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Health in Numbers: The Success and Failure of Vermont's Exchange

Fair Game


Published December 18, 2013 at 1:58 p.m.

Fair Game is Seven Days’ weekly political column.

To which Vermont health care reform narrative do you subscribe?

There are several choices, so hold on to your hat!

Option A: Despite early hiccups, Vermont’s online insurance exchange is up and running — and signing people up at a rapid clip. Last week alone, Vermont Health Connect enrolled more than 5000 people — as many as in the previous six weeks combined. According to a recent federal tally, Vermont’s per capita sign-up rate well exceeds any other in the country.

Of the 65,000 Vermonters Gov. Peter Shumlin now says he hopes will be covered by the new VHC plans by January 1, nearly 45,000 have picked one.

“Whether they’ve gone through the website or through the carriers, roughly two-thirds of the eligible folks have enrolled in one plan or the other, depending on their choosing,” Shumlin said last week. “So we’re making great progress and we have more progress to make.”

Option B: While the situation has improved for those who don’t currently obtain coverage through an employer, it still sucks for those who do.

Of the 45,000 enrollees Shumlin was crowing about, 30,000 of them are small-business employees who were unable to use the state’s new website to sign up. Instead, their bosses bypassed the exchange and went directly to insurance companies to sign up for VHC plans, thereby limiting employees’ choices. Or they were automatically and involuntarily “mapped” to a new, comparable plan.

Which sounds kind of like the old system. The one we’re trying to replace.

Not counted in Shumlin’s 45,000 figure are another 3500 employees whose bosses made the mistake of trusting Vermont Health Connect enough to sign up through the website. Because the state still hasn’t figured out how to bill those folks, their new plans are in limbo — and their current plans will be extended for as many as three months into the new year.

Nor is Shumlin counting the 5800 employees whose bosses punted and took advantage of a three-month delay to just figure the whole damn thing out.

So that leaves us with a grand total of 15,000 people — many of whom are moving from expiring state-subsidized programs like Catamount and Vermont Health Access Plan — who have successfully navigated the system. (That number is to sure to rise in the next week, as the December 23 deadline to draw down federal subsidies in January passes.) Those 15,000 success stories, by the way, include at least 2000 people who enrolled through the supposedly online Vermont Health Connect using paper applications.

Yep, paper applications.

While we’re at it, here’s another narrative choice to add to your collection. Let’s call it option C: As Shumlin veers from mini-crisis to mini-crisis, he keeps contradicting his own explanations about when he knew the deployment of Vermont Health Connect wasn’t going smoothly.

Throughout the fall, he alternated between dismissing a major problem as a “nothing-burger,” berating reporters for asking about it and acknowledging there would be more “bumps in the road.” After those bumps grew into a roadblock in November and prompted Shumlin to allow businesses to bypass the website, he issued a mea culpa and told Vermont Public Radio’s Bob Kinzel that he had no idea “the magnitude of the challenges we were going to face” by the time Labor Day rolled around.

“Because we didn’t have the time to test [the system], we didn’t know what our problems were, to be absolutely honest with you,” he said on VPR’s “Vermont Edition.”

But last Wednesday, VPR’s Taylor Dobbs obtained a slew of documents showing a contractor had started warning the state in April that the system was at risk of failing. So Shumlin changed his story again. At a Statehouse press conference that day, the governor said he was “told in summer” about those reports. He said he was forthcoming about them as early as July 8, when he briefly suggested at a sparsely attended Lake Champlain Chamber of Commerce event that the site might be “bare bones” at first.

“I was very transparent about that,” Shumlin said last week of his July remarks. “I said, ‘Listen, this isn’t going to have all the bells and whistles, but we’re going to have a website that functions, that gives Vermonters the information they need on October 1.’ And I want to point out that’s exactly what we delivered.”

Tell that to the nearly 40,000 small- business employees who haven’t been able to use the system as advertised!

So which of these narratives is the truth? As far as I can tell, all three.

Which one matters the most probably depends on whether you’re a liberal booster of the Affordable Care Act, a thoroughly inconvenienced small-business owner or employee, or an Ahab-esque political columnist, hunting for the white whale of Shumlinconsistency.

The day after last Wednesday’s press conference — during which narrative C dominated the discussion — Shumlin tried to recapture the message at yet another Statehouse presser. His goal: Refocus on narrative A.

Standing beside legislators, health care advocates and a consumer, Shumlin argued that the Vermont Health Connect website had improved dramatically since its launch. Despite all the negative attention it’s garnered, he and the others said, Vermonters should give it a chance and sign up soon.

