Editor’s note: This op-ed is by Peter Sterling, the director of the Vermont Campaign for Health Care Security Education Fund, a nonprofit organization that works to educate Vermonters about, and enroll them in, public health-care programs.
John McClaughry’s piece “Ducking the health exchange bullet” obscures or misrepresents the facts on several key aspects of the new health insurance exchange the Legislature and the Shumlin administration are currently debating.
Set to begin in January 2014, the federally mandated health care exchange will be an online, Expedia-like marketplace where consumers can compare various health insurance plans. And the majority of working families in Vermont, such as those earning less than $90,000 per year for a family of four, will likely receive federal subsidies to make their insurance more affordable.
Mr. McClaughry’s first misstatement is that if Gov. Shumlin has his way, Vermonters “will only be allowed to buy legislatively mandated one-size-fits-all benefit plan offered by a single carrier.” In fact, it’s legislatively mandated that the state work to have at least two Vermont-based carriers offering health care in the exchange. More to the point, under Shumlin’s proposal, there will be three levels of insurance plans with different deductibles, co-pays and the like. Additionally, because there will also be two federally mandated, multi-state plans, most observers expect there to be somewhere between eight and 12 plans offered in the exchange.
It is true that the administration is proposing a comprehensive, standard level of benefits that every Vermonter will have access to, no matter which plan they choose. McClaughry paints this in a negative light, but based on my experience helping people get access to health care, this is a major step forward, substantially simplifying the process of selecting an insurance plan.
Why should a person have to spend time trying to figure out if a plan covers the cancer drug they need, or fear that their insurance won’t cover the mental health treatment they need, whereas another plan might? The exchange will take the guesswork and confusion out of choosing health care benefits, because they will be standardized across all plans.
McClaughry uses classic doublespeak when he states, “This provision of the act will kill off all but the most expensive and impractical HSA high deductible policies.” To translate: in the exchange plans with high deductibles like $5,000 or $10,000 will be banned. Again, he makes this sound like a terrible idea. But I haven’t heard any support for these high-deductible plans from the people who are actually in them and on the hook for thousands of dollars in medical costs. Virtually every day, in fact, we hear from people in these plans who feel trapped and financially squeezed, and want to know how they can get into low-cost Catamount Health or VHAP instead.
McClaughry expresses his opposition to the state mandating that businesses with 51 to 100 employees be required to purchase health benefits through the exchange. This would cost Vermonters millions of dollars because anyone buying insurance outside the exchange will not be eligible for federal premium and cost-sharing subsidies. If McClaughry had his way, millions of dollars would be going to insurance companies instead of being saved by Vermonters and spent in our economy.
What he also fails to mention is that if Vermont does not set up its own exchange, designed and implemented by a governor and Legislature accountable to Vermonters, the federal government will do it for us. I don’t see how that is a preferable outcome.
Based on what we now know, thanks to tens of millions of dollars from the federal government and comprehensive, standardized benefits, the exchange should make getting health insurance easier and more affordable for both individuals and thousands of business owners. Unlike Mr. McClaughry, I see this as helping Vermonters lead healthier, more productive lives.
