Details emerge on health care exchange extension

Robin Lunge, the state's director of Health Care Reform, speaks to a group in Montpelier. Photo by Roger Crowley/for VTDigger

Robin Lunge, the state’s director of Health Care Reform, speaks to a group in Montpelier. Photo by Roger Crowley/for VTDigger

Gov. Peter Shumlin’s backup plan for the state’s new health insurance market is designed to ensure that Vermonters eligible for the program have access to medical coverage on Jan. 1.

The two key takeaways? 1. Under the new guidelines, if small businesses don’t make a decision by the new year, the insurance companies can make it for them. 2. The state is extending coverage for VHAP and Catamount beneficiaries.

The latter could drive up unforeseen costs for the state budget.

A week after Shumlin announced a contingency plan for the state’s new health insurance market, his commissioner of financial regulation put it into motion. On Thursday, Susan Donegan issued an order defining the parameters of the new options available to 100,000 Vermonters buying health insurance independently or via businesses with 50 or fewer employees.

Vermont Health Connect released guidelines Friday for employers and employees and Vermonters who are extending their subsidy plans or buying insurance independently.

Vermont Health Connect was set to become the sole health insurance marketplace for these groups on Jan. 1. But technical problems and delays plaguing the Web-based exchange forced the administration to offer new options.

The administration is automatically extending state-subsidized Catamount and VHAP plans for low-income Vermonters who are already enrolled in the plans through March 31.

The Catamount and VHAP programs were initially set to expire at the end of 2013. Mark Larson, commissioner of Vermont Health Access, said he believes the federal government will continue to fund these programs at a 55 percent match for three additional months. That funding is not guaranteed, however.

Of the roughly 50,000 Vermonters covered by the plans, the state estimates about 30,000 are eligible for Medicaid in 2014. The state will automatically enroll those Vermonters in the Medicaid program.

The remaining 19,000 Catamount and VHAP beneficiaries are eligible for the three-month extension, officials said.

The state did not budget for this scenario.

Larson did not provide cost estimates for the extension.

Deductibles, Deadlines and Defaults

Small businesses have three options.

They can keep their current health insurance plans until March 31, which is the end of the federal open enrollment period for new plans. They can buy one of 18 plans offered on Vermont Health Connect directly from one of the two insurers selling them — Blue Cross Blue Shield of Vermont and MVP Health Care. Or they can default by deciding to make no decision about health insurance by Jan. 1.

The latter option would effectively give insurance companies the power to make the decision for a business. Insurers would choose the plan for employers and employees that most closely resembles their current plan.

“If they don’t make a decision, they would be mapped to the most similar 2013 VHC plan,” Larson said.

Robin Lunge, director of Health Care Reform, said the insurers will send small businesses a letter letting them know what plan most closely resembles their current plan and what the deadline is for extending coverage until March 31. Deadlines could vary.

While only small businesses have the option to buy directly from insurers, Vermonters buying plans independently can also extend their current coverage. If these Vermonters decide not to act on health insurance by Jan. 1, their coverage will automatically be extended through March 31.

To be covered on April 1, Vermonters buying new health insurance independently must do so by March 15 through Vermont Health Connect.

Although the open enrollment period for purchasing plans technically ends March 31, Vermonters will have 60 more days to buy new coverage because the end of their current plans constitutes a so-called “qualifying event.”

Small business employers and employees have tighter deadlines. For new coverage to take effect April 1, employers must choose plans by Feb. 1 and employees must choose plans by Feb. 28.

Deductibles and out-of-pocket limits will reset Jan. 1 for extended plans. What Vermonters spend on health care costs toward those deductibles and out-of-pocket limits can only be applied to another plan offered by the same insurer.

If an individual reaches his or her $1,000 deductible on a Blue Cross plan by April 1, that payment toward the deductible will only carry forward if he or she buys a new Blue Cross plan. That person’s deductible would be reset if he or she decided to switch from Blue Cross to MVP, or vice-versa.

Lunge said that the two insurers handle contributions toward out-of-pocket limits differently. She encouraged Vermonters extending their plans to call the insurers to find out more about the details. The fact that a person’s current plan might not have out-of-pocket limits could complicate the situation for that person.

Larson says Vermonteres can buy plans through Vermont Health Connect by phone or paper. The state is working with its contractors to make the website’s payment mechanism functional.

“We continue to encourage Vermonters to use Vermont Health Connect,” Larson said. “We believe that there are very clear advantages and opportunities for them.”

