State makes slow, steady progress in health care reform

ADDISON COUNTY — Despite flagging enrollments in CatamountHealth, Rep. Steve Maier, D-Middlebury, stressed that the nearly three-dozenreforms currently being made to the state health care system have seen successin the 11 months since lawmakers put them in place.
“It’s big, it’s complicated, it doesn’t move or changequickly,” said Maier of state health care reform. “But I think we’ve made somegood progress so far.”
In less than a year, he reported, the state has enrolledone-sixth of uninsured Vermonters — a number officials estimated in 2006 atabout 63,600  — in state-sponsoredhealth care programs. Enrollments come in the wake of more than 35 specificinitiatives recommended by the Vermont Commission on Health Care Reform anddesigned to contain costs, increase access and improve the quality of healthcare for state residents.
But reforms still sparked concerns at a meeting of thecommission last Tuesday. Commission members worried primarily aboutbelow-expected enrollment numbers in the Catamount Health Premium AssistanceProgram (CHAP), a new program for those not eligible for existingstate-sponsored coverage programs such as Medicaid, Medicare or Vermont HealthAccess Plan (VHAP).
According to published reports, the state had estimated thatalmost 6,000 residents would be enrolled CHAP, in the state-subsidized versionof Catamount. The state added CHAP to its suite of health care programs — whichalready included VHAP, Dr. Dynasaur and Medicaid — last October. As of lastmonth, CHAP enrollment hovered near 4,000, including 253 Addison Countyresidents.
Maier stressed that Catamount enrollments are a small pieceof a larger picture.
“It’s a much more accurate picture to look at all of theprograms, because we made important changes across the board to make it easierfor people to enroll and less expensive,” he said.
According to a survey done by the Department of Banking,Insurance, Securities and Health Care Administration (BISHCA) in 2005, AddisonCounty had the third lowest rate of uninsured residents among the state’s 14counties. The county’s 8.4 percent rate, representing an estimated 3,051residents, falls below the 9.8 percent state average.
But health care in the county remains a significant concernfor residents — particularly because even state-sponsored programs can be tooexpensive for some. On the front lines of health care for the county’suninsured and underinsured is the Open Door Clinic, which operates twice a weekin Middlebury and plans to open a satellite clinic in Vergennes this fall.
The clinic is sponsored by Community Health Services ofAddison County, a local nonprofit agency dedicated to providing access forcounty residents who fall below 200 percent of the poverty line. (For aone-person household, this equals a monthly income of no more than $1,733.) Theclinic provided almost 1,000 clinic visits last year, and serves approximately300 patients each year, volunteer Betsy Hedley estimated.
The clinic, Hedley said, offers a “bridge” for patients onthe way to a permanent health care home. Its volunteers screen every patientfor eligibility for state-sponsored health care services. In the last sixmonths, she said, the clinic helped 80 of around 150 patients apply forinsurance, and knows of approximately 20 who have been accepted for coverage.
The response to the state’s new low-income health services bytheir target audience, said Hedley, is “mixed.”
“Most people would like to have insurance,” she said, “butfor most people, or a percentage of people, it’s about cost. Even though it’svery reasonable, we’re talking about lower income people.”
When you take into account the premium, co-pays anddeductibles, even what Hedley termed a “very reasonable” package can take up asignificant portion of an individual’s income. Until recurring or serioushealth care problems exceed the cost of coverage, she said, some applicants arereluctant to pay monthly fees.
“If you have a young, healthy person who sees the doctor oncea year for a strep throat, they can’t see any need to pay a premium,” Hedleysaid. “There are a certain percentage of people who fit into that category.”
BISHCA, the state’s health care watchdog, will surveyVermonters again this fall — reasons why the state’s uninsured do or do not signup for state-sponsored health insurance plans could be among they questionsthey pose.
According to the Rutland Herald, BISHCA’s telephone survey will poll 4,000 households about questionsrelating to health care. Dian Kahn, a statistician at BISHCA, told the healthcare reform commission that a portion of the survey will focus on the state’suninsured.
Although BISHCA surveys are among the state’s mostcomprehensive, Kevin Veller, a Coordinator of Outreach and Enrollment in HealthCare Reform Implementation, said estimates about the number of uninsuredVermonters are just that — estimates.
“In any state, Vermont included, that are in the throes ofhealth care reform, these are projections,” said Veller. “It’s a snapshot intime.”

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