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Survey shows local health insurance trends

MIDDLEBURY — Addison County residents have been registering in decent numbers for medical insurance through Vermont Health Connect, but local officials remain concerned about the number of children who are falling through the cracks of the federal program.
A total of 1,430 Addison County residents have enrolled thus far for insurance plans through Vermont Health Connect (VHC), according to Melanie Clark, one of a handful of part-time “navigators” who are helping steer citizens to affordable plans. That 1,430 represents 3.9 percent of the county. Statewide, 5 percent of Vermonters have enrolled. Folks who already have employer-sponsored health insurance deemed “affordable” are exempt.
Vermont Health Connect is the state’s health insurance exchange.
But there are 205 Addison County children 18 and younger who remain uninsured, Clark noted, largely because they are part of households that make slightly more than the threshold needed to qualify them for health care coverage through the state’s Dr. Dynasaur program.
These findings are included in the 2014 Vermont Household Health Insurance Survey, commissioned by the Vermont Department of Financial Regulation Insurance Division. The recently released survey was initiated, in part, to measure the health insurance coverage status of Vermonters.
Clark is a navigator with Middlebury’s Open Door Clinic, which dispenses health care to Addison County residents and assists people in finding affordable health insurance. The clinic sees a lot of patients (by appointment) who are uninsured or under-insured. Clark offers to sit down with these patients to assess their respective household incomes and steer them toward insurance they can afford — through Vermont Health Connect or other plans.
“We don’t always hit all of the uninsured individuals,” Clark lamented.
Local officials are taking stock of the 2014 Vermont Household Health Insurance Survey, which is giving navigators a sense of where to focus their outreach. And one logical outreach area will be households with uninsured or under-insured children.
“We were actually pretty surprised by this,” Clark said of the 205 uninsured children in the county. “We actually thought that Addison County was ahead of the game and doing really well.”
Clark noted all of the uninsured children in Addison County appear to be part of households earning between 300 percent and 399 percent of the federal poverty guideline. That translates to roughly $71,550 to $95,400 annually for a family of four, according to VHC information.
Clark explained that children in households earning less than 317 percent of the federal poverty guideline can qualify for Dr. Dynasaur, a health insurance plan for children of low-income households.
At the same time, statistics provided by the Vermont Department of Health show that Dr. Dynasaur insurance is reaching all of the Addison County children who are eligible to receive it. Navigators like Clark helped sign up a substantial 456 new enrollees in Dr. Dynasaur between 2012 and 2014, for a total of 2,247.
“It looks like in Addison County, we’ve done a tremendous job of getting all the kids who qualify for Dr. Dynasaur on to that program,” Clark said.
As for adults, Clark has been generally pleased with the number of Addison County residents who have met with her and other navigators in an effort to find affordable health insurance.
Between Nov. 15, 2014, and Feb. 15 — the open enrollment period for VHC — Clark helped 124 individuals, or an average of around a dozen per week. The majority of them required multiple consults or follow-ups during this period. Clark works approximately 20 hours per week as a navigator.
The 2014 Vermont Household Health Insurance Survey found there were 1,546 uninsured Addison County residents last year, representing 4.2 percent of the county’s total population. More than half of those without insurance have pointed to cost as the reason they were going without. And most are in an income range that barely disqualifies them from the more generous state subsidies, Clark noted.
“They qualify for some subsidies, but they don’t feel like it’s enough to allow them to pay for the insurance,” Clark said. “They feel it’s still unaffordable, even with the subsidies that the state is giving them.”
She hastened to say that most of those who have chosen to remain uninsured would prefer to have insurance, but feel they simply can’t afford the premiums. Some have cited child support payments as an expense that precludes them from purchasing their own insurance, Clark noted.
The cheapest plan through VHC — the “Bronze” plan — carries a $5,000 deductible, though preventative services are free.
“For a lot of them, they feel it’s not worth it to just have some sort of insurance,” Clark said. “Some will come in, sit down and say, ‘Tell me what my penalty (for not enrolling) is going to be,’ and, ‘Tell me what the cheapest plan is going to be,’ and they’ll decide they just want to take the penalty instead,” Clark said.
The “penalty” is the “shared responsibility payments” that are assessed as part of the Affordable Care Act to those who don’t sign up for a health care plan. Last year, that penalty was $95 per adult and around $50 per child, or 1 percent of the family’s household income — whichever is greater. The penalty is prorated and assessed through one’s federal income tax return.
“For some people, they are having to pay the whole year’s fine,” Clark said.
This year, the penalty is going up to $325 per adult or 2 percent of the household income, according to Clark.
“That can add up,” she said.
STILL TIME TO SIGN UP
It should be noted that VHC has opened up a special enrollment period for Vermonters who don’t have health insurance and who learn about the shared responsibility payment when they file their 2014 taxes. Those affected by the fee may apply and select a plan within 60 days from the date they discovered they would be subject to the penalty, but no later than May 31. Coverage will be effective as of the first of the month following plan selection.
To qualify for this special enrollment period, individuals must contact the Vermont Health Connect Customer Support Center at 1-855-899-9600. Individuals wanting one-on-one assistance to enroll should contact one of our local navigators and they can help walk them through the process.
“The goal of the state is not to fine people; they want people to get health insurance,” Clark said.
Clark and the state’s other health care navigators are keenly aware of the Shumlin administration’s recent ultimatum on the state’s health insurance exchange. The governor announced last month that the state will abandon VHC and invite the federal government to step in if the Vermont exchange misses another deadline for functionality. The VHC website has been plagued with various delays and glitches that have impeded some people from enrolling. The state has spent more than $126 million on the system thus far.
Clark said pulling the plug on VHC could make health insurance plans even less affordable for Vermonters, because she doesn’t think the federal government’s health care exchange would preserve the subsidies now available through VHC.
“I do want to acknowledge that although VHC’s system appears to be working much better for new enrollees, there are still a number of people who were automatically renewed into a plan for 2015 who continue to have problems with their bills and/or their coverage,” Clark said. “For the people who fall into this category, the delay in getting changes made in the system in a timely manner has been extremely frustrating and stressful.
“Vermont Health Connect’s goal is to have all pending changes done by April 15 and to have the technology in place by the end of May to significantly decrease the amount of time it takes to process a change in the future.”
Those seeking a VHC navigator can call Clark at 989-6872; Tom Turro at Porter Medical Center, 388-8831; and Debbie Goodrich at CVOEO, 388-2285.
Reporter John Flowers is at [email protected].

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