Vermont leads the nation when it comes to per-capita enrollment in the new health insurance exchange. But for many customers, the transition to Vermont Health Connect has been anything but smooth. And thousands of Vermonters are now stuck in a sort of insurance limbo as the state works to iron out wrinkles in the system.
Nearly a sixth of the state’s population will soon be getting its health coverage through plans sold on the new online exchange. And officials in the Shumlin Administration say they’ve exceeded their enrollment targets.
But the technological glitches that plagued the rollout of Vermont Health Connect are now creating problems for the people who purchased insurance on it. And as of this week, about 8,000 households are still waiting to have issues resolved.
“There are Vermonters who are frustrated, who have the reasonable expectation that if they needed to change something, that the change should be able to be done very quickly, and they have been frustrated that it hasn’t been done faster,” says Mark Larson, the commissioner of the Department of Vermont Health Access.
The primary issue facing his department right now centers on its inability to process what’s known as a “change-of circumstance.” A change-of-circumstance can involve any number of things, from adding or subtracting someone from a policy, to reporting a change in household income.
The problem is that the new online system isn't capable of processing those changes automatically. And that means that customer service representatives and eligibility specialists have to deal with each change manually, a laborious practice that has resulted in a long backlog.
“Now the state has been working hard to correct them all, but in the meantime people are in limbo,” says Trinka Kerr, who heads the office of the Health Care Advocate.
Call volumes at Kerr’s state-funded office for the first quarter of this year are up by 42 percent over the same time last year. Kerr says the spike is attributable entirely to issues on Vermont Health Connect. And she says many of those calls are related to the change-in-circumstance issues.
Kerr says it can create anxiety for people when they can’t add dependents to a policy, or move readily from one plan to another.
“Well, I am aware of situations where people have delayed care because they knew their coverage isn’t straightened out or they didn’t have coverage yet. I’m definitely aware of that,” Kerr says.
Kerr says the inability of the system to quickly re-calculate premium payments based on a job loss or an income reduction means that people are getting billed far in excess of what they actually owe. One of the most touted features of the exchange is that it provides federal subsidies to low- and middle-income residents.
“So some people end up, you know, getting bills that are too high that they can’t afford if they’ve lost their job. It can be very difficult for people, and it can take a long time to fix,” Kerr says.
Larson says the state tries to triage the backlog, to resolve the most severe issues the fastest. And he says he’s not aware of a case in which someone didn’t get the care they needed as a result of the problem. Larson said he doesn’t have a timetable for a fix.
“And so it’s hard to predict exactly how long it will take to resolve the cases, because frankly we try to keep making the process more efficient so that we can do them faster,” Larson says.
A spokesperson at BlueCross BlueShield says the change-in-circumstance problem has presented the biggest challenges to customers newly enrolled in plans sold on the exchange.
Kerr says she gives the state credit for working hard to fix the problem. But she says the fact that no one knows how long the issues will endure is “discouraging.” Larson says the customers dealing with “access to care” issues jump to the top of the triage list, and can generally have their problems resolved within 24 hours.
