Navigators say insurance through Vermont Health Connect 'is unaffordable for many'


MONTPELIER -- Navigators helping Vermonters understand and enroll in health coverage through the state's insurance exchange reached people more than 1.5 million times in the past year, according to state estimates.

"That includes outreach by direct mailings, staffing tables in libraries and farmers markets and obviously helping individuals one-on-one," said Donna Sutton Fay, with the Vermont Campaign for Health Care Security Education Fund. The state figure includes many individuals who interacted with navigators on more than one occasion.

Navigators shared stories of the positive experiences they had helping people get covered at a Statehouse news conference Wednesday, but they acknowledged that the Affordable Care Act hasn't worked in everyone's favor.

"Depending on what your circumstances are determines sort of whether you're in a better position than you were before the Affordable Care Act," Fay said.

While subsidies have made coverage more affordable for some, other low- and middle-income Vermonters are feeling squeezed by the new system, Fay said.

"Coverage in Vermont Health Connect is unaffordable for many," Fay said. "For those who aren't eligible for Medicaid, the premiums are too high even with state and federal subsidies."

The out-of-pocket costs are even more prohibitive for many, Fay said, and several navigators said they had worked with people who chose not to purchase coverage because of its cost.

Vermont extended subsidies to a higher income level than the federal law required, and the only way to make insurance through Vermont Health Connect more affordable would be to increase state subsidies.

It's possible that premiums could rise when rates are set over the summer, but insurers have said it's too early to tell what their rate request from state regulators will be.

The federally set open enrollment periods are also problematic, Fay said. Previously, people with state subsidized insurance through VHAP or Catamount could cycle on and off those programs month to month.

Now people who don't purchase insurance during open enrollment can only get coverage if they qualify for Medicaid or have what is known as a "qualifying event," such as getting a new job or adding a new dependent.

The navigators agree with advocates and insurers who are calling on the state to conduct its Household Insurance Survey over the summer so the results can be used to coordinate outreach and target the uninsured.

For Vermonters newly on Medicaid the law is undoubtedly an improvement.

"There's no premium, no out-of-pocket costs, it is very good coverage," Fay said. The Medicaid expansion has given many Vermonters a dental benefit for the first time, although it caps coverage at $550.

The federal expansion of Medicaid allowed roughly 80 percent of people on VHAP and Catamount to enroll directly in the program. Another 23,000 people qualified by applying through Vermont Health Connect.

Although the Vermont Health Connect website has improved since its launch last year, navigators do more than help people negotiate the online application, Fay said. They go into communities to encourage people to seek coverage, help people parse the vagaries of health insurance and determine what coverage makes sense for their situation. With a short window to enroll in health coverage, their role will continue to be important, she said.

There are 278 navigators and certified application counselors working for 31 grant-sponsored organizations.

The Department of Vermont Health Access awarded $2 million in federal grants to navigator organizations last year. A new round of $2.7 million - including $400,000 in state dollars - will be awarded in July, according to the department.

"As thousands of Vermonters can attest, the Navigators are an invaluable resource and have helped so many Vermonters better understand health insurance and access coverage," Emily Yahr, a department spokeswoman, said in an email.


If you'd like to leave a comment (or a tip or a question) about this story with the editors, please email us. We also welcome letters to the editor for publication; you can do that by filling out our letters form and submitting it to the newsroom.

Powered by Creative Circle Media Solutions