Andrew Stein


  1. Patricia Crocker :

    It amazes me how government enacts patches to fix problems they originally created. Then problems arise in the patches used to “fix” the original problem. Kind of like the proverbial sketch in the Three Stooges where Moe hits Larry’s head with a Hammer so he forgets his toe is hurting. Then when he complains about his head hurting, he hits his hand…

  2. Dave Bellini :

    Extending Catamount and VHAP is the right thing to do. Vermont Health Disconnect wouldn’t be able to handle these folks by January 1st. Catamount and VHAP are more affordable plans for low and moderate income people. The state should find a way to keep VHAP and Catamount permanently. If the idea is to help people obtain quality health care, keep Catamount and VHAP.

  3. Patti Komline :

    This article is as informative as it could be I suppose but the Governor’s administration is not being totally forthcoming.

    “Larson did not provide cost estimates for the extension.” – I can tell you that if the Feds decide not to provide the 55% match for our VHAP and Catamount programs Commissioner Larson knows what the minimum cost to taxpayers will be. And the fact that he didn’t provide that information says it’s significant. If the state gets hit with that cost it is totally due to the Governor’s exchange debacle. And it isn’t like we didn’t have enough money to spend on good IT.

  4. Rev. Lyle M. Miller, Sr. :

    If anyone can understand what is going on with this mess. I will be amazed. I don’t think that any of the folks who put this mess in place in the first place has any idea of what is happening and what the cost will be going into the future. The only outcome will be the onslaught of rationing of healthcare, especially for out senior citizens which means that there will be increased pressure to get folks to choose the so called ‘death with dignity’ solution to their health care needs. Mr. Shumlin and all his cronies on the left with a socialist agenda need to be put out of office before they do any more damage to our Great Country.

    • Jeanne Keller :

      Rev Miller: Our senior citizens continue to be covered by Medicare, a federal program, that has nothing to do with Vermont Health Connect. Nothing whatsoever. VT cannot institute “rationing” to senior citizens, because VT does not determine Medicare benefits. Your “only outcome” prediction, therefore, is totally off-base. Take a deep breath, OK?

      • Ms. Keller, not so fast on what could be ahead for senior citizens benefits. Remember, the health care exchange fiasco and accompanying escalating premium disaster we’re now experiencing is only a pause on the way to the utopian Shumlin single payer system.

        For the Shumlin single payer system to work, wouldn’t medicare and other Erisa healthcare plans have to be rolled in and come under the control of Gov. Shumlin’s vision of what’s best for all, and his skillful management abilities guaranteed to make it all happen, on time and on budget?

        After Gov. Shumlin, again, gets his hands on things with his single payer system, then what happens to seniors and others?

        I’ll take several deep breaths on this one.

      • James Sault :

        You are so very wrong if this health care gets enacted medicare will will be effected and if the feds don’t pony up the money (as it has the right to) then who do think is going to pay for this mess?

    • Walter Carpenter :

      “The only outcome will be the onslaught of rationing of healthcare, especially for out senior citizens which means that there will be increased pressure to get folks to choose the so called ‘death with dignity’ solution to their health care needs.”

      It should be noted that our health care is already rationed in ways which shocks people who live in nations with single-payer systems. We ration by age, employment status, income eligibility, and general economics.

    • Lee Russ :

      ” The only outcome will be the onslaught of rationing of healthcare, especially for out senior citizens which means that there will be increased pressure to get folks to choose the so called ‘death with dignity’ solution to their health care needs.”

      Based on what? To make a statement that extreme based on the current circumstances helps no one, certainly not any senior citizens who might believe this hyperbole and become terrified.

      Really harmful and unsupported statement, Rev. Miller.

  5. Craig Powers :

    Absolutely unbelievable that decisions regarding our health care coverage are being made by these people. Can the evidence be more clear that they have completely failed so far and lied directly to the public? The supporters will continue to make excuse after excuse about the grand prize that awaits us all on 1/1/17. Do not be fooled by their dreamy Utopian rhetoric!

    Have you had enough Vermonters??? Please vote the reps and senators who voted for this fiasco out of office! They have made very short sighted and poor decisions.

    • Walter Carpenter :

      “The supporters will continue to make excuse after excuse about the grand prize that awaits us all on 1/1/17. Do not be fooled by their dreamy Utopian rhetoric!”

