Technology may prove the tallest hurdle in Gov. Peter Shumlin’s quest for single-payer health care. Problems with the state’s on-line insurance exchange have prompted new concerns among legislators about the next phase of health care reform.
Six weeks ago, analysts for the Vermont Legislature quietly released an issue brief that focused on the role of technology in the state’s push for a universal, publicly financed health care system
Long story short, the analysts aren’t too optimistic that the IT projects needed to operate single payer will be completed by 2017, the target date for the new system to begin.
Some of the most vexing questions surrounding single payer have until now focused on how much the system will cost, and what taxes will be used to pay for it. But as lawmakers continue their post-mortem of the state’s health insurance exchange, technology issues have come front and center.
"What's the technology that's needed for Green Mountain Care? What kind of an IT project is it?" - Calais Rep. Janet Ancel
“What’s the technology that’s needed for Green Mountain Care? What kind of an IT project is it?” asked Calais Rep. Janet Ancel. “We understand that there are a lots of questions about benefits. There are a lot of questions about financing. But those aren’t IT driven.”
Ancel is the Democratic chairwoman of the House Committee on Ways and Means, and a member of a special legislative panel created to oversee health care reform. When top administration officials testified before that committee Tuesday, Ancel was looking for a clearer sense of the technological tasks needed to accomplish single payer.
“I asked the administration what do we have to do for technology to make this work,” Ancel says. “And I didn’t get a clear answer. So I’m not sure they know yet.”
For Caledonia Sen. Jane Kitchel, the complexity of the technological undertakings has highlighted shortcomings in the government bureaucracies that were supposed to carry them out. With so much money flowing from the federal government for the exchange, Kitchel says money hasn’t been the problem.
“We had this big infusion of staff,” she says. “But you have to have a very clear, articulated line of authority and accountability. And it seems like that has been not in place.”
Kitchel and Ancel say that perhaps the key lesson from the exchange is to not let the state bite off more than it can chew, when it comes to the size and scope of IT projects. And they say it’ll be important to keep that in mind as the Legislature considers when, and if, it decides to proceed with single payer.
“And that gets into the ability to how much can you manage well any particular time,” Kitchel says. “And if you try to do everything, then you run the risk of not doing anything particularly well.”
Lawrence Miller, chief of health care reform for the Shumlin administration, says the administration has learned profoundly the lesson of not letting project goals exceed government’s capabilities.
“Scope is the critical thing we can control,” he says. “And we have got to absolutely every single time focus on what do we need, not what do we want.”
Miller says the state has restructured its governance model to address all the management deficiencies exposed in the roll-out of the exchange.
