Kirby Dunn runs the South Burlington nonprofit HomeShare Vermont. Claire Benedict owns the Bear Pond and Rivendell bookstores on Montpelier’s Main Street.
They both have five full-time employees, and by Jan. 1 they and their employees must buy health insurance on the new state-run market, Vermont Health Connect.
But their decisions in dealing with the new system and their experiences with the support network couldn’t be more different.
Dunn was optimistic about the new market. She figured it would be straightforward, and she appreciated the free, personal assistance available from the state’s $2 million, federally subsidized navigator program, which has funded organizations across the Vermont to help residents use the new market.
“I went into this thinking this is pretty simple. I have so many dollars, there are only so many plans, I can go online and do it before the rush,” she said.
She wants to provide full health insurance coverage to her employees, and she was hoping to get their health insurance squared away for next year.
But when the market opened last week, Dunn wasn’t able to register her business. After spending hours dealing with glitches in the system, she called the state’s hotline for assistance.
“I called up Vermont Health Connect, and they couldn’t help me,” she said. “I was on the line for forever, and then I called back the next day.”
She says the hotline worker she spoke to directed her to the Lake Champlain Regional Chamber of Commerce. The chamber received $120,000 from the state for its navigator program, and it has six in-person navigators who specialize in helping businesses. None of them have a formal background in insurance.
“The next day I called the chamber, and I asked for the particular person the website person recommended, and he was away until the 10th,” she said. “The first question to me was are you a member of the chamber? And I said, ‘No.’ And she said, ‘I don’t think we’ll be able to help you.’”
Mark Larson, commissioner of Vermont Health Access, said navigators were given taxpayer dollars to help all Vermonters seeking help with the market, not just members of their respective organizations.
Cathy Davis is a vice president at the regional chamber, and she says the incident should not have happened.
“That should not be the case. I personally have helped non-members,” she said. “We do have folks that volunteer out front … but we have continued to reiterate to staff that in our grant, it’s not just for members.”
Dunn said the navigators at Vermont Businesses for Social Responsibility were more responsive, but they could not meet with her in person for more than a week.
In the end, Dunn called her old insurance broker.
“They didn’t even give me a broker as a solution,” she said about the state. “They said go to a navigator or fill out a paper application. And the navigator turns me away. I didn’t think I needed a broker, but I do.”
A broker will cost her $20 per employee per month, but Dunn says it’s worth it.
“Thank God I went to the broker,” she said. “I think we’ll end up with a better policy and wrap-around services.”
Bear Pond and Rivendell
Claire Benedict had a very different navigator experience.
Benedict met Vermont Businesses for Social Responsibility navigator Anissa Lewis at a Montpelier Business Association meeting. While Lewis is a former insurance broker, many navigators have little to no health insurance background, but most have received training.
Lewis met with Benedict and her husband, Rob Kasow, who co-owns the bookstores.
“We thought it was great,” Benedict said. “She came right to our office and met with Rob and I and then met with any employee who wanted to talk to her. It was great service. She definitely knew her stuff.”
After more than two hours, Benedict said she and her employers had formed a consensus.
“It was pretty clear to us that the best thing to do was to no longer offer health insurance through Vermont Health Connect,” she said.
Benedict said her employees were able to pull down subsidies to make health insurance more affordable. The Affordable Care Act provides premium subsidies for individuals and families earning up to 400 percent of the federal poverty level. For an individual, that’s about $46,000 a year. For a family of four, that’s an annual income of almost $95,000.
“Not only would it be beneficial for the company to not offer health insurance, but it would be beneficial to the employees,” Benedict said. “The health insurance we were offering was extraordinarily expensive with high deductibles and high co-pays, but it was all we could afford.”
Benedict and Kasow will pay a price for not insuring their employees. For each employee they don’t insure, they will be assessed about $480 a year by the state.
In recent years, Bear Pond has paid the lion’s share of its full-time employees’ health insurance premiums. But like many small business owners, they have been grappling with soaring health insurance premiums in recent years.
“It’s getting to be a real problem for us,” Benedict said. “Our revenues are not going up as fast as our health costs are.”
Benedict and Kasow have not yet tried to register on Vermont Health Connect. They learned about the troubles others were experiencing and decided it’s best to give the state a month to work out the kinks.
“For us, it’s been all good,” she said.