• Patch job
    December 15,2013
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    Vermonters are signing up with greater speed and ease on the Vermont Health Connect website as deadlines loom for those seeking health-care coverage.

    The news was good enough that Gov. Peter Shumlin held a press conference last week to talk about the progress achieved in signing people up for coverage. Of 65,000 people eligible for coverage on Vermont’s exchange, about 45,000 have signed up. Shumlin said nearly all of the 20,000 who remain will have coverage by the first of the new year.

    It has been 2½ months since the launch of Vermont Health Connect and health-care exchanges across the country. Most states have chosen to provide coverage to residents by means of the federal exchange, which has performed so poorly that it created a major political crisis for the Obama administration.

    States that established their own websites, as Vermont did, are mostly enjoying better results. These include California, Colorado, Washington, New York, Connecticut and Kentucky, among others. Other states have encountered disastrous problems with their websites, notably Oregon.

    No simple summary statement can describe the way the new exchanges are affecting people. It’s impossible to say that people will get cheaper coverage, because for some, coverage will be more expensive. It’s impossible to say coverage will be improved, because for some, it will be diminished. Ultimately, judgments about the new system will be cumulative as millions of people sign up and conclude for themselves that they are better off, or not.

    One of the purposes of the exchange is to ensure that the policies available to people will actually serve them well. Thus, the new system does not allow for policies that, while they may be less expensive, provide sketchy, unreliable coverage. Policies must meet standards. These standards are comparable to regulations for medications: The government does not allow companies to sell quack medicines that, though they may be cheap, do not work.

    President Barack Obama, in the enthusiasm of the election campaign, frequently repeated the promise that if you like your insurance policy you will get to keep it. But if the policy you like happens to be substandard — is not good for you — then it will be canceled and you will have to pay more money for a policy that will actually do you some good.

    Other quirks are cropping up. A New York Times story has reported that independent artists, performers and others have been able to gain coverage through their professional organizations, rather than as individuals. But the new law does not allow those professional organizations to serve as go-betweens, which means those independent artists have to sign up on the individual market on New York’s exchange, which often is more expensive.

    The question is the degree to which quirks such as these will undermine the credibility of a program that is meant to provide affordable, effective health care. For millions of people who had no access to health care, access on the government website — either state or federal — will be a godsend. Medicaid rolls are expanding rapidly, which was one of the aims of the new law.

    In Vermont, the challenge has been less about providing care to the uninsured than about containing costs. That’s because Vermont was already among the leaders in the percentage of residents who had coverage. Thus, Vermonters who had coverage through Catamount Health are being shifted over to Vermont Health Connect. Of the 18,000 people on Catamount, about 15,000 had already made the move to the new exchange, according to Shumlin.

    Opponents of the Affordable Care Act now find themselves in a peculiar position — working to prevent their own citizens from gaining health care coverage. States such as Texas have not signed on to the federal program, have not sought expanded Medicaid money and have done little to promote the federal exchange. Texas also happens to be a state with a high percentage of residents without coverage. What can the appeal of Republican leaders be? Stick with us — we’ll make sure no one succeeds in helping you gain health care.

    Shumlin has done the opposite, casting himself in the role of architect, promoter and cheerleader, issuing optimistic statements about the prospects of Vermont’s program. When the website failed to perform well at the outset, he had to pivot sharply to admit the problems and to pledge that he would fix them. As things have improved, he has returned to the role of cheerleader, eschewing a prolonged look backward at the problems of the faulty launch.

    It’s out of his hands at this point. The bureaucracy, the tech companies, the insurance companies, the health-care providers — all are scrambling to put together the boat after it has already been launched, hoping it doesn’t sink before they are done.
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