Whether or not teachers and school employees will participate in the health benefit exchange is still in question. VTD/Josh Larkin
A provision in the federal health care law may mean teachers and other educators will not be in the so-called health benefit exchange insurance market in 2014.
Critics say this is unfair.
According to the Department of Vermont Health Access, 30 plans in the state in 2010 qualified for “grandfather” status under the federal health care reform law. Grandfathered plans are exempt from some new consumer protections and may not be included in the exchange if they continue to offer the same plan as they have in the past.
One such plan is through the Vermont Education Health Initiative (VEHI), a large, nonprofit purchaser of health care plans for school employees. The plan covers some 40,000 people, including teachers and other educational professionals, their families, and retirees.
Critics say it is unfair that groups like educators will be allowed to be outside the exchange while individuals and businesses with up to 100 employees will be required to be inside.
“Why give one group the potential to let some people stay out and not others?” said Jeanne Keller, a health policy analyst and lobbyist. “One can only speculate that this is a political and not a policy reason.”
The problem, Keller says, is that the exchange will limit what types of insurance people can buy, and, she fears, it will cost more. Essentially, people on the VEHI plan, could end up with better plans and not have to cover the overhead of the exchange, she said.
“If people resented the teachers before … cowabunga,” Keller said.
Under federal law, in 2014 and 2015 states will be required to include employers with 50 or few employees. The proposed legislation, House Bill 559 now in the House Committee on Health Care, proposes that employers with between 50 and 100 employees be “in” the exchange during this time — an option under the federal law. The proposed legislation also mandates that these groups can only buy insurance on the exchange.
The issue, says Sen. Vince Illuzzi, R-Essex Orleans, is that the under-50 employee and 50-to-100-employee groups are required to be part of this marketplace, while the larger over-100-employee businesses and certain plans like VEHI are exempt. Illuzzi proposed legislation that would have limited the exchange to businesses with 50 or fewer employees and allow them to purchase insurance outside the exchange.
Illuzzi said he is concerned that the proposed bill will allow large businesses and some unions to have a wider variety of plans to choose from outside the exchange while individuals and small businesses will be limited to the plans in the exchange.
“It’s not fair because if the exchange is being publicly promoted as a stepping stone to single payer and you give the largest group in Vermont a political pass it wants, how does that public proclamation stand in the face of scrutiny,” Illuzzi said.
The Shumlin administration has promoted the exchange as a way to bring more lives into the insurance risk pool to ensure more stability.
As for the inclusion of teachers in the exchange, Rep. Mike Fisher, D-Lincoln, who sponsored House Bill 559, said there is nothing the state can do about whether they are in or out.
The requirements for grandfathering, Fisher said, are “federal rules that we would have no power of changing or ignoring.”
“Will they be grandfathered on January 1, 2014, has to do with their ability to keep costs down,” he said.
Darren Allen, communications director for the Vermont-National Education Association, said the union is “taking a long hard look along with everyone else” at health care reform.
Allen said educators have worked very hard to achieve what they have in terms of health insurance. He said the contract they have for their health insurance has saved taxpayers millions by keeping premiums for these employees from rising as sharply as other plans.
Whether the 40,000 or so people on VEHI insurance will be in or out of the exchange, it is still an open question that hinges on those plans continuing to meet federal requirements.
For the teachers union, Allen said, “We are very concerned about what this will do to our members and retirees. It’s something we’ve worked decades to build.”
Permalink |
The exchange is just a stepping-stone to the single-payer universal Green Mountain Care system.
When we roll out GMC, will the educators on the union plan be forced to go into the basic GMC plan or will they be allowed to get additional coverage and keep the benefits they have now?
Will the tax payers be accepting of this, when they receive fewer GMC health care benefits than teachers?
Will those seeking social justice remain silent if the teachers are allowed to have more GMC health care benefits than the rest?
Other employees with generous health care benefits should have similar concerns about the future of their health care benefits under GMC. Hopefully the GMC Board can come up with acceptable solutions to these concerns.
Permalink |
As an interim step, the exchange should be as strong as possible, but it won’t be close to perfect. Ultimately, the solution is to create a benefit plan for everyone that is equal to what teachers and municipal employees and other professional have, and equal or better than what large employers offer. To create a multi-tier system rather than comprehensive health care for all will doom the system and undo all the hard work done so far.
