MANCHESTER -- With sweeping changes to the way many Vermonters are covered by health insurance now inching closer, an information forum scheduled for next Tuesday, April 30, may help provide answers to some of the questions and uncertainty that have surrounded the subject.
Robin Lunge, the director of Health Care Reform within the state’s Agency of Administration will be leading a discussion about the new health insurance marketplace, known as Vermont Health Connect, through which many Vermonters will begin purchasing their health insurance coverage, starting in January, 2014. The marketplace -- essentially a website where various insurance plans will be offered and comparisons can be made -- will launch on Oct. 1, 2013. Consumers will be able to start selecting and enrolling in plans from that point on.
With much underway between the state’s own health insurance overhaul efforts, which may by 2017 result in the nation’s first universal health care system if a needed federal waiver is granted, and the changes being ushered in by the federal Patient Protection and Affordable Care Act ("Obamacare"), it’s understandable that questions about cost and coverage are widespread, said Sean Sheehan, the director of education and outreach for Vermont Health Connect.
Lindsey Tucker, the Deputy Commissioner of the Department Health Access, a part of the state’s Agency of Human Services, was originally going to be leading the talk and taking questions during next Tuesday’s forum, but Lunge, one of the state’s top officials in the health insurance overhaul, will be appearing instead, he said.
"Robin will be explaining the big context of why the need for health reform is so pressing and looking at the calendar of what changes are coming this year and into 2014, compared to what is being talked about in the steps to universal healthcare in 2017," he said. "From there, she’ll focus on the changes planned for 2014 with Vermont Health Connect."
The forum starts at 6:30 p.m. and will be held at the Mark Skinner Library.
About 250,000 Vermonters are expected to be eligible to purchase their health insurance through Vermont Health Connect starting in 2014, according to its current, and largely informational, website. They include individuals who don’t have coverage at all, those who purchase insurance for themselves, those on existing state programs such as Medicaid, Dr. Dynasaur, Catamount Health or the Vermont Health Access Program (VHAP). Small businesses -- those with 50 or fewer employees -- will also be able to take part, with larger businesses -- those with 100 or fewer employees -- slated to follow suit in 2016. For these groups of people, Vermont Health Connect will essentially serve as a "one stop shop" where four basic different levels of coverage, ranging from "bronze" through the top of the line "platinum" plans, will be arrayed. Consumers should be able to compare the plans and select the one that best suits their individual or family needs, Sheehan said.
Staff will be available to field questions and render assistance over the telephone, for those who don’t feel comfortable with computer technology, he said.
All the plans offered must, under law, offer so called "essential" benefits, which include, among others, hospitalization, prescription drugs, preventative and wellness services, as well as pediatric services, he said.
The distinction between the bronze through platinum plans will be in how families and individuals opt to pay for them. Someone selecting for a bronze plan would pay a lower premium, but higher out-of-pocket costs, whereas a platinum plan would be the opposite -- higher premiums and lower out-of-pocket expenses, he said.
"Each (health insurance) carrier is required to offer multiple plans," he said. "Folks will be able to go on Vermont Health Connect and compare what the rates are for each of the plans."
And under federal law, it won’t be an option not to have health insurance. Financial assistance, in the form of tax credits and cost-sharing subsidies, will be available to help qualified individuals and families defray those costs. To qualify, an individual or a household has to earn less than 400 percent of the federal poverty level, which translates into $46,000 in annual income for an individual, and up to $92,200 a year for a family of four. Much debate and discussion has centered around the obligations and opportunities for small businesses, and Lunge will also be tackling that part of the health insurance changes as well, Sheehan said.
One of the thorniest questions many small business owners are grappling with is whether they should keep offering insurance benefits to their employees or drop it, since those employees will have the option, when the program kicks in next year, of going to Vermont Health Connect and shopping for their own insurance. About 47 percent of the state’s small businesses currently offer some kind of health insurance package, and unfortunately, according to Vermont Health Connect’s Web site, there’s no one-size-fits-all answer to the keep or drop question.
"Robin Lunge will address that," Sheehan said. "We’re in the process of developing tools to help them make that decision because it’s really an individualized decision for each business."
For example, according to the Health Connect’s Web site, a small village market staffed by lower or middle income employees might decide to drop their coverage in order to allow employees to take advantage of the federal tax credits. But a law firm, for example, with high income partners, might decide it made sense to continue their business coverage plan. Those businesses with a wide range of employee salaries will have a harder time crunching the numbers, according to the website.
Vermont Health Access is one of the state exchanges that have been much discussed since the Affordable Care Act passed Congress in 2010, and mandated that states establish them. States can develop their own, or the federal government will do it for them if they choose not to, Sheehan said. Should a federal waiver eventually be granted for a universal health care system -- sometimes referred to as a "single-payer" system -- the Vermont Health Connect exchange will fit into that broader initiative, he said.
"It will make quality health coverage accessible to more Vermonters and builds the technological infrastructure that will be the underpinning of universal care," he said.
The state’s health insurance program, much like its federal counterpart, has not avoided its share of controversy and concerns about costs. Vermonters for Health Care Freedom, an advocacy group concerned, as they state on their Web site, about healthcare reforms being pushed by Gov. Peter Shumlin, have raised questions not only about the nature of the exchange, but the high per capita costs required to develop and operate it. They stated the Vermont exchange will be unique among the state exchanges under construction because of the requirement that all individuals and businesses must purchase their insurance through the exchange without other alternatives.
For more information about the health insurance community forum, contact the Mark Skinner Library at 802-362-2607, or visit Vermont Health Connect’s Web site at healthconnect.vermont.gov.