      Well, it is a private company, CGI, which has bungled this up so far. And we to go back to the same system of high-deductibles and policies which do not cover anything, tens of thousands of people without insurance, insurance dictated by employment, and so on, which has failed so dramatically?

      • Craig Powers :

        No Walter, I am sorry, you are really wrong this time. You are offering up CGI as an excuse, exactly as I predicted.

        It really is your beloved public servants in Montpelier who legislated that all individuals and small groups must purchase coverage via the exchange. They made a huge error and have created mass confusion. It did not need to be this way, but those in charge know what is best for us guinea pigs. They even lied directly to Vermonters that everything would be “just fine”.

        When I wrote one of my state reps about this mess, the email response to me was “good luck”! I am glad I never voted for that legislator. That legislator could care less about the ramifications of his party line vote. That was on October 3…three days after the VHC opened. As of today, my business, and my employees, still do not have anything ready for 2014. I have spent countless hours trying…I have called every conceivable person connected to this mess…still no one knows how to advise me to proceed.

        Care to offer up any more excuses or continue to blame everyone else but the people who passed these laws? Are you really happy that those who had coverage before are now scrambling to maintain what they had with the added stress involved? Is the playing field more even now?

        • walter carpenter :

          LOL Craig, like it or not, it is the people designing the website who mucked up the website. This is a fact. Whether the exchange is voluntary or whether it is as Vermont has designed it now, it is the people constructing the website who mucked the website up.

          • Chris Lewis :

            It is the responsibility of a project manager to perform due diligence to make sure they have all the necessary components to complete a project. Absent that, the manager needs to stop the project.

          • Walter Carpenter :

            “Absent that, the manager needs to stop the project.”

            Or re-model the project and I would like to see this remodeled as single-payer.

  6. Ralph Colin :

    This is a disgrace!

    It gets more and more complicated to the point where what was difficult to understand in the first place now becomes totally incomprehensible to everyone. The inmates ARE in charge of the asylum.

  7. Jim Christiansen :

    Will the monthly premium cost stay the same or increase with the Governors three month extension?

  8. Ruth Gaillard :

    All of this confusion and complexity would be avoided if we had single payer for all. Other advanced countries have decided that this works most efficiently and cost effectively, with better health outcomes.

    • Dan McCauliffe :


      Please realize that there are very few single payer systems in the world and Vermont will be intends on implementing a Canadian-style single payer system.

      I think that the general public and many single payer advocates are unaware that the best health care systems in the world are not single payer yet offer universal access.

      I have read so many op-ed pieces and comments on how the US needs to adopt a single payer health care system, as in the European countries and Canada. Well what these folks don’t know is that virtually all of the European health care systems are not single payer. What are considered to be the best health care systems in the world are not single payer but are mixed payer systems with both public and private funding.

      Canada is one of the few remaining single payer health care systems in the world, and this may change as the long waiting times are harmful to patients and creating an impetus to reform the Canadian system to be more like the mixed payer systems of Europe.

      A 2010 study found Canada dead last in timeliness and quality of health care compared to six other developed countries. It ranked 6th overall, just ahead of the US.

      In the 2010 Euro-Canada Health Consumer Index, Canada’s single payer health system ranked poorly compared to the many mixed payer systems in Europe. Canada ranked 25th compared to 33 European countries.

      The 2012 Euro Health Consumer Index is available, but did not include Canada. However, there is still much to learn from this latest analysis. The results of this latest study show how consumer empowerment, and abandoning the single payer model leads to better health care system results.

      From the full report:
      The Swedish authors of the latest study state:

      “The Dutch have established a European model to copy – NOT LEAST BY ABOLISHING SINGLE-PAYER SYSTEMS.” (Cap emphasis is mine.)

      “The NL [Netherlands] is characterized by a multitude of health insurance providers acting in competition, and being separate from caregivers/hospitals. Also, the NL probably has the best and most structured arrangement for patient organization participation in healthcare decision and policymaking in Europe.”

      “Here comes the speculation: one important net effect of the NL healthcare system structure would be that healthcare operative decisions are taken, to an unusually high degree, by medical professionals with patient co-participation. Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the NL than in almost any other European country. This could in itself be a major reason behind the NL landslide victory in the EHCI 2012.”

      The highly rated Netherlands’ mixed payer model is clearly not the future of Vermont’s Canadian-style single payer system with bureaucratic top-down control, that disempowers patients and their providers in medical decision making.

      The above study was critical of the single payer systems for good reason: they do poorly compared to other universal health care systems such as the Dutch and Swiss systems. It should also be noted that Canada spends about the same on health care as do the Netherlands and Switzerland.

