Q & A: Legislators Fire Questions at Cover Oregon Director

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State legislators had plenty of questions for Cover Oregon’s acting director, Dr. Bruce Goldberg, when the House and Senate healthcare committees held interim hearings on Wednesday.

Rep. Mitch Greenlick, D-Portland, who chairs the House healthcare committee, allowed each committee member to ask a few questions of Goldberg–a highly unusual move for Greenlick, who is known for running a tight ship during committee hearings. Legislators asked questions on a variety of topics that they said reflected concerns they’ve heard from constituents.

Here are some of their questions, edited for clarity and brevity.

Rep. Greenlick:  I’ll start. The issue that Representative [Carolyn] Tomei, D-Milwaukie, really wanted to ask you is, how are you doing with vulnerable populations, such as people who may be mentally ill, who might be eligible for health insurance? 

Dr. Goldberg:  We’ve done a reasonable job of getting our most vulnerable people onto coverage under the Oregon Health Plan. We’re working with our community partners who work with hard-to-reach populations.

Rep. Jason Conger, R-Bend:  This is the most incredible train wreck I think I’ve ever seen. Perhaps it’s time to throw in the towel. Instead of waiting until April, when you said you would look at contingencies, why not declare a loss and stop throwing good money at bad?

Dr. Goldberg:  I share your disappointment and embarrassment. I would agree with you that the credibility of Cover Oregon has been damaged. My job right now is to work to do what we can to try to restore that credibility. The next couple weeks are going to be a critical point. I think over the next month, we will see whether or not we have a viable system. If we don’t, I agree with you that it’s time to look at contingencies.

Rep. John Lively, D-Springfield:  What I continue to hear a lot is that the application is a very frustrating process.

Dr. Goldberg:  The complexity of the application is extremely frustrating. That application was not designed with user-friendliness in mind. It was designed to comply with a whole host of federal regulations. Having said that, I do believe that there is an ability to substantially revise that application. We are in the process of doing that right now. We’re having our Community Advisory Committee give us some input. Then we are going to get that to [Health and Human Services] in DC to approve. It’s been a huge problem. It can’t happen fast enough from my vantage point.

Rep. Bill Kennemer, R-Oregon City:  Yesterday, I received a letter from an insurance agent, and I’ll read a brief segment from that, because it raises an interesting question that we haven’t addressed. “From the time period of October 16, 2013, to December 4, 2013, I have submitted 74 applications to Cover Oregon on behalf of my clients. As I write this letter, I am only aware of 19 clients that have received information on their eligibility status. Of those, seven of those have been inaccurately enrolled in Medicaid based upon their projected income. That is an error [rate] of 36 percent.” That is not a representative sample. But I guess the question is, what are we doing to ensure that those applicants we are processing, in a hurry, with very minimally trained, quickly assembled staff, [are] being done accurately?

Dr. Goldberg:  We want there to be no errors. I got the same letter yesterday, and having investigated those seven cases… [in] five of those, the determination to be in the Oregon Health Plan was accurate. Federal policy and some of the rules about qualification are, indeed, confusing and difficult. Eligibility for Medicaid is determined based on monthly income. Based on federal rules, we looked at the monthly income, and it qualified them for Medicaid. And people’s incomes fluctuate from month to month. That’s a big issue. We’ve raised that with the feds, and are looking to work through that. Two of those cases were indeed errors…that involved someone who had submitted their application and it was keyed in wrong. We’re working through training to not have those happen.

Rep. Jim Thompson, R-Dallas:  If we’re not in a death spiral, we’re close. I’ve gotten complaints from my constituents that their applications are incomplete, and they show me a copy that is, in fact, complete. They’re baffled. We’ve got a cadre of people who are in sticker shock, because their premiums are jumping 100 percent. On top of that, what we didn’t measure accurately is a huge air of indifference on the part of [consumers] who—for educational, cultural reasons, whatever—don’t give a damn. They’re not going to sign up for this or anything else. I’m starting to question whether our projections are anywhere near accurate. 

Dr. Goldberg:  These are exactly the questions we have to work through in the coming months. It is going to take a tremendous amount of hard work over the coming months [to restore credibility]. We have a situation where there is a lack of confidence from consumers. There is difficulty in enrollment. We’ve had a confusing and changing policy environment. We see individuals who see their out-of-pocket expenditures go up. Are we getting the right enrollment to have a sustainable marketplace? I cannot predict the future anymore than any of us can. We’re putting together a work plan…that will look at what the information is that we need [and] all those pieces of information in order to make the kinds of decisions we need to make as a state. We have a couple checkpoints along the way. One is certainly in the next month—is the technology we’ve been building viable? The other will be about the marketplace and how viable that is. In April, we’ll have a better sense of that.

Rep. Brian Clem, D-Salem:  I don’t want to throw in the towel and go back to the old system. It was terrible. I want us to make Oracle—they’re a very big company, I’m looking at their profits, $10 billion last year in net income—make them deliver the product that we paid them for. That’s what I want.

Dr. Goldberg:  I agree with you, and we’re looking at what our options are so that we can ensure we get an operating system.

Rep. Greenlick:  Bruce, I want to thank you. Your pessimism makes me feel much more optimistic. [Former Cover Oregon Director] Rocky [King]’s optimism always made me pessimistic.

Dr. Goldberg (laughing):  I’m glad I made you feel better.