by Wendy Wilton It is good news that Auditor Doug Hoffer has scheduled a performance audit of Vermont Health Connect this Spring. The Auditor’s work will be vitally important information for the legislature to consider as it determines the fate of the state’s health insurance exchange, Vermont Health Connect. Hopefully Hoffer will release his report before the end of the current legislative session.
Much has been said and written about the problems with development and roll-out of Vermont Health Connect and the expected $200 million cost of this poorly managed effort. However, there could be more financial costs lurking on the horizon that the Auditor needs to tell us about.
Vermont Health Connect has been dysfunctional from the start and it still is. The backlog of coverage changes is over 11,000 cases. Enrollment, determining Medicaid and subsidy eligibility, changing eligibility and benefit profiles, processing premiums, processing insurance claims, and other activities have all experienced failures. The state owes participating insurers millions of dollars in premiums, but the carriers have continued to pay for care. This will have negative impacts on other subscribers’ rates unless the state makes good on what it owes.
Auditor Hoffer should explore these areas of concern:
•How many premium payments have been processed through Vermont Health Connect but have not been reconciled and paid to Blue Cross Blue Shield of Vermont and MVP? What is the total dollar amount?
• Where, and in which account, is the cash representing the unreconciled premiums?
• What is the value of provider payments made by BCBSVT and MVP associated with the beneficiary application and claim processes that remain unpaid?
• Of those newly enrolled in Medicaid, how many have eligibility documentation that is inaccurate? What is the state’s financial exposure due to flawed Medicaid enrollments?
• Similarly, how many premium subsidies are associated with flawed income determinations, and what is the dollar amount?
• The state has a significant ($57 million) no-bid contract with the computer systems company Optum - possibly similar to the Jonathan Gruber contract. What controls exist to ensure that the invoices are detailed and accurate, work will be done on time and within budget, and the contractor will deliver the required solutions?
• What is the per month - per member cost of Vermont Health Connect? How does this compare to BCBSVT’s and MVP’s per member per month costs?
Three years ago I ran a detailed spread sheet that showed that a single payer health care system would make the state insolvent due to unforeseen cost escalation, lack of savings, and unsustainable taxes. Vermont Health Connect represents a similar risk to the state’s precarious finances, with unexpected costs and lack of control. The Auditor’s report, if thorough and timely, could give the legislature essential facts to take decisive and imperative action.
Wendy Wilton is Rutland City Treasurer and a member of the Board of the Ethan Allen Institute (www.ethanallen.org).