      We should all be striving for the best health care system for Vermont that provides universal access while preserving high quality, containing costs, and avoiding rationing through long waiting times or other measures that cause patients harm. The single payer system, as used in Canada, is not the best suited system for achieving these goals.

      We should be looking at the best European health care systems as models for health care reform in VT and in the US, not the inferior single payer Canadian model.

      • Lee Russ :

        Anyone interested in the health care system currently used by the Netherlands should read a comprehensive description of it. The best one I’ve found is by Civitas and can be found online here:
        In essence, the Dutch system uses public funds to pay for long-term care for chronic conditions. The money is obtained by “income-related salary deductions, supplemented by a general government revenue grant.” For 2012, the income-related contribution was 12.55% of taxable income. Keep in mind that this pays only for the long-term care portion of total health care expenses.
        For basic healthcare—doctors, hospitalization, etc—the Dutch moved to a mandatory insurance system that in many ways resembles the Affordable Care Act (”Obamacare” to its opponents). The private health insurance market is responsible for providing the basic package of health insurance to all Dutch citizens, and purchase of the basic package is mandatory. Failure to buy it carries a penalty of 130% of the premium.
        For the private insurance, “The nominal premium is around €1,065 per annum (2009 average)…An income-dependent employer contribution is also deducted through their payroll and transferred to the Health Insurance Fund whose resources are then allocated among the health insurers.” Further, “Tax credits make the package affordable to those on low income.”
        The government specifies the minimum health insurance deal that must be offered by insurers, which includes:
        • Medical care: GP appointments, hospital care, prescribed specialist care
        • Dentistry for under 18 year olds; specialist dentistry and dentures for those over 18
        • Ambulance services
        • Post-natal care and midwifery services
        • Certain medications
        • Rehabilitation care: e.g. diet advice
        • Quit smoking schemes
        Further, at the time of the Civitas report, there were 29 insurance providers, down from 57 at the time the private insurance program was introduced in 2006. And “20 of these 29 providers belong to four companies which together have a 90% market share.”
        As to the Powerhouse report quoted by Mr. McCauliffe, its rankings of health care systems is a very subjective process, and the report itself notes that the Dutch system’s incorporation of patients and patient organizations into the decision-making process is a considerable part of what produced the Netherlands ranking. That kind of input can certainly be obtained under the planned Vermont system of publicly financed universal care if we do our planning properly.
        The ultimate fact is that Vermont has duly adopted a plan to institute a specific type of health care plan: publicly financed universal care. We have a limited time to get that plan finalized. We cannot abandon that plan and race to adopt the Netherlands’ system based on some subjective ranking. Not to mention, what would then do if the rankings changed next year and Norway suddenly became “number one?”
        It would really, really help if people worked on optimizing the plan we’ve adopted rather than putting all their effort into trying to kill that plan.

        • Walter Carpenter :

          “Dutch system’s incorporation of patients and patient organizations into the decision-making process is a considerable part of what produced the Netherlands ranking”

          Another thing to think about here. In our current health care chaos (pre-obamacare) patients have been pretty much left out of it.

        • Dan McCauliffe :

          Mr. Russ,

          You, Walter Carpenter and other associates of the Vermont Workers’ Center have campaigned strongly to establish a single payer plan for Vermont. Unfortunately for Vermonters you were successful and we are on track to develop a Canadian style single payer system despite its problems including very long waiting times.

          We need to reform our health care system to lower costs and achieve universal access. However, we should not be modeling our system after a system that does poorly compared to the non-single payer systems in Europe. I am not suggesting that we adopt the Dutch system as you insinuate. I suggest we utilize features of the best mixed-payer European health care systems, rather than adopt a failing single payer model.

          Over the years European countries, including the Netherlands and the United Kingdom, have been moving away from the problematic single payer model. Even Canadians are discussing a similar move, and a couple of Canadian provinces no longer outlaw the use of private funds to purchase health care services that are covered under their national health care program.

          It is not too late to consider alternatives, and we may have more than enough time, particularly if the Shumlin administration has difficulty developing a viable financing plan for single payer, as some have predicted. The skepticism has grown since the details of the single payer financing plan were not clearly shown in January of this year as required by law (Act 48 – the single payer law).

          It is important for people to understand that you can achieve universal access without a single payer system, and that is how the best health care systems in the world do it. So should we.

