a lot of trust on the part of Vermonters and I am really, really concerned this exchange fiasco is going to really undermine our ability to implement it.”
Democrats are reluctant to start publicly pointing fingers before January.
“As to what mistakes were made and when and who made them and what money should be collected from CGI, there will be time for that,” Fisher said. “But right now, I don’t want to be distracted, and I don’t want the administration to be distracted.”
That rationale mirrors Shumlin’s explanation for why his administration has yet to levy penalties — permitted in the contract — against CGI for failing to meet multiple deadlines. (At the press conference announcing the delay last Thursday, Shumlin publicly stated, for the first time, that the state would seek financial compensation from CGI for the missed deadlines.)
Rep. George Till, D-Jericho, who sits on the House Health Care Committee, said, “I don’t know if it was sugarcoated or not. I think down the line it will be important to find that out. Is this the right time to do it? I don’t think it’s going to change anything right now.”
Even the most forceful critics say it doesn’t behoove them to probe for wrongdoing right now. “I’m not saying people should be fired and heads should roll. I just think we need to get on the same page,” Pollina said.
At the same time, lawmakers also expressed remorse at not having asked more questions ahead of Vermont Health Connect’s launch.
“As bad as Washington, D.C., is, wouldn’t it have been logical if we had had our Health Oversight Committee or some other standing committee decide to hold hearings to bring in the technology people [CGI contractors] and try to shed some light on this thing?” Pollina said.
Till, too, felt lawmakers hadn’t done a thorough of vetting of the framework of the exchange. Referencing the mandate — unique to Vermont — that small businesses and individuals enroll, he said, “Nobody asked how much did that contribute to those problems? How much did that add to the complexity?”
In the meantime, lawmakers have a few requests for the administration. “It would be nice going forward to get regular, realistic updates and not a bunch of fluff, so we can all make a decision together,” Pollina said.
Ancel said she needs continuous backup planning to feel comfortable. “I don’t think until everything is working perfectly, you ever stop working on contingency plans,” she said.