“I think a lot of the bad experiences people have been reading about are stopping people from enrolling or making them reluctant to enroll, because they’re fearful of how onerous it’s going to be,” said Vermont Campaign for Health Care Security executive director Peter Sterling, who contracts with the state to sign people up. “But when they actually sit down and do it, they realize it’s not too long a process.”

Point taken! If you haven’t already enrolled in a plan for next year, go sign up! Heck, you might well qualify for subsidies.

No doubt we in the press have focused on what’s gone wrong — and it’s quite possible that our chronic Debbie Downer-isms have contributed to Vermont Health Connect’s woes. But that’s our job — to figure out how and why a system is broken, and whether assurances it’s being fixed are credible. Particularly when the state is spending millions of dollars on a taxpayer-funded propaganda campaign to whitewash the problems. Ahem, I mean communicate the temporary setbacks.

There’s plenty more we haven’t focused on, as Shumlin was quick to point out last Thursday.

“There are 30,000 Vermonters out there who were on VHAP or were on Catamount who were paying a premium before who are no longer paying a premium,” the gov said, referring to those who are newly eligible for Medicaid. “Pretty well-kept secret. Thirty thousand folks who are getting a reduction automatically because of the Affordable Care Act, where they were paying a premium — and struggling to, because these are not folks who are making a lot of money — who are now paying zero.”

And then there are the expanded consumer protections the ACA offers, such as free preventive care, banning discrimination against those with preexisting conditions and letting anyone younger than 26 remain on their parents’ health plans. Not to mention the $11 billion Sen. Bernie Sanders managed to sneak into the ACA to fund more federally qualified health centers — including three new ones right here in Vermont.

There are also plenty of negative points upon which we have not dwelled — such as the astronomical cost of building Vermont Health Connect. According to the Pew Center on the States, Vermont is spending $267 per person to build the website. That’s well more than the next closest state, Hawaii, which is spending $145 per person, and the nationwide average of $30.

No, there are no easy narratives in this story. Or maybe there are too many.

It’s a clusterfuck. It’s a godsend. It’s a testament to government incompetence and it’s a testament to government perseverance. Perhaps in 10 years’ time, it’ll be a testament to government brilliance. Or perhaps it’ll be long-since repealed.

Media Notes

It ain’t every day that an out-of-state news organization swoops into Vermont and deploys a new reporter. So imagine my surprise when, a month ago, I received a press release announcing that a Jon Street was joining’s “bureau in Montpelier, Vermont.”

What the?!

Robert Maynard at the right-leaning website True North Reports jumped on the news, hailing Watchdog’s arrival as “a welcome development in maintaining an informed citizenry.” Two weeks later, John Walters at the left-leaning Green Mountain Daily pounced, referring to Watchdog as “right-wing pseudo-journalism.”

As Walters noted, Watchdog is operated by the Virginia-based Franklin Center for Government & Public Integrity, which itself is funded by a network of right-wing political groups. According to the Center for Public Integrity, 95 percent of Franklin’s 2011 funding came from the anonymous collaborative Donors Trust, which is dominated by the conservative bogeymen Koch brothers.

But according to Street, who dropped by Seven Days’ office this week, he has no agenda but to dig up the truth.

“Watchdog is doing in Vermont what we are doing in a number of other states across the country, and that is to expose government waste, fraud and abuse at the state and local levels,” Street said.

A Missouri native and 2012 graduate of Missouri Baptist University, Street said he’d never stepped foot in Vermont until he moved to the Burlington area last month to take the job. But already, he said, it reminds him of his home in the Midwest, where “you say hi to people as you’re walking down the street.”

While Street’s last two gigs were at conservative news outlets — and the One America News Network — he claimed he has no idea who’s behind the Franklin Center.

“I cannot tell you whether the majority of the funding comes from left-leaning organizations or right-leaning organizations or independent organizations. I won’t get into any of that. I would direct any of those questions to our headquarters,” he said. “But as far as any pressure to report from a certain angle, I don’t feel any of that.”

Street’s boss, California-based Watchdog editor Will Swaim, says much the same.

“We don’t reveal who our funders are, unless of course the funders want to make themselves public. So I can’t tell you whether the Koch brothers fund us. I can tell you that I wish that they would,” Swaim says. “I think what we’re doing should be funded by Bill Gates and the Ford Foundation and the James L. Knight Foundation. I think we do really good work. And I’m not being coy. I honestly don’t know, and that’s intended to protect me and the reporters as much as anybody. They don’t tell me what to write, and I don’t ask them where the money comes from.”

While Swaim, a former longtime editor and publisher of the OC Weekly, calls himself a “leftie libertarian,” he says most of his staff share a belief in “limited government.” Either way, he says, political orientation is beside the point.

“The whole role of is to write really local stories that have some kind of national impact,” he says.