Vermont Business Magazine If a new plan laid out Friday by the Shumlin Administration does not meet intended goals, the governor said he will move the state health insurance exchange to a new model which could include dropping much of VHC and using the federal exchange. Governor Peter Shumlin today has announced that Vermont has finalized a contract and timeline to deliver long-sought automated “change of circumstance” functionality to the Vermont Health Connect website, and will present a plan to deliver improved customer service to Vermonters that includes specific legislated milestones and contingencies in the event Vermont Health Connect fails to meet expectations for improved service in the coming months.
Chief of Health Care Reform Lawrence Miller outlined the plan in the Legislature.
Plan Outlined by Lawrence MillerNow that 2015 open enrollment is over, Vermont Health Connect is focused on continuing to make technology improvements to ensure a better customer experience for Vermonters. A series of milestones have been developed that we believe are realistic and achievable. However, if those milestones are not met, we have developed a contingency plan that will be pursued. We have identified critical milestones to assess Vermont Health Connect’s progress. · By the end of May – The vendor Optum is expected to deliver “Change of Circumstance” technology which will allow customer service staff to significantly reduce the amount of time it takes to process account changes. · By October – Customer service staff is expected to process changes that are reported by the 15th day of a month in time to be reflected on the next invoice. · By October – The vendor is expected deliver the technology needed to enable a smooth renewal and enrollment process for 2016 health plans. If Vermont Health Connect fails to deliver improved service for Vermonters, we will pursue a move to a Federally-Supported State-based Marketplace (FSSBM). · There are three federal marketplace options, all of which use the healthcare.gov web platform and federal call center. · Of the three federal options, the FSSBM allows states to maintain the most authority over their health plans, which would enable Vermont to preserve such health reform efforts as Blueprint for Health and payment reform. · There are drawbacks. o The federally supported marketplace would only serve as the enrollment gateway for private health insurance plans. o Medicaid applicants would still come through Vermont Health Connect and VHC would still need to be finished for this purpose. o Families with both a private health insurance plan for some and Medicaid or Dr. Dynasaur for others– as well as those who transition between programs – would need to call two different phone numbers and deal with two separate call centers. Any issues signing up for private health insurance would go to the federal government’s call center. · As policymakers, we need to weigh the costs and benefits of making such a move. Important questions remain. Answers will be clearer by fall. · Will the Supreme Court allow customers of federally supported marketplaces to benefit from tax credits that reduce the cost of health insurance? o This is a critical consideration, given that Vermonters received over $50 million in premium tax credits last year. o The decision is expected in June. After the decision, the state will work with our federal partners to understand the potential impact on Vermonters. · Will Vermont be able to continue to offer state premium and cost-sharing assistance to individuals and families purchasing qualified health plans through the federally supported marketplace? o No states that use a federal marketplace currently offer such help to their citizens. And none have been able to achieve an uninsured rate as low as Vermont’s. o Without this help, a Vermonter earning $35,000 would pay $524 more per year in premiums and could pay as much as $2,300 in additional out-of-pocket costs. o The Administration will explore alternative premium and cost-sharing models, including any additional costs or implementation issues. · Will the Department of Financial Regulation and the Green Mountain Care Board’s review of health plan designs and rates be impacted by new federal deadlines? · In November, the Chief of Health Care Reform will report to the Joint Fiscal Committee on these questions and on Vermont Health Connect’s performance on critical milestones, together with a recommendation on the best path forward. · If the Joint Fiscal Committee makes a decision to transition to the FSSBM model, the Administration will then file requests for federal permission, propose necessary changes to state law, and work with our federal partners and contractors to make the move in time for the 2017 open enrollment period. |
The governor acknowledged the significant frustration felt by Vermonters whose enrollments or bills have been incorrect or delayed due to continuing inadequacies in Vermont Health Connect technology. Shumlin said that he is gratified the State has completed both contracting and planning for an upgrade due at the end of May to add automated change of circumstance and related functionality to the website, since many of the delays and errors customers have experienced are due to the cumbersome manual workarounds currently in place.
Although the Governor expressed confidence that the State’s technology partner, Optum, will complete this upgrade as planned, he also presented milestones designed to give Vermonters and legislators confidence that the State will deliver improved customer service, and will execute contingencies if it fails.
Lieutenant Governor Phil Scott issued the following statement in response to Governor Peter Shumlin’s announcement that the state will abandon Vermont Health Connect if it doesn’t meet new deadlines for functionality: "While appreciative of Governor Shumlin's much-delayed conclusion that the state will abandon Vermont Health Connect if it misses yet another deadline for functionality, too many Vermonters have been stuck in limbo for far too long, unsure if they’re insured and understandably frustrated while the state struggles with a poorly designed, one-of-a-kind website.
"In addition, there are still many unanswered questions. How much money are we going to spend to get us to this May deadline, on top of the hundreds of millions of dollars already spent? Who will have input as to which options we explore in the event that Optum is unable to bring functionality to Vermont Health Connect by then? We've known for quite some time that we needed an escape hatch, and many people have presented options, including the one outlined today. To date those options have either been dismissed or met with silence.
"In my opinion the Administration should have developed a contingency plan at the very first sign of trouble, not after a year-and-a-half of dysfunction and spending over a hundred million dollars. While positive news, this isn’t an announcement to celebrate. In short, and to put it simply: It’s about time."
Scott is considered a possible challenger to Shumlin in the 2016 election, though neither has announced whether they're even running.
