Transition to health benefit exchange in Vt. nears

VERGENNES — At a Legislative Breakfast in Vergennes Monday, Addison County lawmakers served notice that residents this fall will begin to see a transition to a new federal health care system — and possibly a single-payer system four years down the road.
Many residents have been anxious about the impending transition to provisions of the federal Affordable Care Act (ACA) and then possibly to a state-initiated single-payer health care system beginning in 2017. Addison County has two legislators who will play a leading role this biennium in shaping that health care transition: Rep. Mike Fisher, D-Lincoln, who chairs the House Health Care Committee; and Sen. Claire Ayer, D-Addison, chairwoman of the Senate Health and Welfare Committee.
Ayer and Fisher explained at Monday’s breakfast that Vermonters will be able to see how they will fit into the state’s new health benefit exchange (a major mandate of the ACA) starting this fall. Operating under the moniker “Vermont Health Connect,” the health benefit exchange will be a marketplace where individuals, families and businesses in the state select a health plan that “fits their needs and budget,” according to a state flyer on the program.
Every plan offered through Vermont Health Connect must offer basic services like checkups, emergency care, mental health services and prescriptions. The program is for individuals, families and small businesses in Vermont, including those who are already insured; uninsured; covered by Medicaid or other subsidized health care programs; or who can’t afford the plans that are being offered by their employers.
Plans call for eligible Vermonters to be able to apply for tax credits and other financial assistance to help pay for their coverage through Vermont Health Connect. The first open enrollment for the program will run from this October to March of 2014.
State officials estimate that more than 200,000 Vermonters currently either don’t have health insurance or are under-insured. Vermont Health Connect, Ayer explained, is a step toward Vermont’s effort to establish a single-payer health care system by 2017. That single-payer system would be called Green Mountain Care.
Starksboro resident Dennis Casey was one of several people looking for more information on Monday about looming changes in the state’s health care system.  He spoke of the challenges, as a small business owner, in affording his family’s health care premiums as well as contributing to his one employee’s plan.
“It is tough to plan for the future when you don’t know how much (health care) is going to cost,” Casey said. “It doesn’t sound right that we should be starting some huge, new government bureaucracy.”
Ayer said consumers will begin to get health insurance cost estimates this summer. That’s when the insurance companies will be expected to declare their rate schedules for the ensuing year. That’s at least two months earlier than usual and is in recognition of Vermont Health Connect, Ayer said.
“If you are not in the group market, or in an individual market … chances are you are going to do a lot better (with your rate through the benefit exchange),” Ayer said.
Fisher stressed that establishing the benefit exchange is mandated by the ACA. The federal government will establish a benefit exchange in states that don’t take on the task.
“It is not the law that I would have voted for,” Fisher said. “My job for the past couple of years is to make the best of it for Vermont.”
Fisher warned that there will be “winners and losers” in the transition to Vermont Health Connect. The winners are expected to include those consumers who are currently in a more expensive insurance pool who will be moving into a broader, healthier insurance pool in the exchange. On the other hand, younger and healthier individuals moving into the broader pool could see some rate increases, according to Fisher.
“One of the things I like about the benefit exchange is that it creates more of a single risk pool for Vermont,” Fisher said, noting there are currently 17 risk pools in the small group and individual insurance market. “When you have a number of small pools, there is more variability.”
As for the concept of a single-payer system in 2017, Fisher said state officials are still crunching the numbers on costs. He believes the Legislature will not pursue such a system unless it proves to be viable and unless it saves the state a significant amount of money. Fisher believes the state needs to take some action soon, as Vermont’s current health care system is costing $5.3 billion annually and is seeing double-digit increases in insurance premiums.
“I will be the first to work against (single-payer) if there are no savings,” Fisher said.
Ayer agreed.
“We are not going to move to a system where we don’t know if we can do better (than $5.3 billion),” Ayer said.
Reporter John Flowers is at [email protected].

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