Wednesday February 6, 2013

In 2014 the world of health insurance will look very different for about 250,000 Vermonters. According to state officials, up to 40 percent of the state's population could be buying their insurance through something called Vermont Health Connect, the state's version of the federally mandated exchange. More enlightened health policy advocates think we should be calling the exchanges market places, to more accurately reflect the true nature of the beast.

The Vermonters who will be herded into the new plan will include individuals, families and small businesses such as Vermonters: who do not have health insurance, who currently purchase insurance for themselves, who have Medicaid or Dr. Dynasaur, who currently have Catamount or Vermont Health Access Program (VHAP), who are offered "unaffordable" coverage by their employers and small businesses that provide coverage for their employees.

The concept of the exchange is that it will be a place similar to the Orbitz travel web site where a person can shop for health insurance and compare prices and coverage. Of course, the process will still be as complicated as it is now (although policymakers want us to believe it will be simpler) and that is why they have set aside a big pile of money for states to hire navigators to be available to help people find the best plan.

According to the Jan.


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24 Vermont "Health Care Reform Financing Plan," some of the goals of Vermont Health Connect will be to: reduce the number of uninsured and underinsured, reduce disruption when individuals lose employer-based insurance, reduce administrative costs in the insurance market, contain costs, promote health, prevention, and healthy lifestyles by individuals and improve quality of health care.

Keep in mind that this whole exchange process was something forced upon the states by the federal Affordable Care Act. Vermont as been ahead of the curve in the realm of health care reform and that means that much of what has to been done to comply with federal law is a step backwards.

Vermont Health Connect is to have a number of critical functions that include: screening for and enrolling individuals in Medicaid and private insurance plans with federal tax credits, coordinating with other departments and insurance companies to ensure that individuals are seamlessly transitioned between coverage programs if their eligibility changes, working with small employers on their plan choices and collection of payments for their employees, negotiating with health plans on products to be offered on the exchange, developing ways for the exchange to drive quality and cost containment, developing and overseeing exchange operations, including the web portal, customer support center, navigator program, financial and reporting functions, and outreach and education programs.

Those are enough of the details for now. Needless to say, one has to wonder how this kind of health care reform will make our lives easier and better, considering that the insurance products being sold in the exchange will all be provided by commercial insurance companies.

It all means that 40 percent of us will have a lot to learn before the start of 2014 if we want to understand this new world of health insurance. This Thursday, Feb. 7, at 7 p.m. in the second floor conference room at Marlboro College Tech Center in Brattleboro, the Vermont Citizens Campaign for Health will be hosting an event to begin that learning process.

Peter Sterling, executive director of the Vermont Campaign for Health Care Security and one of a handful of people who understands the exchanges and can actually explain them in terms people can understand, will be on hand to talk about exchanges.

Sterling will address questions such as, "How will the new exchange affect me?" "How does the exchange impact the implementation of single payer?" and "What new health care reforms measures are being considered by the legislature and the governor?"

For more information contact me at vcch@universalhealthvt.org or check out details at the calendar section of the VCCH web site at: www.universalhealthvt.org.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.