          • Lee Russ :

            Mr. McCaulifffe,

            It is important for people to understand the whole picture when it comes to health care. That includes how our system works (or doesn’t work), how the system we’ve enacted is intended to work, and how other alternative systems work.

            Both here and elsewhere you have quoted the article praising the Dutch system and rating it the best in Europe and closed with a statement that we should be looking at “the best” European health care systems as models.

            I think it is important that people understand the details of the system that your source rated as the best in Europe. As a matter of fact, that system includes a pretty hefty price tag, a mandate to purchase insurance, a very hefty penalty for not doing so, and a fairly rapid loss of anything like insurer competition during the mere 7 years the system has been in place.

            You are free to advocate for whatever you want, as are the organized forces opposing the planned publicly financed universal care system. But your advocacy tends to be in very general terms (i.e., “the best systems”) which makes it very hard for people to know what it is that you think is better.

            I think readers should certainly be able to take account of the actual details of any system offered up as “better” which is why I provided the link to the analysis of the Dutch system.

            I think readers should also be aware that many people–certainly including me–are of the opinion that, since we have a limited time to get our system optimized and running, our efforts are better spent doing that than second guessing the decision to adopt that system in the first place. Especially in light of the abundant evidence that a publicly financed universal care system works better than what we have now.

          • Dan McCauliffe :

            Lee Russ: “But your advocacy tends to be in very general terms (i.e., “the best systems”) which makes it very hard for people to know what it is that you think is better. ”

            I’ll say it again then, in simplistic terms. Mixed payer systems are better than single payer systems. This is the reason why countries are moving away from the single payer model.

          • Lee Russ :

            Mr. McCauliffe,

            I think we’re just talking past each other at this point. Given the wide variations in the types of “mixed” systems, and the wider variation in how these systems rank in terms of “quality” that really doesn’t clarify much: which systems, or at least which aspects of those systems are you advocating?

            Or are you saying that all mixed systems are better than all single-payer systems? If so….the Commonwealth Fund report you cited and linked in your original comment here, whch compared Canada, the US, Australia, New Zealand, the UK, Germany, and the Netherlands found that the UK–a single payer system, right?–the second best.

    • Amen, well said Ruth.

    • David Dempsey :

      We don’t. What is your remedy for the current problems?

      • David Dempsey :

        Ruth, you said “all this confusion and complexity would be avoided if we have single payer for all.” That may be true, but we don’t. What do you think we should do about the confusion and complexity we are encountering right now?

  9. Kathy Callaghan :

    A few thoughts on some of the comments above.
    Patti Komline is exactly right.
    Rev. Miller: I totally agree with your first 3 sentences.
    Craig Powers is also right .

    Ruth Gaillard – examine the state’s performance regarding the Exchange – both their work performance and ability to tell the truth to the voters (ability to be transparent), while contemplating handing over your health care fate to them in 2017. Really think about it.

    • walter carpenter :

      “Really think about it.”

      I do not suppose that Catamount, Dr.Dynasaur, Vhap, etc are a good examples of how the state could run a health care system.

  10. rosemarie jackowski :

    Single Payer saves money and Single Payer also saves lives. Every taxpayer in Vermont should be supporting Single Payer. Keep the money here instead of sending it to Wall Street.

    • Jim Barrett :

      Would you please give us some details on who has been saved by a government health plan in this country that would have otherwise died because they had a private carrier!

  11. Dave Bellini :

    I think the Governor and his political appointees should be required to be in the exchange plans. The administration doesn’t think the state employees health plan should be the design going forward. Why don’t they lead with their wallet? Lead the way. Show everyone how great the exchange plans are. The political appointees all make around $100,000 – $150,000, they can afford to pay the premiums. Lead the way political appointees. “Put your money where your mouth is.”

  12. Utopian healthcare pipe dreams, death with dignity panels, rationing healthcare, creeping socialism infecting the country, etc. ad infinitum, ad nauseam all because of efforts to provide decent health care for everyone! Get real!
    Every advanced country has a form of universal healthcare at half the price of our convoluted non system system with better results (they live longer)..the only socialism we have here is the perpetuation of our health insurance system regardless of performance due to political pressure from insurance lobbyists, Super Pac politicos, and some ideological demigods.

    • Craig Powers :

      I find it highly amusing that you are posting about ideological demigods…your posts are some of the most politically polarizing on the VT Digger website.

      • Walter Carpenter :

        “your posts are some of the most politically polarizing on the VT Digger website.”

