Wednesday October 10, 2012

Last week, the Green Mountain Care Board voted 3-2 not to include adult dental benefits in the Health Benefits Exchange that will begin Jan. 1, 2014.

Despite responses by 1500 people urging the board to include the benefit, it appears that the relatively modest price tag of between $17-$24 million was enough for the majority of board members not to include adult dental care in exchange benefits. Pediatric dental and vision benefits will be included.

Here is what the board said in a public statement issued Oct. 4: "While the full board did not support mandating coverage of adult dental benefits through the Exchange, board members acknowledged that lack of insurance coverage for and access to appropriate dental care is a major challenge in Vermont. The board heard testimony to that affect at a public hearing in May and received more than 1500 written comments from Vermonters stressing the need for better dental coverage.

"The GMCB subsequently voted to commission a professional analysis of current access to dental care, organization of dental care delivery and financing of dental care in Vermont. The purpose of this study is to provide the GMCB with an objective analysis of these issues to support future decisions regarding additional investment of state, federal and/or private funds to improve dental care access and insurance coverage for dental care."

There are a few ways to look at this decision. One could say that the board acted in a fiscally prudent manner.


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They did not have a way to pay for an adult dental benefit, so the majority could not vote to include the benefit.

On the other hand, two of the five board members (Con Hogan and Karen Hein), not exactly reckless individuals, voted to put the dental benefit in the package because they knew how important healthy teeth are to overall health. I also suspect they may have realized that pinching pennies on dental care now costs more in the short and long run when people show up in the emergency room to be treated for a toothache or they can't get through a successful job interview because they don't have any teeth.

The Governor also has a lot of influence over this process. He has drawn a line in the sand and will not propose any new taxes. It is a troubling political stance for a politician who built a career on compromise.

A number of advocates have proposed a sugar-sweetened-beverage tax that would generate about $28 million a year in revenue. Shumlin is absolutely opposed to the tax, yet it would cover the cost of putting an adult dental benefit into exchange plans. A soda tax will not only raise money but it would also result in a decreased use of dental care. It is a perfect way to pay for dental care.

If the Governor and the Green Mountain Care Board can't take bold steps now, what will happen when they have to take even bolder steps to implement a single-payer health care system in Vermont when the stars become aligned in 2017? Will they cave in to the political pressure that comes when heading into uncharted territory or will they rely on common sense and the common sense of Vermonters to guide their decisions?

We need a governor and a board that can balance fiscal responsibility with the health care needs of Vermonters as we move forward into new territory. They must be willing to take calculated risks in the service of needy Vermonters instead of allowing political calculations to become too high a priority when developing benefits packages.

The board also presented some of the costs to consumers of six insurance plans that will be offered through the exchange. There may be a total of about 30. The figures are troubling and the board said they are concerned that "two of the six plans will leave Vermont's low-income residents with high health care costs in times of greatest need."

The GMC did not create the rules for the exchange, they only followed Federal laws to put it into place. It is insurance sold by private insurance companies. The exchange is really a step in the wrong direction for Vermont, but it is hoped it will eventually lead to an exchange with only one insurer that provides affordable coverage.

It is estimated that 80,000 Vermonters will buy insurance through the exchange. It will include people who purchase individual insurance and workers in businesses with less than 50 employees. It will also include people now on VHAP and Catamount Health who will have to choose one of these plans.

Why the concern? The cost of premiums will not be known until the summer of 2013 but we do know that one of the cheapest plans will have an Out of Pocket maximum of $6,250 a year as well as a drug maximum of $1,250. In addition, the policy will only cover 50 percent of inpatient hospital costs and outpatient costs, as well as only 50 percent of emergency room costs and primary care, urgent care and ambulance coverage. There will be a $12 co-pay for generic drugs.

It is beyond absurd to believe that a person now receiving benefits under VHAP or Catamount Health would even consider purchasing such a policy. It will make more sense for them to pay the $95 penalty and take their chances without insurance. Not exactly the kind of common sense progress Vermonters have come to expect.

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.