Lawmakers Angered By Continuing Problems At Health Exchange

Here’s how one critic of Vermont Health Connect describes the experience of many of the customers who bought their insurance through it:  

“It’s occupying people’s whole days. It’s invading their sleep. It’s keeping people up at night. It’s causing a tremendous amount of stress for a lot of folks.”

That’s not an opponent of the controversial insurance reform program – it’s Lawrence Miller, the government official who runs it. And in an appearance before the House Committee on Health Care, angry lawmakers castigated the administration’s newly installed chief of health care reform for problems that continue to plague Vermont Health Connect.

  Snowballing technological problems at Vermont’s online insurance exchange are drawing new scrutiny. And advocates warn that the situation for many customers who bought plans through Vermont Health Connect is becoming increasingly dire.

Trinka Kerr, director of the Office of the Health Care Advocate, said the issues have resulted in record-breaking call volumes to her shop, where Vermont Health Connect customers call to register complaints.

Frustrated Customers

“We are getting more and more calls from really irate people … people who initially were really excited about getting coverage and now are feeling really, really frustrated,” Kerr told lawmakers Wednesday.

The problems are legion, but an issue of primary concern is the state’s inability to process changes in policy holders’ domestic or financial circumstances. One of the benefits of the new system was that it was supposed to be able to process those changes automatically. But the technology isn’t working. And that’s created a backlog of more than 14,000 people unable to alter policy errors – errors that, according to Kerr, have in many cases impeded their access to care.

Then there are the hundreds of Vermonters who have newly joined the ranks of the uninsured, not because they didn’t enroll in a plan and pay their premiums, but because the state, for reasons still unknown, according to Miller, hasn’t transmitted that information to the insurers.

“Even though the withdrawals from their bank have gone through, the checks have been cashed … their coverage hasn’t been activated,” Kerr said.

Blue Cross Blue Shield is the private insurer that covers the vast majority of the approximately 66,000 Vermonters with exchange plans. And it’s provided those people with temporary “shell plans” that, according to Blue Cross’ Dawn Schneiderman, “gives them sort of the illusion of coverage.”

But while the arrangement has helped people maintain access to case as their coverage issues are resolved, it’s also required doctors to provide in some instances thousands of dollars of care without being immediately compensated.  

Throw in long wait times to talk to customer service representatives staffing Vermont Health Connect call centers, and the fact that these issues have persisted since the site’s launch nearly a year ago now, and even legislators who pushed heavily for mandatory enrollment in the exchange are beginning to lose faith.

“So I need to express in the strongest terms … that this is a crisis. This is a crisis in our communities,” said Lincoln Rep. Mike Fisher, the Democratic chairman of the House Committee on Health Care.

Waiting On Hold

Miller, a former private sector entrepreneur who headed up the Agency of Commerce before being reassigned by Gov. Peter Shumlin to right the Vermont Health Connect ship, said lawmakers are justified to be angry. Asked by one lawmaker if call center employees could simply take down consumers’ names and call them back, rather than force them to endure long hold times, Miller offered this:

“Our history of calling people back is so god awful I hesitate to do it. I wonder why the hell – excuse my language Mr. Chairman – I wonder why we tell people we’re going to call them back at all,” Miller said.

Miller’s ready acknowledgement of the exchange’s problems marks a stylistic contrast from Commissioner of Vermont Health Access Mark Larson, the government official at whom lawmakers have directed their outrage in previous hearings. Larson, who has had a somewhat tense relationship with legislators, in part for failing to preemptively disclose problems that they didn't yet know about, wasn’t present at Wednesday’s hearings. Miller said he was working with officials from the federal Centers for Medicare and Medicaid Services who were in town for a routine review.

Miller said the consumer dissatisfaction with Vermont Health Connect stems in large part from operational deficiencies in the program, deficiencies he says will be addressed by the new director of operations brought on last week.

Dave Martini, who most recently served as Vermont’s director of health insurance policy at the Department of Financial Regulation, will oversee a staff that Miller says needs to be segregated from the day-to-day “chaos” of customer service trouble shooting.

Miller says the reforms administered by him and Martini may be substantial.

“There’s a bunch of decisions, you know, tens of thousands of individual decisions that were made along the way in designing Vermont Health Connect, many of which need to be revisited now that we’re in operation,” Miller says.

For instance, Miller says the plan to automate any changes in customer circumstance may not be a viable one. He says the state proceeded with technological automation, as per federal mandates. But he says it’s a plan that defies industry standards – Blue Cross Blue Shield, for instance, inputs change in customers’ circumstances manually – and that Vermont may seek federal approval to abandon aspects of that requirement.

That would create a need for more state employees to perform those manual functions – precisely how many, Miller says he isn’t yet sure.

But the change-of-circumstance situation is symptomatic of the broader issues that Miller says has thwarted the smooth rollout of Vermont Health Connect.

“The scope of work that was bitten off exceeds the capacity to do that effectively,” Miller says.

Other major issues under Miller’s watch include a problem with the re-enrollment of 50,000 Medicaid recipients who, for reasons the state is still trying to determine, haven’t been submitting the online forms or paperwork needed to make sure they continue to get benefits.

Miller said the immediate problem was solved when federal officials agreed to allow Vermont to automatically re-enroll everyone who is in Medicaid now.

The blanket fix means that people whose financial situation has improved in recent months – not uncommon for people in the program – will be getting benefits for which they’re not eligible. But Miller says the imperfect solution heads off what would have been a much larger crisis.

IRS Comes Calling?

The state is also preparing for what one lawmaker called the “looming train wreck” of a financial true-up come tax time. The issue centers on the subsidies and premium assistance available under the Affordable Care Act for people living below 400 percent of the federal poverty level.

The problem will arise for people whose calendar year 2014 income exceeded the amount they predicted when they filled out their insurance enrollment forms earlier this year. The Internal Revenue Service has said it will be looking for discrepancies when people file their income tax returns next year, and collecting from those filers whatever federal assistance it determines they shouldn’t have been eligible for.

Miller says the IRS has capped the value of the overpayments for which it will hold people responsible at $1,250 for individuals, and $2,500 for a family. But those caps are only for people living below 400 percent of federal poverty. And Miller said he’s especially worried about how the IRS will handle people whose unanticipated income took them over 400 percent of poverty, and therefore ineligible for any assistance whatsoever.

The state’s inability to process change-of-circumstance forms means that even people who tried to alter their income information were unable to do so, and that thousands of dollars in unanticipated health care costs could suddenly come due next April.

Fisher said that the Legislature’s ability to intervene in the situation is diminished by the fact that it’s not in session. If the problems at Vermont Health Connect aren’t resolved by the time the House reconvenes in January, then Fisher said the Shumlin Administration should expect significant legislative intervention.

“People ask, ‘what are we going to do about it?’” Fisher said. “From my perspective, everything is on the table… It’s just untenable to continue to be in this situation.”