In Vermont, Frustrations Mount Over Affordable Care Act by Abby Goodnough/NY Times
Vermont: Your bad website is making people sick
My experience getting health care through the now-legendarily bad exchange
The New York Times has now publicized the story most Vermonters already know: Vermont’s online health insurance exchange is so difficult to use, so poorly functioning, that people are choosing not to use it. Those who have stuck with it have had to endure months of outages, accidental disenrollments, and thousands of dollars in out-of-pocket costs while people claim to be fixing the problem that is still unsolved.
I’m a writer and a librarian. I teach people how to use computers for a job. I’m also a freelancer who buys health care on “the exchange.” The exchange in Vermont is funny because there are only two companies: Blue Cross and “the other one.” Despite this, there is a complex system requiring a hundred million dollar website (approaching $200 million in total costs) to assist us in shopping for health care. This mostly has to do with the verifications and data aggregating and security that go along with Obamacare. I am fully on board with Obamacare as is the majority of the state of Vermont, but it’s been a tough few years buying health care on the exchange.
Before Obamacare, we had state-subsidized health care for low-income folks in Vermont. If it had a website, I don’t remember it. What I do remember is that when I was underemployed a decade ago, I could maintain my health insurance for eleven dollars a month until I got a full-time job.
I bought health insurance through the exchange last year when I went back to freelancing. The website had some problems. It was very slow, it seemed only partway built, it was hard to do basic tasks. The phone support, by contrast, was quick and friendly and capable. I emailed my local state representatives to complain about the bad website. Often. My local reps have email addresses at AOL, gmail, and their internet service providers. One of my reps shares an email address with her husband. We’re not super tech-savvy as a state. This keeps me gainfully employed but has its downsides.
Each month you had to log in to pay your bill. You couldn’t set up recurring payments. You couldn’t pay your bill until after an invoice had been generated. They used to send emails notifying you “Time to log in to make a payment!” but now we only get a letter. In the mail.
The payment page is noticeably incomplete. This is what it looked like in mid-2014.
The page where you pay by debit card is similarly unfinished. There’s a 2.5% fee tacked on if you want to pay with a credit card.
It’s a year later and these pages still look exactly like this, despite all that’s happened.
The original website was geared towards Vermonters without health insurance, fewer than 100,000 people. When asked, CGI Technologies, the company who designed the site explained they were just designing to the specifications they were given. Specifications that we all now suspect may not have been very good. The 400 page contract, available at the Vermont Department of Health Access website, had six amendments before it was finally rescinded.
Partway through 2014 we were told “You and everyone else are right, this website is awful and non-functional. We’re firing the company responsible.” Assurances were made that the new company and the new website would be better. The site was down for over two months, just totally down. All transactions needed to be done over phone or by mail. Going to any page on the website got you this message.
The clock was ticking on the open enrollment period. I was going away for holidaytime and wanted to pay my bill before I left town. We were told to keep checking our mailbox for a bill which would let us know that the invoices had been generated.
Invoices for January’s premiums never arrived. If you called, you were informed that it was okay, no one would lose their health insurance because they hadn’t received their invoices. People who did not call just worried and kept reloading the web page. Eventually Vermont Health Connect put up a notice explaining the issue, on the site that had been down for months. When I eventually made a payment by phone, the woman I spoke with read me the words on the website that she could see, the website that wasn’t available to customers. “Do you agree that by clicking this button…” she’d ask me and then click the button for me.
Vermont Health Connect came back online in December 2014. To no one’s surprise, it wasn’t fixed. From a user perspective it had barely even changed.
The biggest change to the “new” site was that there was now a Sign In button, a feature that the previous site hadn’t had. It also had a link to a FAQ. Otherwise it looked basically the same, absent the smiling Vermonters.
I logged in to check my account after finally making my payment. The site was the same beneath the surface also. Pages were unfinished. Load times were slow. I still couldn’t set up a recurring payment.
Worse yet, my online profile said I actually didn’t have health insurance. I had to call someone to verify that I was insured, take their word for it. “The website is wrong, we show that you’re insured.” When I went to pay my March bill, the website said I owed them for three months of insurance. Another phone call followed. When I finally paid my bill there was no record of my payment on the website. I got no receipt.
I was double-billed for the first three months of 2015, with one set of bills showing a gradually increasing total and one showing the normal totals. I called and emailed every month asking them to fix this. Once I started cc’ing a lot of people with state.vt.us email addresses, in April, the duplicate bills stopped.
I should also mention that I am a single person with an uncomplicated financial situation that has not changed in the year-plus that I’ve had health care through the exchange. Speaking to my neighbors, I hear stories similar to mine, only they’re worse. Their problems are more complicated and often involve paying thousands of dollars out of pocket for medicine or doctors due to insurance snafus before things (eventually, usually) got sorted. These are people who, like me, are on board with Obamacare. They are not always so tech savvy. They shouldn’t have to be.
The most chilling part of the New York Times article I am responding to is this
There’s a backlash against all things health care reform because Vermont Health Connect has been such a bad experience,” said Trinka Kerr, the chief health care advocate at Vermont Legal Aid, which gets several hundred calls a month from people who have encountered problems with the exchange, including billing errors and even delayed access to care. “Sometimes they’ll say, ‘I’ll just go without insurance,’ and we try to convince them that’s not a good plan. They don’t like the way this is working and want to go back to the old way.
One of the things health care consumers are taking away from this experience is “computers are hard, really hard.” That is, the belief that making a system of interconnected websites function together is at a level of difficulty somehow akin to building a space shuttle or doing neurosurgery. It’s not only making them skeptical about Vermont’s ability to deliver health insurance, it’s making them skeptical about the idea of using technology to solve problems in any fashion.
Part of my technology work, helping ease the digital divide in places like rural Vermont is trying to incent people to use computers, to get online. I want them to have good experiences with technology so that they have some positive associations with it before they’re forced into using a poorly performing website as part of their interactions with the government or their job.
I work with people and we look at a Google Map view of their house. We buy cheap toner ink. We get their facebook profile photo looking right. Vermont Health Connect is a huge setback to my work. I keep telling people “You are not a bad person, this is a bad website.” My students want to know how websites this bad get made, and why they are so expensive. I only sort of know the answers: the interconnected systems; the bad specifications; the administrators who don’t know how to manage a technology project; the lack of usability testing or any real user testing; the absence of a feedback process.
People who were skeptical about Obamacare might have changed their minds if this process solved a problem for them, if it helped them get healthy, if it didn’t increase the amount of hassle and uncertainty in their lives. That opportunity was lost and we may not be able to get it back.
Vermont Health Connect phone support handled almost 9000 phone calls per week in January 2015. 85% of those calls were answered in under 30 seconds, significantly less time than it takes me to log in to the website and get to the page to pay my bill. 31,000 Vermonters were insured through the exchange last year. By all accounts that part of the program has been a success.
I can’t be the only Vermonter wondering if, with such a team of friendly capable support people, we might have been able to spend some of that website money hiring our neighbors to help keep our other neighbors insured.
How many support people could you hire with 100 million dollars? I don’t know the specifics of why this website is so complicated to build and maintain, but I know that everyone I’ve spoken to on the phone has been wonderful.
Let’s fix this, for good.
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