Editor’s note: This op-ed is by Peter Sterling, the director of the Vermont Campaign for Health Care Security, a nonprofit organization that works to educate Vermonters about, and enroll them in, public health care programs.
In an opinion piece in yesterday’s VTDigger.org, “Small Businesses Have Valid Concerns about Health Care Exchange,” Shawn Shouldice confuses readers about how individuals and businesses will and won’t be impacted by the federally-mandated Health Care Exchange and the goals of the state’s single payer initiative, Green Mountain Care, which can begin in 2017 at the earliest.
Ms. Shouldice writes, “Under the single carrier ‘exchange’ envisioned by the governor, private insurers would be forced out of the health care business.” In fact, this is the exact opposite of how health care will be offered in the exchange.
By law, the exchange, set to begin in 2014, can only include private insurance carriers (such as Blue Cross Blue Shield and MVP) offering various highly regulated, insurance products much as they do now. Nowhere in the federal or state law governing creation of the exchange is there any reference to a “single carrier.” Many of us who are monitoring the construction of the exchange expect both BCBS and MVP, the only two carriers currently offering individual coverage in Vermont, to continue to do so under the exchange.
Not only will private insurers not be forced out of the health care business but public programs such as VHAP and state subsidy for Catamount Health will be eliminated under the exchange and these enrollees will have to enroll in private insurance. So in fact, under the exchange, thousands of people will be moved from public health care programs into the products offered by private insurance companies.
Shouldice fails to mention that if the state were to decline to implement the exchange, the federal government, by law, would have to step in and do it for us. In what way is this preferable to a system designed and implemented by Vermonters? Would the 100,000 plus people who are going to be in the exchange be better served by a system run from Washington, D.C., rather than one that is accountable to a governor and Legislature we elect? I would think not.
Shouldice also writes that, “The deputy commissioner of Department of Vermont Health Access is busily working to build the benefit plan that will include two levels of out-of-pocket limits, so the Green Mountain Care Board can give its stamp of approval.” Again, she seems to be confusing readers with what may happen under Green Mountain Care and in the exchange. Under the exchange, there will be three levels of plans with differing actuarial values (the amount of health care costs paid by the enrollee versus the amount paid by the insurer) and within each level there will likely be several plans offered, a far cry from any limit to choices.
It is also not clear what the basis for Shouldice’s assertion that small business “…have valid concerns, yet they are being ignored.” No decisions have yet been made by the state regarding benefit packages, costs, etc. for any product that will be offered to businesses or individuals in the exchange.
What Shouldice also omits from her analysis is that under the exchange for the first time ever, public dollars will be used to subsidize small businesses that offer insurance to their employees. This will save Vermont employers millions of dollars each year in health care costs. And for small employers who choose not to offer insurance to their employees, these employees if they are in households under 400 percent of the federal poverty level (about $90,000 a year for a family of four), will receive a federal subsidy for their health care costs. In short, because of the exchange, Vermont small business owners and their employees will receive millions of federal dollars in subsidies for their health care costs.
While far from being a cure all to what ails our health care system, the exchange should serve as a good foundation for the necessary reforms of Green Mountain Care by bringing down the cost of health care for small businesses, making the application process simpler, making it easier for consumers to make informed choices, not to mention eliminating many nasty aspects of the existing private insurance market such as annual lifetime limits, pre-existing exclusions and waiting periods for publicly subsidized care.
Ultimately, the Shumlin administration is on the right path—moving Vermont away from the exchange which is built on private insurance companies (and their need to make a profit from providing health care) to Green Mountain Care—a single, efficient state run health care system that places the priority on cost control and providing the appropriate, high quality and affordable care people need.
