Rep. Doug Gage, R-Rutland, urged the man in charge of the state’s health care exchange to let Republicans choose a contractor to review the rollout of the problem-plagued website.
In a tense exchange on Tuesday, Gage, one of two Republicans on the House Health Care Committee, also questioned Mark Larson about why CGI, the technology firm that built the site, was hired again after bungling three previous state contracts.
“They failed three times in a row and you picked them again, what does that tell me about your organization?” Gage asked, sitting just to Larson’s right.
Borrowing an analogy from fellow administration critic Darcie Johnston of Vermonters for Health Care Freedom, Gage said allowing the administration to pick the third-party reviewer would be like letting the fox watch the chicken coop.
“It’s a conflict of interest,” Gage told Larson, commissioner of the Department of Vermont Health Access.
It would be unusual for the Legislature to be involved in the selection process for an executive branch contractor, and there could be legal hurdles to its participation, said Robin Lunge, the state’s director of Health Care Reform.
It’s also important that the evaluation be nonpartisan, and that the vendor have the expertise to ensure an honest and factual review, Lunge added.
A request for quotes was sent out Tuesday to four companies — Berry, Dunn, McNeil & Parker, Competitive Computing, AdvizeX Technologies and 22nd Century Technologies — to bid on the review work.
The request asks the prospective reviewers to help Vermont evaluate its approach, staffing and management structure, and what lessons there are to reduce risk and improve implementation of future projects.
The findings will be presented to state officials, but also at two public stakeholder meetings, the request says. The contract will be awarded based on proposal quality, cost, prior experience and the timeline for the review.
Larson said his department is working to recoup money from CGI associated with liquidated damages — compensation for specific breaches written into a contract — and to ensure the state only pays for completed work.
Vermont has paid CGI exclusively with federal money, but the way that money was authorized the state only receives what it spends, regardless of what was originally allocated. Therefore, any money CGI returns cannot be reallocated.
“Vermonters pay federal taxes, and it’s important to ensure those dollars are used responsibly,” Lunge said. “We also want to keep their feet to the fire to complete the work that was supposed to be done Oct. 1.”
The most recent figure Larson could cite was that CGI has been paid $18 million, but he was unsure how current that number was.
Finishing the job
The contract with CGI covers the first two years of the Vermont Health Connect website’s operation and maintenance, Larson said, but the state owns the rights to it, and the contract could go back out for bid.
His current priorities for the website are to get the small business portion running, but even when pressed, Larson refused to give a date or even the probability that it will be running by March 31, the sign-up extension deadline.
Rep. George Till, D-Jericho, pressed Larson because the committee has a bill before it that would allow for the continued purchase of insurance outside the exchange beyond that deadline. Larson acknowledged Till’s concern, and asked if he could return to give testimony when the committee is considering that bill.
The “change of circumstance” function — essentially if a user needs to update their information — is currently offline and being handled by customer service. Making it digitized is also a priority, Larson said.
The technology is in place for the online credit and debit card payment option, but the department is waiting for a payment industry certification showing it’s safe to handle credit card information before that functions comes online.
He also has a team working on the site’s usability, aiming to make it less clunky and more intuitive.
Larson was joined briefly by Richard Boes, commissioner of the Department of Information and Innovation, to give testimony on the site’s security.
Gage raised concerns about media coverage of security issues with the federal exchange website. Larson said there has been some confusion on that issue, but the Vermont Health Connect website is in no way connected to the federal healthcare.gov site.
“We have had no security breaches,” Larson said, “We have had four privacy incidents.”
The distinction is that a privacy breach is when a user’s information is disclosed accidentally to an unauthorized person, whereas a security breach is when the system is compromised by an outsider to obtain information, Bose explained.
There have been numerous attempts at security breaches, Bose said, but none have succeeded.
Success?
Tuesday, when Larson welcomed an opportunity to talk about health care coverage instead of IT problems he planted the victory flag saying, “If our goal was to make sure people had options for obtaining coverage in January, not experiencing a gap in coverage, we feel that the options provided by the governor in early November have successfully accomplished that, despite all our challenges along the way.”
He came prepared with numbers to back that up.
Of the 65,000 Vermonters the administration estimated needed to sign up for coverage by January, 54,000 have done so, and the remaining 11,000 are using the sign-up extension.
The 54,000 fall into two groups — those who obtain coverage through an employer and those who buy coverage for themselves or their families as individuals.
For those who receive employer coverage, two-thirds were enrolled directly through insurers or were automatically enrolled with them using the plan most similar to what they had in 2013. Those people are enrolled in plans for the entire year starting in January.
The remaining third that are using the extension will have to sign up by the end of March.
There were also close to 800 people with individual or family plans who will need to obtain insurance through Vermont Health Connect because their employers decided to drop their employee plans.
“One of the big priorities was to make sure nobody experienced a gap in coverage, and for the small group market we believe that we’ve accomplished that goal,” Larson said.
There are 7,200 so-called sole proprietors, whom Larson described as small group plans of one person or family, who must now seek coverage on the individual market due to changes under the Affordable Care Act.
Close to 34,000 of the more than 45,000 Vermonters on VHAP or Catamount qualified for Medicaid due to the federal program’s expansion. Gov. Peter Shumlin noted in his remarks Tuesday that those Vermonters will pay no premiums and see their coverage expanded.
That leaves roughly 11,000 Vermonters formerly on VHAP and Catamount, who the administration assumed would not be eligible for the Medicaid expansion and would have to enroll in subsidized plans through Vermont Health Connect.
“What we’re finding so far is that about a third who have applied, have actually qualified for Medicaid,” Larson said.
Asked how many formerly uninsured Vermonters now have coverage, Larson said it’s difficult to get an exact figure.
“What we do know is that of those who have been enrolled in Medicaid through Vermont Health Connect, not the ones who enrolled through VHAP and Catamount who transitioned, those who are submitting an application, that there are several thousand who were not in our Medicaid enrollment before,” Larson said, adding that he can’t be certain. “That gives us some indication that there are a number of Vermonters who were previously uninsured who have gained coverage.”
How many? At least 5,000, Larson said.
To know for certain how many of the roughly 40,000 previously uninsured Vermonters now have coverage, the state will have to wait for the annual Household Survey conducted in the fall by the Department of Financial Regulation.
Larson acknowledged that wait times at the call center are still unacceptable, and said his department is still working to reduce them. The waits are the result of higher than expected call volumes and, especially, the length of calls.
“That was an unpredictable factor,” Larson said.
Call times are averaging 18 minutes, but some have taken up to an hour, Larson said.
An additional 71 people are being brought on to work the call center, which has seen a high attrition rate in the past few months, for a total staff of 160. The main call center is in Burlington, but the contractor will open an overflow office in Chicago to handle the high volumes expected through March 31.
That expenditure is covered by his department’s existing contract, and won’t factor into the budget adjustment act.
This story was updated at 10:15 p.m. on Jan. 8, 2014.
