Al Takes Exchange Guys to the Woodshed

by Hamilton E. Davis

      The managers of Vermont Health Connect, the Obamacare insurance Exchange, have travelled a long and painful road getting their system running adequately. Last week, they ran into another huge pothole when they presented their plans for the next fiscal year to the Green Mountain Care Board.
   The presentation consisted of recommendations for changing some of the dozen or so insurance plans that qualified Vermonters can sign up for beginning on Oct. 1. The changes included sharp cost increases in some of the plans areas, along with other tweaks to the intricacies of their management.
   It seemed to the quietly-seething board that the Shumlin administration managers were unprepared to deal with obvious questions about how the plans would actually work and what the suggested changes would mean. The Exchange managers ran into particular difficulty with one of the low-cost plans that they want to modify by tinkering with the blend of copays, deductibles and coinsurance.
   The managers’ problem was that they couldn’t say whether the changes they wanted could actually be  implemented—“operationalize” was the buzzword—by Vermont Blue Cross and MVP—the two insurance carriers whose plans are offered on the Exchange. What made it worse was that the bureaucrats had never asked the carriers if the modifications were workable. The presentation pretty much went downhill from there.
   The players on the presenting side were Dana Houlihan, the Exchange plan management director; David Martini, operations director; and Adaline Strumolo, a policy analyst at the Exchange. Participating by telephone was Aree Blye of UMass-Wakely, a consultant to the state for health care reform. Blye did most of the talking in the back and forth with the board members.

   Al Gobeille, board chair:

   I in no way mean to be disrespectful, but I thought you were here to make your recommendations known to us…I think it’s homework that needs to be done prior to this meeting.


   The paper you have in front of you is our recommendation--


   But you don’t know if it will work, Ok?

   So, if we approved it, it might not work…

   Long discussion on drug costs in the plans.

   Gobeille concludes:

   I really don’t know what to do with the question you’ve laid before us—I mean, if you don’t know it will work how would we know if it would work when we vote on it…so do you want to come back to us in a week and tell us if it can be done?

Stay Tuned

   So, that’s what will happen. The Shumlin administration managers will return to the GMCB boardroom Thursday, Feb. 12, to take another run at the recommended changes for the coming fiscal year. Even if this session goes better, however, it seems clear that the chronic tensions between the Shumlin managers and the rest of the health policy world will continue.
   The reason is that the glitch over the low-cost plan was just the most obvious point of contention. An overarching concern is that the Exchange managers’ sluggish pace is jamming up the timetables for getting the 2016 process in place. By February 15, the board is scheduled to have voted on changes to the plans and gotten them to the carriers.
   By March 2, the carriers are scheduled to submit their plans to the GMC board for approval. This schedule cannot now be met. Gobeille made it clear that the board would let the schedule slide so as to ensure that the work was of high quality. The board’s unhappiness about that, however, was palpable. 
   There were other omens.
  Jessica Holmes, the newest member of the GMC board, wanted to know how Vermonters’ choices among the various plans cast light on the program designs. The Shumlin managers had no idea. Board member Con Hogan was concerned with how patients would handle the cost increases proposed by the Exchange managers.
  The driver of those changes in most cases will be rules promulgated by the federal managers of Obamacare, but the board seemed puzzled by the seeming lack of empathy for the Vermonters who have to live with those rules. And there were small things, like the tentative way the Vermont Exchange bureaucrats responded to questions about how federal poverty levels determine benefit levels.
   That level of detail is utterly foreign to the ordinary person, but health policy adepts normally navigate then effortlessly. Not last week.
   Maybe this week will be different. Stay tuned.