[A] recently released Vermont Health Connect customer satisfaction survey highlights familiar problems that have plagued the health insurance exchange since its launch two years ago, but it also exposes a silver lining.
New customers gave the exchange higher marks than those who struggled through its tumultuous first year. VHC doubles as the state’s Medicaid portal, and beneficiaries of the low-income health program were also more likely to report satisfaction with the exchange than people who used it to buy a commercial health plan.
The survey was conducted by the University of Massachusetts Center for Health Policy and Research at a cost of $229,000, and included feedback from more than 2,500 respondents as well as from two focus group sessions with users.
Despite the signs of improvement, the survey reflects serious dissatisfaction among the group that has experienced the greatest degree of difficulty with the exchange: the roughly 35,000 people in the individual market who had nowhere else to purchase health insurance.
As reflected in the survey responses, people buying commercial insurance through the exchange dealt with billing problems and a long wait for applications and changes in personal information to be processed. The system has also been plagued by thousands of retroactive terminations that resulted in some people finding out that their insurance was unexpectedly canceled.
Twenty-three percent of respondents who bought commercial health plans rated their overall experience with Vermont Health Connect poorly (0-2 out of 10), while 22 percent rated it highly (8-10 out of 10). For new enrollees in commercial health plans, only 12 percent rated their experience poorly versus 28 percent who gave it a high rating. Two-thirds of Medicaid respondents gave their experience a high rating.
Responses from people who were in the midst of trying to make changes to their health plan while the survey was being conducted from April to June were excluded. The UMass survey team said they chose not to include that group to avoid confusing them and also because people in the process of making a change could have incomplete or outdated information.
At the time of the survey, the exchange was working to reduce a backlog of more than 10,000 requested changes, some of which were up to a year old. As of Sept. 2, the latest figure available, there were still more than 3,000 pending change requests, according to state officials.
Customers who had to renew their coverage this year gave VHC the lowest rating. The manual renewal process this year required filling out a paper application or dialing the call center because of incomplete technology. State officials are “cautiously optimistic” that they will have an online renewal process in place by the end of the month.
Automating renewals is the second of two deadlines Gov. Peter Shumlin said would dictate whether the state keeps its current exchange or transitions to some version of the federal exchange in 2017. Vermont is expected to spend $200 million on VHC.
The first deadline was to automate the process for changing coverage or customer information, which the state said it completed at the end of May. That has greatly improved the customer experience, according to Steven Costantino, commissioner of the Department of Vermont Health Access.
“I think there’s been a major improvement since the timing of the survey,” Costantino said. There is still a backlog, but Costantino is “cautiously optimistic” that the queue or change requests will be at a sustainable volume by the end of the month.
Customers still can’t make their own changes online, something that the new automated process is expected to allow, but Costantino said he’s also “cautiously optimistic” people will be able to do that before the Nov. 1 start of open enrollment.
The UMass survey provides a critical window into what Vermonters are saying about the exchange, Costantino said, and one area where it showed that people need additional help is understanding health insurance and the subsidies introduced by the Affordable Care Act.
Health insurance literacy is an issue
More than 70 percent of respondents said they understood the terms premium (the monthly fee for an insurance plan) and deductible (the amount of money spent on health services before insurance kicks in). Less than half of respondents said they knew what coinsurance meant (it’s the percentage of certain health services that an insurer will cover).
Only 16 percent to 26 percent of respondents said they understood terms having to do with the Affordable Care Act subsidies and roughly one-quarter of respondents said they were unclear about the amount of financial assistance they would receive. Nearly half of respondents said they were unclear that premium tax credits would impact their federal income tax filings.
“I think we have to do a better job in assisting Vermonters in understanding those terms and how subsidies work,” Costantino said, adding that health insurance has a “language unto itself,” and even people who study health policy can be confused.
Vermont Health Connect will host a series of 11 educational events at libraries across the state this fall, and in all 55 libraries will help to distribute information about the health plans offered through the exchange, according to VHC spokesman Sean Sheehan.
State officials say their educational mission is hampered by a reduction in federal support for navigators, the nonprofits that help people select a health plan and act as an intermediary with the exchange.
That “one-on-one” engagement is critical, Costantino said, adding that he’s tried to impress that upon the 15 organizations that will be providing assistance during the upcoming open enrollment period.
Customers who worked with a navigator generally reported a better experience, according to the survey. Fifty percent of respondents who worked with a navigator reported that their health insurance plan fit their needs very well, versus only 39 percent of those who did not.
But in general people don’t spend enough time researching and shopping for a health plan. According to a recent national survey by the insurer Aflac, 41 percent spent 15 minutes or less shopping before they bought a health plan during the Affordable Care Act’s first open enrollment period in 2013.
“You can’t imagine someone doing that when they’re shopping for an apartment or a car,” Sheehan said.
This story was updated at 12:22 p.m. Friday to include information from the UMass team that conducted the survey