Don’t mistake VEHI as a neutral entity- VEHI may be non-profit, but lots of people profit from it’s work and others have an interest in continuing to draw handsome salaries there. Educators are a very healthy pool, which accounts for the savings, not some magical work that VEHI performs.
Permalink |
Here we go!
All the advocates for single payer want everyone to be equal, but due to Fed law, big employers/groups will be able to stay out of the mandated exchange and probably have better benefits available. That sure sounds fair to me???…different plans for different groups based on size.
Your trying to create a fair and equal system that will never be fair and equal because of the morass of fed and state laws as well as politics. Once you plug the hole in one end of the dam, another leak will spring up on the other side.
Work on a plan to cover the uninsured and underinsured as a stop gap measure until they can begin to self sustain their own healthcare costs. This will certainly help to drive down costs for everyone because they will finally be insured.
Why tamper with what is working and create a bigger mess?
Permalink |
If Mr. Fisher knows that the federal law protects those who are grandfathered in from being forced into the exchange, why is he building a system that forces the rest of us to participate? The key here is choice: no one, including the smallest of businesses, should be forced to buy in the exchange. And the federal law does not require it. I support Senator Illuzzi’s bill, S 208, which would allow everyone to buy outside the exchange if they want to. If the exchanges turn out to offer a better deal, people will use them. Make them prove themselves.
To all the teachers out there, please don’t vote to force the rest of us into something that you are protected from.
Permalink |
Regarding:
‘The requirements for grandfathering, Fisher said, are “federal rules that we would have no power of changing or ignoring.”’
The multi-year process and financing for VT healthcare reform is dependent upon … “Federal waivers”. So why not ask for an additional waiver to remove this federal ‘grandfathering’ requirement.
Yes, the Vermont Legislature might not have power to change the federal law, but (I would think) they surely can ASK the Obama administration for another federal waiver!
Also, rather than forcing teachers to join the exchange, why not “include” the VEHI insurance plan (for educators and their families and retirees) as a “choice” in the healthcare exchange? Then allow other Vermonters to choose the VEHI option. That way, you start with a base of 40,000 plan members and allow it to grow. That way you don’t force the educators to leave their plan. But you make their plan stronger by having more members (an even larger risk pool).
Permalink |
What an interesting idea to include VEHI’s plans as “choices” on the Exchange. Mr. Pulcer: Please continue to add your out-of-the-box ideas to this debate. Truly refreshing!
Permalink |
“Why tamper with what is working and create a bigger mess?”
Our system is working? Really? Ask the 47,000 or so uninsured or the thousands iunderinsred if it is working for fthem. As for choice, what choices do we now have except one or another high-premium and high-deductible policy or access to insurance that is restricted by age, by income limits or other barriers? An employee with a public or private employer only has a choice of the employer’s insurance offering or none at all.
Permalink |
Like I said in many earlier posts…work on a plan to help those in need and do not take away from those who already have because of some mindset of “fairness”, or expect everyone else to pay. Everyone has to have some skin in the game and so far it does not appear to be the path we are headed down. I also note from other posts, on other topics, that you basically want everything to be inexpensive and paid for by others. This Progressive mindset will not work when there is no more money to take and everyone is on the dole.
Your philosphy of take, take, take and not offer any solutions does nothing to further your cause.
Permalink |
“Your philosphy of take, take, take and not offer any solutions does nothing to further your cause.”
Craig, I must admit that I am a bit curious on your definition of take. Exactly what does your version of take mean when we say financed equitably, everyone in and no one out. Under our current health care system, for example, a hospital will “cost-shift,” payments for the uninsured, who are rationed be economics out of the health care system, onto the insured, but that is, apparently, in your view, not “take, take, take,” from someone. But a system where everyone pays in to share in the same general run of benefits, is “taking.” And what exactly is wrong with fairness? Is that bad?
You say that my philosophy does not offer any solutions. We have tried your philosophy for the last sixty years and more and the only thing we have got for it is the mess that we are now in — that and a few billionaire health insurance CEO’s as the number of uninsured Americans rises every day. It is long past the time for a different philosophy of health care.