House Speaker Shap Smith offered this statement in response to the governor's announcement:
“I am encouraged to learn that the Administration has developed concrete milestones for improvements to Vermont Health Connect. The House has repeatedly stressed the need for a contingency plan that addresses Vermonters’ concerns about the exchange’s troubled rollout and upkeep. Vermonters expect a fully functional system to accommodate their health care needs. It is unfortunate that the troubles of Vermont Health Connect have overshadowed the fact that this reform has increased the number of insured Vermonters. It is imperative that we have a fully functioning web portal so we can focus on the critically important issue of bringing down health care costs and improving public health outcomes. As we proceed with the next phases to repair the exchange, I expect the House Health Care Committee will make a thorough review of the proposal."
Vermont Association of Hospitals and Health Systems (VAHHS) President Bea Grause issued the following statement regarding the Vermont Health Connect deadline and contingency plan:
“Making progress on health care reform requires working toward our shared vision, even in the face of setbacks like those experienced with the state’s Vermont Health Connect health insurance exchange.
"The many Vermonters who rely on the state’s insurance exchange for health coverage deserve the economic security promised by federal and state law and we hope Vermont Health Connect can be fixed.
"We are relieved that Governor Shumlin has imposed a deadline on Vermont Health Connect and has created a contingency plan if this deadline is not met. Both are essential.
"Vermonters deserve a health care system where everyone has access to care and insurance coverage they can afford, from the doctor and hospital they choose. Vermont’s not-for-profit hospitals, the Green Mountain Care Board, the State, and other stakeholders are working together on health care reforms that will result in healthier Vermonters and a stronger economy.”
The deadlines that Vermont Health Connect must meet begin at the end of May, when Optum must provide the technology to allow customer service staff to significantly reduce the amount of time it takes to process account changes. The next technology deadline will come in early October, when the vendor is expected deliver the fix needed to enable a smooth renewal and enrollment process for 2016 health plans. Meanwhile, new service standards will be set: Vermont Health Connect will be expected to process changes that customers report by the 15th day of a month in time to be reflected on the next invoice.
In addition, even though automated renewal for the 2016 open enrollment period, which commences November 1, is expected to be functioning by that time, the Administration will begin immediately to have in place no later than August 1 an operational contingency plan created with its insurance carriers and vendors to provide a smoother customer experience even if renewal functionality is not delivered as expected.
Chief of Health Care Reform Lawrence Miller emphasized that this contingency planning is a prudent step designed to help restore public confidence in Vermont Health Connect, not a sign of any lack of confidence in the vendor currently working on the Vermont Health Connect system.
“Since coming on board last fall, Optum has successfully delivered on every task we have given them,” said Miller. “We expect them to continue to improve service and meet the specified deadlines. But we recognize – and Optum and our insurance carriers agree – that the State must continue to have in place operational plans so that, with or without new technology, Vermont Health Connect customers will have a far smoother 2016 renewal experience than they did this year.”
Miller later today will present the Administration’s proposal to pass legislation this session to require the State to investigate and pursue alternatives to Vermont Health Connect in the event that the State fails to meet these key milestones.
Specifically, if Vermont Health Connect fails to deliver improved service and functionality on the timeline outlined, the State will begin pursuing a move to a Federally-Supported State-Based Marketplace (FSSBM) for the 2017 open enrollment period. There are three federal exchange marketplace options, all of which use the healthcare.gov web platform and federal call center. Of the three federal options, the FSSBM allows states to maintain the most authority over their health plans, which would enable Vermont to preserve important health reform efforts as Blueprint for Health and payment reform.
Miller emphasized that a move to a FSSBM would present a number of challenges that would require careful thought and could not be successfully pursued immediately. And any move would also depend on the outcome of a pending Supreme Court case that could declare federal subsidies through such an exchange illegal, along with any subsequent federal action to deal with such a decision. Vermonters received over $50 million in federal subsidies through Vermont Health Connect last year. Among the key questions that would require answer prior to any such move would be:
· Will the Supreme Court allow customers of federally supported marketplaces to benefit from tax credits that reduce the cost of health insurance?
· Will Vermont be able to continue to offer state premium and cost-sharing assistance to individuals and families purchasing qualified health plans through the federally supported marketplace?
· Will the Department of Financial Regulation and the Green Mountain Care Board’s cost containment efforts and review of health plan designs and rates be negatively impacted by a new federal platform and deadlines?
· Would Vermont save significant money in moving to an FSSBM, given that the State must deliver Medicaid enrollment and related services – built into the same Vermont Health Connect product – even if the Vermont Health Connect website were no longer used for private insurance?
The plan to be outlined today calls for the Administration to report to the Joint Fiscal Committee on Vermont Health Connect’s performance on critical milestones in early November, along with answers to these and other key questions regarding a move to a FSSBM and a recommendation on the best path forward. If the Joint Fiscal Committee makes a decision to transition to the FSSBM model by December 1, the Administration will then file requests for federal permission, propose necessary changes to state law, and work with federal partners and contractors to make the move in time for the 2017 open enrollment period.
“I am proud that despite our very significant technology challenges, Vermont Health Connect’s dedicated staff, Navigators, and brokers have helped tens of thousands of Vermonters sign up for high quality, more affordable health insurance,” said Shumlin. “Our very low uninsured rate is a testament to the benefits of the Affordable Care Act in Vermont. Our state-based marketplace has also allowed us to provide enhanced state subsidies to many Vermonters, making health insurance far more affordable.”
“We now have a vendor with a proven delivery record to finish the job,” the Governor continued. “Ideally, Vermonters will continue to benefit from the Vermont-focused health insurance marketplace that we all envisioned, a system that builds upon our history of health reform and advances our goal of health coverage for all Vermonters. But if our system can’t deliver for Vermonters by next fall, we’ll need to take action to move permanently to a system that can.”
The Administration’s suggested bill language will incorporate performance measures, contingency planning, and reporting regarding any recommended move to a FSSBM so that lawmakers may consider these requirements this session as a part of pending health care legislation and budgeting.