        And how so?

  13. Walter Carpenter :

    “your posts are some of the most politically polarizing on the VT Digger website.”

    Ach, hit the post button by accident…”politically polarizing…” how so? The trouble is is that he is right.

  14. Jim Barrett :

    Government health care is such a waste of resources and for those who think something is free, think again it isn’t going to happen. Just reported on National news today…..Vermont is one of two so called exchanges in America that is the worst. A wonderful distinction for such a small state and millions going down the drain without hardly anyone even noticing.

  15. Todd Taylor :

    Cracks me up that all the ‘Wannabe Experts’ on here have all their articles ready to ‘cut and paste’ regarding European systems. How many of you ‘expert pasters’ have ever lived in Europe? I have. How many of you have relatives under this system? I do. Here’s a tip – quit reading and put your money where your mouth is – move there for a year and deal with it, then come back and tell us all about it. Your credibility will go up considerably.

  16. Pat McGarry :

    The rationing of healthcare to those on Medicare is already a reality- not too many primary care doctors accept patients with Medicare or a Medicare Advantage plan. Even those that currently treat some Mwdicare patients are not taking any new Medicare patients.

  17. The state of the Exchange website and the contingency options all present problems for employers that neither the administration nor, it appears, the insurers fully appreciate. In preparation for purchasing group sponsored coverage on the exchange an overwhelming majority of employers were unable to find a plan design that matched what they offer today. Suggesting that a plan with equal actuarial value is a plan that is equal in value to an employee is just not true. Plans with equal actuarial value can have very different design elements and depending upon an individual’s health scenario can mean a dramatically different financial outcome. This concern is mitigated to a degree given the employee choice that exists if an employer registers on the exchange and then employees enroll on the exchange platform. Employers preparing for this direction spent countless hours determining what would be a fair employer contribution in the exchange environment and an equal amount of time trying to explain the new concept to their employees. Of course now we know that use of the exchange is not a practical option if the employer wants to make sure employees have coverage 1-1-14. The deadline to enroll is November 30th; the deadline to communicate your intentions to the insurers is November 25th. Today is November 13th and we know an employer group can’t completely enroll their employees through the website. No employer can take the risk of banking on the website being fixed in time for all employees to enroll by November 30th. They have to look at the options- both of which present problems.
    The idea of choosing a plan with similar actuarial value and enrolling direct with the insurer forces a dramatic change in the employer design that creates potential employee issues and necessitates a great deal of communication and handholding by the employer. Again, if they were able to use the exchange the employee choice element would mitigate this issue. The administration and the insurers appear to be underestimating the sensitivity and burden of this issue for employers. Changing employee’s health benefits is not a simple task for an employer- It is hard enough to explain a simple tweak to copays and deductibles let alone the types of design component changes for most employers that come with a change to one of the exchange plans. It’s virtually impossible for an employer to look an employee in the eye and tell them that the plan they have chosen and related employer contribution will keep the employee “whole”. Remember employees/ employers were told with the passage of the ACA that you could keep your plan if you like it- understand that there is no truth to that in Vermont for small employers.
    The third option to extend your existing plan 3 months creates a host of additional issues that again seem to be dismissed by the architects of these contingency options. Don’t get me wrong, the idea allowing extension of existing plans is the right thing to do, however if there were a true understanding of what employers are dealing with in providing benefits to employees the extension should be allowed 12 months to 1-1-15. Wrap you head around the common small group benefit scenario where the employer provides an HDHP plan with an HSA. The myriad of issues that employers and employees need to understand regarding starting the year in an HSA compatible design with deductibles resetting on January 1st and then starting a new plan 4-1-14 are overwhelming. Added to the new decision making process for employees choosing on the exchange is the factoring in of any deductible an employee may have incurred in the 1st 3 months of the new year. HSA regulations must be understood- how much can the employee and employer put in an HSA in the first 3 months? And how is that impacted by the plan decision made on April 1? The considerations for what plan to choose changes entirely for employees on 1-1-15. Yes all these questions can be answered but most of the knowledge to answer these questions exists with the benefit brokers/ advisors who have been largely ignored in the contingency planning process.
    The most important point here is that employers are trying to run their business, the inoperability of the exchange, the design of the contingency options and the timeframes for employer/employee decisions are requiring an enormous amount of time and resources to figure out what to do and are robbing them of time they need to spend on issues more critical to their business. The solution is simple. Allow the current plan extension for 1 year.



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