Commentary: Time for Facts About Vermont Health Connect (March, 2015)

By Wendy WiltonWendy Rotator Card

It is good news that Auditor Hoffer has scheduled a performance audit of Vermont Health Connect this spring. The auditor’s work will be vitally important information for the Legislature to consider as it determines the fate of the state’s exchange. Hopefully, they will have his report before the session ends.

Much has been said and written about the problems with development and roll-out of Vermont Health Connect and the expected $200 million cost of this poorly managed effort. However, there could be more financial costs lurking on the horizon that the auditor needs to tell us about.

Vermont Health Connect has been dysfunctional from the start and still is. The backlog of coverage changes is over 11,000 cases. Enrollment, determining Medicaid and subsidy eligibility, changing eligibility and benefit profiles, processing premiums, and processing insurance claims, and other activities have all experienced failures. Participating insurers are owed millions of dollars in premiums, but have continued to pay for care. This will have negative impacts on other subscribers’ rates unless the state makes good on what it owes.

Auditor Hoffer should consider exploring these areas of concern:

  • How many and what is the value of premium payments processed through Vermont Health Connect that have not been reconciled and paid to Blue Cross Blue Shield and MVP?
  • Vermont Health Connect has been dysfunctional from the start and still is.
  • Where (in what account) is the cash representing unreconciled premiums?
  • How many and what is the value of provider payments made by BCBS and MVP associated with the above flawed beneficiary application and claim processes that remain unpaid?
  • Of those newly enrolled in Medicaid, how many have eligibility documentation that is inaccurate? What is the state’s financial exposure due to flawed Medicaid enrollments?
  • Similarly, how many and what is the value of paid premium subsidies associated with flawed income determinations?
  • The state has a significant ($57 million), no bid contract with Optum-possibly similar to the Gruber contract. What controls exist to ensure the invoices are detailed and accurate, work will be done on time and within budget, and that the contractor will deliver the solutions?
  • What is the per month-per member cost of Vermont Health Connect? How does this compare to BCBS and MVP’s per month-per member costs?

Three years ago, I concluded a single payer health care system would make the state insolvent due to unforeseen cost escalation, lack of savings, and unsustainable taxes. Vermont Health Connect represents a similar risk to the state’s precarious finances with unexpected costs and lack of control. The auditor’s report, if thorough and timely, could give the Legislature essential facts to take decisive and imperative action.

– Wendy Wilton, is treasurer for the City of Rutland, and a member of the Ethan Allen Institute board of directors.

 

{ 0 comments… add one now }

Leave a Comment

Previous post:

Next post:

About Us

The Ethan Allen Institute is Vermont’s free-market public policy research and education organization. Founded in 1993, we are one of fifty-plus similar but independent state-level, public policy organizations around the country which exchange ideas and information through the State Policy Network.
Read more...

Latest News

Scott’s Net Metering Cutback

November 20, 2019 by John McClaughry Three weeks ago Gov. Phil Scott said at a news conference that he supports cutting price supports for solar photoelectric power. It’s...

Economic Freedom in Vermont

November 18, 2019 by John McClaughry Our friends at New Hampshire’s Josiah Bartlett Center are applauding their state for being rated the most economically free state in the...

Scott Reiterates Opposition to Carbon Tax/TCI

November 15, 2019 by Rob Roper Vermont is one of a dozen states contemplating entering into a regional cap and trade scheme for gasoline and diesel, the Transportation...

Remington Arms Case

November 13, 2019 by John McClaughry Last Tuesday the US Supreme Court cleared the way for a lawsuit against Remington Arms Co. brought by survivors  of victims of...

Scott: Make Paid Family Leave Voluntary, Unless Nobody Wants It

November 12, 2019 By Rob Roper For the past year, Governor Scott has been making the good fight on Paid Family Leave in demanding any such plan be...

Video