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Show me the money… and the regulation

BRATTLEBORO—H2O participants say state and federal law allows for the formation and funding of health care co-ops, but funding remains an “elusive piece” for the initiative, says insurance consultant Hilary Cooke.

In addition to mandating the purchase of health insurance advocating mainstream medicine, he said, the law also provides “statutory exemptions from the mandate to purchase health insurance for those with minority religious and spiritual beliefs and provisions favorable for health ministries and new health co-ops.”

There is also a provision for states to opt out and adopt their own system. Vermont is already considering seeking such a waiver.

According to Cheryl Conner, the new federal health care bill offers $6 billion to create co-ops.

Vermont allows employers to self-insure employees without sending any money to an insurance company. Therefore, employers or networks could, for example, self-insure employees (or members) with a structure that encourages the use of herbs over painkillers.

Changes and funding would have to occur locally and at the state level, said Conner, because at the federal level meeting “minority preferences” of the holistic 40 percent would not create cost savings.

The co-ops will need to start small, get traction serving as many members as possible with available resources, and think big along the way, Cooke said.

Ralph Meima views Conner’s approach as one that provides an alternative to government-funded insurance, yet still gives members universal access and preventative care.

But people can’t just go to the government for funding, he said. At the end of the day, no matter the delivery, someone pays for health care, according to Meima.

A family of four with employer-funded insurance pays on average $12,000 a year in premiums, not including their share of co-pays or medicines. Uninsured people often end up going the emergency room receiving either crisis or public funded care paid with by tax dollars, he said.

“Somebody’s still paying for it,” said Meima.

Sojourns Community Health Clinic in Westminster is a holistic medical establishment model in practice, said Meima.

Members of a health care co-op would “get more proactive information to be and live healthy,” said Meima.

Meima said he’s surprised co-ops have not been used to fund health-care delivery before, given their long history like rural electric companies or agricultural co-ops.

Success will mean having a large and diverse pool of members with a balanced mix of health-care needs to spread costs across. Success also depends on how well the organization is governed. Governance will prove tricky at first because these co-ops don’t yet exist, said Meima.

The Brattleboro Food Co-op is an example of a well-run organization, said Meima — one that started well and continued to develop a professional and successful culture.

Passion will yield results

To Cooke, participants clearly stated their “dos” at Saturday’s forum.

They do want universal access, income sensitivity, access to providers important to them especially “alternative” health care providers, and an emphasis on wellness. Participants also want more primary and preventative care.

Participants don’t want to pay for services they philosophically object to, like pharmacy and redundant services, said Cooke.

The next step, he said, entails engaging interested participants in continuing the development process.

According to Conner, she thinks Vermont will build the health care co-ops first but that groups in North Carolina, Hawaii, Alaska, Oregon and Northern California are also exploring the option.

“We want to change the health care landscape,” said Conner.

The H2O team wants to have three pilot locations up and running within six months.

“Let’s test it out,” said Conner.

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Originally published in The Commons issue #77 (Wednesday, November 24, 2010).

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