Health Care

Officials bullish on health exchange for now, but not long term

Phil Scott
​Gov. Phil Scott. File photo by Erin Mansfield/VTDigger

(VTDigger’s Erin Mansfield contributed to this story.)

State officials say this year’s open enrollment period for Vermont Health Connect should go smoothly, even though they say the exchange needs to be replaced or overhauled in the long run.

The open enrollment period for 2018 insurance plans on the exchange will run from Nov. 1 to Dec. 15 this year, about a month shorter than in recent years.

During that period people will be able to sign up for, renew or change their commercial health insurance plans through Vermont Health Connect for any reason. During other times of the year, people can make changes only if they have life changes like the birth of a child or loss of a job that affects their coverage.

About 29,000 Vermonters are enrolled in commercial health coverage through Vermont Health Connect, according to the Department of Vermont Health Access, which runs the exchange. An additional 140,000 people use the website to renew their Medicaid coverage each year, though not necessarily during the open enrollment period.

Cory Gustafson, the commissioner of the Department of Vermont Health Access, wrote in a July 21 memo that the Vermont Health Connect team expects to build on the progress it made on the exchange last fall.

Sean Sheehan, a deputy director in the department, said in an interview that technical difficulties have plagued Vermont Health Connect for several years since the state created it in 2013 under the federal Affordable Care Act.

“When it was first launched, it was in bits and pieces,” he said. “I think the analogy was you could get your plane ticket, but if you wanted to change seats or you wanted peanuts or no peanuts, you were in a lot of trouble.”

Even through 2015, Sheehan said, the computer code designed to automatically renew plans succeeded in only around 80 percent of the cases — and those only after multiple runs. The remaining 20 percent had to be handled manually, and the process “took a few months – well into 2016,” he said.

In 2016, after the state anticipated smoother functioning of the exchange, the system still could not reconcile customer accounts on a monthly basis. As a result, Blue Cross Blue Shield of Vermont, which covers 90 percent of Vermont Health Connect enrollees with commercial insurance, is asking for millions of dollars from the state for unpaid insurance premiums.

Cory Gustafson
Cory Gustafson, the commissioner of the Department of Vermont Health Access. File photo by Erin Mansfield/VTDigger

Gustafson said in his memo that, during the upcoming sign-up period, the department hopes to enroll 95 percent of customers without manual intervention, answer phone calls promptly, and transmit files to insurance carriers with 99 percent accuracy.

Additionally, Sheehan said the process for manual intervention has been greatly streamlined since 2015 and it now takes only a couple of days to resolve cases that the system can’t handle automatically.

Despite the department’s rosy projections for the immediate future, both Gov. Phil Scott and Gustafson say the technology underlying Vermont Health Connect is still in need of a major overhaul, and Scott said he still thinks the system needs to be replaced.

Neither Scott nor Gustafson gave a deadline for replacing or overhauling the exchange, and both said uncertainty in Washington, D.C., over the potential repeal of the Affordable Care Act is making it difficult for them to act.

Most recently, a bill to repeal the Affordable Care Act failed narrowly in the U.S. Senate, but similar bills have come back to life before. There is one bill that has passed the U.S. House, the American Health Care Act, but it does not include language on the funding of health insurance exchanges like Vermont Health Connect.

Meanwhile, the state continues to work with a $62 million grant the federal government gave Vermont in 2016 to fix the exchange — by removing dysfunctional pieces of code that were built on top of it — by November 2018.

“I’m committed to making changes with the exchange in particular, but first we have to find out what they’re contemplating (in Washington) before we can move forward,” Scott said at a news conference Thursday. “But replacing the IT structure is still something that I think is essential in some manner.”

During his campaign for governor in 2016, Scott made getting rid of Vermont Health Connect a central plank in his health care platform. In March, he said the administration would have a plan for replacement by the end of the year.

At the news conference Thursday, Scott would not say whether his administration will have a proposal on how to reform or replace Vermont Health Connect ready for the Legislature in January. But he did say his administration should be the one to decide the future.

As lieutenant governor, Scott had suggested the Green Mountain Care Board oversee an independent review of Vermont Health Connect. The board mainly regulates hospital budgets and insurance prices.

During the 2016 campaign, Scott advocated creating a new exchange in partnership with another state such as Connecticut. Now he said Vermont can still partner with another state, but not necessarily Connecticut.

“When I’m speaking with, let’s say, Massachusetts, their exchange is working very well,” Scott said. “And when you look at the Northeast region in particular, I think there are many opportunities for us to work together in so many different ways, particularly with IT.”

“We’re engaging in conversations just to see what the possibilities are, and I’m not saying that it will happen with (a multistate) exchange, but why not?” he asked. “If they have an IT structure that works for us and we could share in some way in providing services, then why not?”

Gustafson, whose team runs the exchange, said in an interview that he agreed with Scott that the repairs and changes made to Vermont Health Connect so far haven’t been made in a way that can be maintained long-term.

“The patchwork of efforts that have led us to a place where the system is functioning better is on the one hand good,” Gustafson said, “but on the other hand will limit our ability to upgrade the system and keep it functioning to a level that is acceptable, so we are at risk that way.”

The department, Gustafson said, is “working on an enrollment and eligibility system that will be more highly functional, upgradeable and sustainable for the state of Vermont. … I think that’s where the governor is going when he’s talking about Vermont Health Connect — you know, it’s the long term for the system.”

“We don’t have a date in mind — we have a process in mind,” Gustafson said. “We’re talking to vendors right now, and every one of the vendors has a different idea of what should happen. Sometimes it feels like you’re asking a barber if you need a haircut.”

Gustafson also said present circumstances make it difficult to plan.

“We’re all just understanding that there’s been a heck of a lot of good work done to make sure that system is working better, but it still needs improvement,” he said.

In 2016, a study commissioned by the Legislature to investigate options said the state should stick with Vermont Health Connect, in large part because of the $62 million grant the federal government gave the state to fix it.

The study said replacing the exchange with anything else would “introduce excessive costs” and risks to the state. Additionally, the federal government would not pay for Vermont to create an entirely new system, the study said.

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  • Meanwhile, the state continues to work with a $62 million grant the federal government gave Vermont in 2016 to fix the exchange Can you imagine if that amount of money was used to actually help people with medical issues?

    • Homer sulham

      The amount of wasted money would help treat many people.