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Experts explain health-care system in flux

More people gather to understand changes in store from Affordable Care Act

Reporter’s note: Vanda Warner, who organized the forum, is reporter Olga Peters’ stepmother.

WHITINGHAM—On a frigid November Monday evening, 60 people crowded into the Municipal Center in Jacksonville to ask experts some questions about the state’s new health insurance exchange, Vermont Health Connect.

The audience sat watching the panel, and the panel sat watching the audience, and Dr. Karen Hein, physician and Green Mountain Care board member, said she could see the looks of “concern, confusion, and consternation.”

She sought to reassure audience members that the state is following federal and state laws, that everyone is moving through this transition together, and that Vermont is ahead of the health care curve in many respects.

“[Still], it’s very complicated,” Hein said.

The state intends for every person in Vermont to have access to high-quality care, Hein said, adding that it also aims to bring down costs and develop an equitable method of paying for care.

“The exchange is a part of a much larger picture,” said Cassandra Gekas, health access policy and planning chief with the Vermont Department of Health Access.

All the decisions the state makes now are leading Vermont to a universal, publicly funded single-payer health care system, said Gekas.

Making the exchange mandatory for individuals and small businesses now helps ensure the right economies of scale, so the program can support itself, she said.

Vermont Gov. Peter Shumlin recently announced that insurance plans set to disappear on Jan. 1, 2014 could be extended to March 31. Small businesses and employees can also buy insurance plans directly through Blue Cross Blue Shield or MVP Health Care. Vermont Health Access Plan (VHAP) and Catamount Health may also be extended.

The extension was prompted by technical problems plaguing the debut of the online exchange.

As of Nov. 5, about 11,528 people have set up an account on the online exchange, VermontHealthConnect.gov, according to representatives of Vermont Health Connect.

According to Hein, Vermonters pay the highest amount for health care in the country, about $8,000 per person. She added that medical expenses are the chief cause of personal bankruptcy.

About a third of health care costs comes from over-treatment, Hein said, noting that inefficiencies, such as lost test results, drive costs up as well.

Hein stressed the importance of building a system that focuses on preventative care. She characterized a mismatch between the factors affecting health and how health care is paid for.

The strongest contributors to health rest with behavior, while health care accounts for about 10 percent of a person’s quality of health. That said, Hein contends, an average of 88 cents of each dollar spent on health goes towards health care.

Vermont opened its health insurance exchange Oct. 1. The program features 18 insurance plans arranged into bronze, silver, gold, and platinum tiers, all aimed at individuals and businesses with 50 or fewer employees.

Blue Cross Blue Shield of Vermont and MVP are the two insurance carriers in the exchange.

Although the state’s health care reforms have been decades in the making, the exchange falls under the federal Patient Protection and Affordable Care Act (PPACA), also known as Obamacare.

Starting in 2014, Americans will be required to have health insurance.

The state-managed health insurance programs designed to help low-income Vermonters — VHAP, Dr. Dynasaur, and Catamount — will dissolve as the exchange takes over.

Federal tax deductions and state subsidies will help eligible individuals pay their insurance premiums. PPACA has also set 10 standards for coverage, allows children to stay on their parents’ insurance until age 26, and provides for free preventative care without co-payments.

As well, people with pre-existing health conditions can no longer be denied coverage.

According to Anissa Lewis and Joan Bowman, certified navigators trained to help consumers choose health plans in the exchange, the 18 plans will contain the same 10 basic services — prescription drug coverage, hospitalization, and laboratory services among them.

Navigators are trained to counsel people and businesses entering the exchange. They can speak over the phone or meet people face-to-face.

The plans will differ the most in the amount of out-of-pocket expenses, they said.

Some of the other changes before the Green Mountain Care Board include changing the traditional fee-for-service model to a “bundle payment” system wherein consumers pay for an entire procedure at once, said Hein.

This model would focus on the results of a procedure: say, whether a patient receiving a hip replacement regained full mobility, and not just services.

The PPACA also caps out-of-pocket expenses at $6,300 for an individual and $12,700 for families.

The state estimates some 100,000 people will receive insurance through the exchange. According to Gekas, the state hopes to have 70,000 Vermonters covered by January.

Many small business owners wondered whether to offer insurance to their employees. The panel said small-business owners should speak with a navigator, the call center, or an insurance broker, as there is no one-size-fits-all solution.

Chiropractor Michele Doucette quizzed the panel on people having access to alternative therapies. The problem with the reform thus far, she said, is that it forces people to buy into a health care system that they may not benefit from or support.

The upshot of the discussion: “I wouldn’t put pen to paper without speaking to [a navigator],” said forum organizer Vanda Warner.

Each person’s or small business’ situation “is a case-by-case basis,” said Lewis and Bowman.

“It’s just a leveling of the playing field,” said Lewis.

Lewis said that VHAP has been her insurance program for years. When it disappears, her monthly premium will jump from $66 to $200 a month. This upset her until she met a self-employed woman dealing with cancer who had paid more than $1,000 for years, whose premium will now decrease.

The Vermont Health Connect call center is at 855-899-9600. For TTY/TDD call 888-834-7898. To find a local navigator, or to sign up for insurance, call the call center or visit VermontHealthConnect.gov.

The forum was co-sponsored by Whitingham’s town Democratic and Republican committees.

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Originally published in The Commons issue #228 (Wednesday, November 6, 2013). This story appeared on page A1.

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