Last week it was announced that Vermont’s health insurance web site, Vermont Health Connect, was being taken offline line for two months to deal with security issues and to prepare for open enrollment in November. While some may look at this move as a reason to trash Vermont’s efforts at health care reform, I think they may be misguided in their interpretation.
The electronic version of the health exchange has been a nightmare, but that is not all there is when it comes to this new health insurance product. People can still call someone and enroll on the phone and navigators are still available to help with enrollment.
I don’t know how many times I can repeat this: enrollment in the state’s new health insurance program is not dependent on the Internet. The Internet is merely one tool in the enrollment tool box.
There is no question that the problems with the online process have been poorly handled and that IT companies have done a terrible job of trying to facilitate online enrollment. But that does not mean that as Vermont moves to a single payer system that past problems will be a predictor of future circumstances.
Keep in mind that this ridiculously complicated new insurance system was forced upon us by the feds. Vermont was ahead of the curve and heading in a much better direction in terms of simplicity and ease of enrollment. The state had to stop dead in its tracks and completely retool in order to meet federal mandates.
I asked Peter Sterling, director of the single payer advocacy organization Vermont Leads (of which I am a board member) to offer his perspective on the current mess with the exchange. Sterling has worked behind the scenes with the state to improve the application process based on his experiences enrolling people.
While not a big fan of this new system, he has made every possible effort to get people enrolled, and he has done a great job, as have all of the other navigators. The enrollment numbers, as well as the numbers of Vermonters with affordable health insurance for the first time in their lives, tell the important story.
Here is what Sterling had to say. He framed his comments by stating that "problems with the Exchange’s website won’t impact Vermont’s ability to create a single payer system."
1. "The Exchange is a federally-mandated bureaucratic nightmare with 18 private plans offered by two private insurance companies with different co-pays, deductibles, co-insurance charges. This complexity makes it nearly impossible for consumers to navigate effectively. Vermont single payer, Green Mountain Care, on the other hand is more similar to creating a Dr. Dynasaur-for-all system — everyone is in one plan, created by Vermonters, managed by Vermonters with little or no cost sharing
2. The federal government imposed strict deadlines for states to create their own Exchanges which led to a lot of the problems we are now seeing with Vermont Health Connect’s website. We won’t have any such deadlines with Green Mountain Care. It’s like building a house- if you can do it right from the start, it’s much cheaper and better built than if you have to renovate an existing house.
3. 80 percent of Vermonters are eligible for Exchange subsidies, meaning their case has to be handled by the IRS in Washington, D.C., the Department of Vermont Health Access and then a private insurance company, either MVP or Blue Cross Blue Shield. These three institutions are not used to communicating enrollee’s changes to each other and this is why a significant part of the bureaucratic complexity of the Exchange exists. Green Mountain Care enrollees will only have to communicate with the State of Vermont, which we know can be done relatively efficiently from our decades of experience with Dr. Dynasaur, VHAP and Medicaid.
4. Under the Exchange, the state has to administer a system of federally mandated qualifying events (loss of health insurance because of loss of job, divorce, etc) in order to determine if someone can receive coverage after the three month long open enrollment period ends in addition to other ever changing income and household information for over 100,000 people. For example: under the Exchange if a single woman making more than $31,000/yr is uninsured (for reasons other than a qualifying event) once the open enrollment period ends, she would have to pay for her pregnancy out of pocket. She would not be allowed to get coverage in the Exchange until Jan. 1. Under Green Mountain Care, this would never happen. Everyone is always enrolled if they are a resident of the state of Vermont."
The move to single payer should not be abandoned because of the current bureaucratic website nightmare. Single payer is the solution to the current mess.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at rbdav@comcast.net.