Marketplace ‘Milestone’: A Bright Spot or Two in Troubled Health Reform Law

Who has been able to select a health-care plan

Who has been able to select a health-care plan

Hartford — Colleen O’Brien was ready to buy some insurance.

She had the documents. She knew what she could afford and what level of coverage she wanted. She had even set up her online account at, the state-run website where uninsured Vermonters could purchase health insurance.

But she had tried — without success — to enroll for coverage before. And she knew she wasn’t alone. Thousands of Vermonters have been frustrated by error messages and other hang-ups when trying to buy insurance online.

So, it was with a little bit of faith that O’Brien went to the Good Neighbor Health Clinic on Nov. 7 and sat down with Pam Vernon, one of the so-called “navigators” trained to help people enroll.

They logged into the website, filled out some personal information for O’Brien and compared plans. They chose one. They clicked the button to select it.

Success. Relief.

“I decided which plan I wanted right then and there,” O’Brien said.

O’Brien was a milestone for Good Neighbor, as she became the first person to walk through the clinic’s doors and successfully enroll in a plan through the new online marketplace, a key provision of the Affordable Care Act. And she is among the few bright spots in what has otherwise been a disastrous month and a half for President Obama’s signature health reform law.

Technical problems have plagued the rollout of the insurance marketplaces nationwide since they launched Oct. 1. Two weeks ago, Vermont Gov. Peter Shumlin said that he had “been extraordinarily frustrated with the pace of progress with our website at Vermont Health Connect” and vowed to press for improvements. He recently extended by three months the time through which individual and small businesses could retain their current coverage.

Meanwhile, Obama last week announced that individuals could keep their current insurance policies through next year even if those policies did not meet all the requirements for the Affordable Care Act. Obama’s proposal was intended to assuage millions of frustrated Americans who have been unable to buy coverage through the troubled federal website,, through which consumers in dozens of other states, including New Hampshire, can buy insurance.

So far, enrollment figures remain far behind the original goals everywhere. Vermont expected to sign up 100,000 people for insurance coverage through the marketplace, and 170,000 more for Medicaid, in the first year. As of Friday afternoon, 15,150 Vermonters had set up an online account and 4,100 picked a plan through the website.

In New Hampshire, the numbers were far more dismal. According to a federal report released Wednesday, only 269 Granite Staters picked an insurance plan through in the first month. Nationally, 106,185 people have picked a plan. Most of those, however, enrolled through 15 state-based marketplaces (79,391) rather than the federal website (26,794).

O’Brien’s experience, however, illustrates the incremental improvements that are being made. And she is glad for it. Although Shumlin is allowing individuals to keep their insurance plans through the end of March, O’Brien wasn’t eager to take him up on the offer. She lives on a pension and has been struggling to afford her individual plan through MVP Health Care. The policy costs her more than $400 per month. The new insurance she is purchasing through the marketplace will cut her expenses in more than half. After qualifying for subsidies to help her with the premium costs, O’Brien now expects to pay $169 per month for an MVP plan that offers better coverage. “It’s definitely better. So much cheaper,” she said. “I was wondering whether I was going to be able to afford fuel for the winter.”

Navigators elsewhere in the Upper Valley have been able to enroll individuals, albeit not without some difficulty. Staff at Gifford Medical Center in Randolph have been able to help people pick plans online, said hospital spokeswoman Robin Palmer. And the website fixes to are coming at just the right time as volume increases.

“We’re augmenting the process with paper in some circumstances, and are extremely, extremely busy,” Palmer said in an email. “Appointments are booked out a solid week as community members hear the message about the need to sign up.”

Yet serious challenges remain. Kathy Castellini, coordinator of the Windsor Community Health Clinic, has been able to enroll three people online, the first on Oct. 24. But it is far from a smooth process. For example, there are problems in calculating the amount of subsidy a person is eligible for, she said. The website will give her a dollar amount, and then when it comes time to pick a plan, a different subsidy amount is shown.

“They’re not consistent on the amount of subsidy they’re going to give you,” Castellini said.

Vernon, of Good Neighbor, said the training she received this summer to become a navigator did not prepare her for all the questions consumers would have, especially regarding the nuances of the website and details of the plans being offered.

She and Castellini said they have called the help center with questions, but don’t get answers. On four separate occasions, Castellini said, she filed a “trouble ticket” over the phone with the help center, which told her that someone would investigate her question and call her back. She has yet to have someone return her calls.

“I have never spoken to anybody,” Castellini said.

Typically, it takes multiple sessions to enroll someone for insurance, Vernon said. The first session takes as long as two hours.

Vernon said the expectations for the roughly 200 navigators spread out across Vermont may have been too high.

“I think they thought that navigators were going to be this bridge,” she said. “But we need the information. We’re doing work that the insurance carriers were doing before.”

Despite all the problems, state and federal officials who support the Affordable Care Act say that the long-term benefits of having access to better insurance will make up for the immediate frustrations with the website.

“If some of the folks who are on these inadequate policies go to the exchange, they may find that for the same amount of money, or perhaps a little bit more, they’re going to find that they get a lot better coverage,” said U.S. Sen. Bernie Sanders, I-Vt., in an interview Thursday.

Technically, nobody will be enrolled for coverage until they pay their invoices. O’Brien has not yet received her bill, but she has other concerns. Republican efforts to defund the Affordable Care Act have made her nervous about the future of the program.

“You never know with Congress, the way they are, what’s going to happen,” she said. “I know it’s a law, I know it’s signed, it’s a go. But Republicans versus Democrats, are things going to go bad later on down the road? … I have all this that’s in my head.”

For now, she said, she thinks she is better off.

“It’s made it very affordable for me,” she said.

Chris Fleisher can be reached at 603-272-3229 or