Scheuermann, Komline call for change to allow individuals on VHC to enroll directly with insurers


MONTPELIER -- Two state representatives called on Gov. Peter Shumlin to allow Vermonters to purchase health insurance outside the state's troubled health care exchange and instead buy it directly from insurance carriers.

Ongoing problems with Vermont Health Connect, the state's online health insurance exchange, are having "a disastrous effect" on thousands of Vermonters' access to care, said Rep. Patti Komline, R-Dorset.

Rep. Heidi Scheuermann, R-Stowe, joined Komline in calling on the governor to allow people who purchased coverage on the exchange to renew it directly with insurance carriers, and allow new entrants to do the same.

Making the exchange mandatory for people in the individual market was a mistake, they said, and goes beyond what other states that chose to build their own exchanges require.

"Mr. Governor, Vermonters are hurting. It is time now to admit that was a mistake, and allow those people who are stuck in this abysmal system to work directly with their insurance carriers if they so choose," said Scheuermann, who briefly entertained a run for governor earlier this year.

The pair acknowledged that people receiving Medicaid or subsidies must use the exchange to receive those benefits, but argue that people paying full freight should be able to deal directly with insurers.

The vast majority of Vermont Health Connect users are on Medicaid, receive subsidies or may have a change in income that would qualify them for subsidies, said Lawrence Miller, chief of Health Care Reform for the Shumlin administration.

"Solving a problem for the minority of people that don't have a subsidy hasn't been our priority so far," Miller said.

At this point all options are on the table to improve the ailing system, he said, but Miller's understanding when he joined the effort to fix Vermont Health Connect was that the carriers "did not have the appetite" to direct enroll individuals.

He was not sure that it would be feasible for them either, but said it's something the state would look into.

"I doubt it's that simple," he said.

In their joint statement Scheuermann and Komline wrote, "approximately half of those Vermonters who are in limbo would not qualify for these subsidies," and could more easily manage their plans through insurers.

There are 33,000 people who purchased commercial insurance in the individual market. More than half receive subsidies, according to state officials. There are more than 14,000 people who need to make corrections to their account information or changes to their coverage. Twenty percent of those are Medicaid beneficiaries, making it improbable that half of the people in limbo are paying the full cost of their plan.

Even if it's a smaller number, it still makes sense to allow individuals to purchase directly from carriers if they elect to do that, Komline said in a follow-up interview.

"Say it's only 5,000 people - say it's 3,000 - if they choose to leave the exchange, this would let us focus our efforts on vulnerable populations," she said.

In addition to the 14,000 people who need corrections or changes, there are roughly 22,000 Medicaid beneficiaries that have not renewed their coverage and will eventually need to do so through Vermont Health Connect.

Because some of those Medicaid beneficiaries may have tried to use the website, but entered information incorrectly, there could be some duplication in those two groups.

The Vermont Republican Party also issued a statement Tuesday calling for the governor to "fire CGI" and replace Agency of Human Services Secretary Doug Racine and Department of Vermont Health Connect Commissioner Mark Larson.

Shumlin said recently he does not intend to make any changes in leadership.

The governor said it is his responsibility to see that contingencies are in place, so that Vermont Health Connect is working smoothly by open enrollment in November when thousands of new users and tens of thousands of existing users will flood the system.


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