Recent news highlighted the negative impacts ongoing mismanagement and problems with functionality are having on the care thousands of Vermonters receive. Replacing the primary contractor, CGI, is a start. Replacing them with Optum without competitive bids and without agreed upon cost for services, however, is ill-advised when one considers Vermont's experience with Optum in the last month.
In June, the Shumlin administration signed a 6-month, $5.69 million contract with Optum for additional help. Since then, a problem that started with 10,000 Vermonters with coverage problems grew to over 14,000.
These are real Vermonters - in need of critical care, MRI's, medication for chronic illnesses, and hospital care - denied coverage by the state, even though they enrolled and paid.
This didn't have to happen. Unlike all other states with state exchanges, Governor Shumlin and legislative leadership insisted that Vermont's be mandatory. Knowing this enormous project might have complications, many of us fought to preserve your right to choose insurance inside or outside of the Exchange. Unfortunately, the Governor doesn't support this right, and now we are facing a real crisis.
To address the difficulties Vermonters are experiencing, we have encouraged Governor Shumlin to allow people stuck in this abysmal system to work directly with their insurance carriers, if they so choose. Specifically, we propose allowing Vermonters to move the management of their plans off the Exchange, and allow new enrollees to purchase their plans directly through approved carriers.
This isn't a new idea. When it was clear last year that the Exchange wouldn't be able to process coverage of small businesses, the Governor allowed them to purchase insurance directly from insurers.
Vermonters who qualify for federal subsidies must go through the Exchange.
But thousands of Vermonters who are in healthcare coverage limbo don't qualify for these subsidies, and could more easily be managing and purchasing their plans directly. This move would help over 4,000 people forced into the system and free up the staff at Vermont Health Connect to focus on the remaining enrollees who receive subsidies and new applicants.
Unfortunately, the concerns of many have been dismissed by the Governor and his health care chief Lawrence Miller who said, "solving a problem for the minority of people that don't have a subsidy hasn't been our priority so far." Ensuring affordable care for every Vermonter should be their priority! Instead, the Shumlin administration seems to be doubling down on plans to make the Exchange something it was never intended to be: The foundation of a new $2.2 billion, government-run healthcare program. While they've failed repeatedly to create a workable Exchange, they continue to insist they can be trusted to upend our entire healthcare system. Governor Shumlin despite promising a silver bullet in 2010 when he was first elected, and 4-years of promises - has yet to tell Vermonters what exactly this system will look like, what will be covered, and how it'll be paid for. What we do know is their failed experiment is supposed to be the platform upon which the Governor's "single-payer" system will be built.
We should all be concerned. While most Vermonters aren't affected by the problems over 14,000 people have been dealing with, the Governor and those in control of the Legislature want to take control of your healthcare in a few short years.
To be clear, we will fight for real reforms that work for Vermonters. We believe strongly in the need to ensure universal access to healthcare, at a cost Vermonters can afford, and in a way that keeps Vermonters in charge of their own healthcare decisions. Single-payer won't provide this.
But, the Exchange can be a valuable step in the right direction - if we do it right. If we restructure the Exchange into one that is voluntary and that ensures a larger risk pool (either enter into a regional exchange, or join the federal exchange), we can provide more healthcare options for families and businesses, at a lower cost.
As legislators, we've spent a great deal of time assisting Vermonters with their difficulties in the Exchange, and we can tell you with absolute certainty that it is getting worse, not better. We need to put Vermonters first and get healthcare reform right.
Heidi E. Scheuermann and Patti Komline are state representatives in the Vermont Legislature.