The Scary Deadlines

By Hamilton E. Davis

   There has been so much bad news about Vermont Health Connect that good news might generate a shock wave all of its own. Yet, there is a real possibility, finally, that the huge mess at the federally-financed insurance Exchange may be resolving.
   The next milestone will occur on June 1, when the computers at the Exchange are supposed to be able to handle “change of circumstances”, which occur if an eligible person has a child, gets divorced, or undergoes a change in income. In such a case, the federal subsidy may go up or down or go away. A change now can only be handed manually, which means in many cases that it doesn’t happen at all.
   The second test will come on Oct. 1, when the Exchange’s computers have to be able to automatically renew old policies and enroll new customers. The enrollment window for the policy year 2016 will open Nov. 1, and that almost certainly can’t be handed manually either. Moreover, the change of circumstances is a separate stream of program tasks, so that one can’t presume being able to handle change of circumstances improves the chances for succeeding with open enrollment.
   So, the news may continue to be bad, and failure to get the system running properly by October would be catastrophic. The reason is that there isn’t time to develop a Plan B for the open enrollment period beginning Nov. 1. The alternatives that have been discussed so far—moving to the federal Exchange computer platform, or buying the Connecticut system, which works—couldn’t be accomplished until the 2017 cycle.
   What that adds up to is that failure is not an option. Which is not very comforting, given that so far, failure is all we’ve had.
  Nevertheless, my sense just from talking to several of the people involved, is that things look better than they have before. Lawrence Miller, Governor Shumlin’s health reform chief, says he feels good about how the system is progressing. “We’re on track so far,” he says. Some of the veteran navigators—people who help enroll in the Exchange—sound more optimistic than they have in the past.
   Glitches could arise in the next few weeks, but several interim tests have been passed so far and there is no obvious reason the system now under construction can’t work.
   How can that be true, given how much has gone wrong so far?
   The problems that plagued the Exchange since its inception seem pretty obvious from this time and vantage point. The task of setting up the Exchange was originally assigned to the Department of Vermont Health Access (DVHA), which is a unit of the Agency of Human Services. The first planning grant came to the state at the tail end of the Douglas administration, about 2010.
   The Exchange was supposed to go live in Oct. 1 of 2013, but it became clear by the spring of that year that the project was irretrievably deep in the weeds, where it has remained for the last two years.
   The underlying problem, in my view, was twofold: first, the consultant retained to do the work was completely incompetent to do so; and second, the AHS management team had no idea how to handle such a situation. It took Governor Peter Shumlin a year too long to move on his management problem, but he did so finally in early 2014, when he turned the problem over to Lawrence Miller, then his Secretary of Commerce. Miller, a former business executive and one of the few Shumlinites with straight-face operations experience, began looking into the situation in the winter of 2014 and moved over to the Exchange problem permanently in June.
   So Miller has been in place for just under a year. By midsummer of 2014, he had dumped CGI, the Canadian consultant that had made a mess of the situation to that point, and shortly thereafter turned the work over to a new consultant, Optum, a national firm. Evidence abounded that CGI was incapable of doing the work—there is no such evidence that Optum is unable to perform. Optum has had just nine months or so to work, but they have hit all their interim targets so far, according to Miller.
    In addition, Miller turned the problem of actually directing the Exchange project to a new leader, Bob Skowronski, a retired insurance executive with long experience in insurance management systems. It is too early to be certain that Skowronski can get done what earlier bureaucrats couldn’t.
   But there are at least some straws in the wind. For example, on Feb. 5 of this year, a couple of bureaucrats from DVHA came before Green Mountain Care Board to discuss the insurance products that will be offered by the Exchange in the coming year. Their presentation was so inept that the Board seethed with outrage, a fact noted by Robin Lunge, Miller’s colleague on the health reform team, who was at the meeting.
   One week later, Lunge sent Skowronski in to accomplish the same task, and he did so with such facility that the Board gushed all over him. A straw in the wind.
   Getting the Exchange going is now under the direction of Skowronski, reporting to Miller, along with State Health Commissioner Harry Chen, and AHS Secretary Hal Cohen. There is no inherent reason that they can’t succeed.
   That leaves the question of what Governor Shumlin intended in his recent press conference when he said that if the DVHA failed to meet the June 1 deadline for getting change of circumstances operational he would shift to a new plan, like moving the Exchange to the federal platform, which is favored by some members of the Legislature.
   What was striking about that press conference was that when Lawrence Miller went into the legislature to talk about it the next day, he seemed to be saying that deciding now to do something like either joining the federal system, or buying the Connecticut system would be a bad idea…
   So, where are we on this question? If it is now June 2 and the system does not allow changes of circumstances, what happens on June 3? Do we fire Optum? If going to the federal platform or buying Connecticut’s system can’t be accomplished this year, how do we handle open enrollment beginning Nov. 1?
   According to Miller, contingency planning for failure to meet the deadline is simply something the state has to do. It does not, he emphasized, mean that Optum stops work. In other words, June 1 is not a drop-dead deadline, merely one that could trigger contingency planning. If  Optum and Skowronski get change of circumstances working by, say, June 12, then Vermont will use that capability and then shift its focus its focus to the open enrollment period.
   Oct. 1 will be the second deadline, but that also could slide at least a little bit. If open enrollment, or automatic renewal of current policies, is ready by, say, Oct. 6, then the whole Vermont system will be good to go.
   Nevertheless, Miller says that he would have to initiate contingency planning if the June 1 deadline isn’t met. The administration arrived at that conclusion, he said, by simply backing up from the Nov. 1 open enrollment date. Contingency planning would go on in parallel with the Optum work on the Vermont system.
   How would that work? Miller says he would have to put together a planning team and start figuring it out. Neither Miller nor anyone else, however, has any clear idea how to proceed if Optum fails. So there will be lots of crossed fingers over the next three weeks.