Representatives from the state’s largest dental insurer, Delta Dental, say Vermont’s new health insurance exchange, Vermont Health Connect, could leave many of its 150,000 members with poorer coverage and higher out-of-pocket expenses.
In 2014, the exchange will become the sole health insurance marketplace for roughly 120,000 Vermonters who purchase insurance individually or through an employer with 50 or fewer employees. The plans on the exchange must provide the essential health benefits laid out in the Affordable Care Act. One of those essential benefits is dental coverage for children.
While the Green Mountain Care Board voted in October 2012 not to make adult dental coverage an essential benefit in Vermont, dental plans can still be sold on Vermont’s exchange as standalone plans or as part of comprehensive health insurance plans.
Delta Dental wants the Vermont Legislature to require the separation of dental and other health care plans on the exchange. This week, Delta Dental Vice President Bill Lambrukos pleaded with the Senate Finance Committee to do just that. Lambrukos asked the committee to amend House bill 107, but the committee did not.
“Separate Price and Offer works, and is working today. It is not broken,” he said. “Delta Dental Plan of Vermont joins the American Dental Association in supporting the selling of the dental product separate from the medical product. Such offering provides the promised transparency, the ‘apples to apples’ comparison of products, the choice of the plan and carrier the purchaser wants.”
Blue Cross Blue Shield of Vermont, the state’s largest health insurer, has embedded pediatric dental benefits into its proposed plans for the exchange, and Lambrukos is not pleased. He said this practice would hurt consumers in that it would obfuscate pediatric dental coverage by spreading those costs across all policyholders, including those without children. He also criticized Blue Cross for not providing full preventive dental coverage.
“Whereas Delta Dental, with much lower deductibles, starts to pay on diagnostic and preventive services immediately (first dollar coverage) the filed BCBSVT product does not switch to paying everything until a much higher out-of-pocket maximum is met,” he said.
Blue Cross representatives did not respond to requests for comment.
Despite Lambrukos’ best efforts, legislators are not convinced parsing out dental coverage in the exchange is the right way to go, and the administration is not fond of the idea, either.
Robin Lunge, Gov. Peter Shumlin’s director of health care reform, said the proposal would complicate the exchange. Separate components would also drive up the costs of state review and information technology, she said.
“It’s really an operations issue,” Lunge said. “It really would operate as two separate plans, and I think that would be pretty burdensome for families.”
Lambrukos argues that it would be more burdensome for families to pay more for dental care than they do now. He also says his team has tried working with the administration for more than a year on this proposal and was told not to push for legislation last session. He said it wasn’t until recently that it became clear that the administration was not in favor of the proposal.
“I’m surprised by that,” Lunge said about Lambrukos’ comments. “I know our exchange team was involving them in discussions around the operations. If the carriers can’t integrate the plans on their end to ensure that individuals and families aren’t burdened with tracking their own out-of-pocket costs, I don’t see that as feasible.”
Lunge said Delta Dental could offer standalone plans on the exchange or team up with other carriers, such as MVP Health Care. But neither option is likely to be as financially advantageous for Delta Dental, if Blue Cross continues to offer its integrated plans.
Sen. Kevin Mullin, R-Rutland, said he’s concerned that the issue wasn’t fully aired in the Legislature this session. He sits on the Finance Committee and said there isn’t enough time left in the session for the committee to fully consider Delta’s proposal.
“I don’t think anybody is taking the time to give Delta a fair shake on this one,” he said. “My concern is that we have the best pediatric dental coverage we could have, and at this point I feel like I don’t know about the issue and there is just not enough time for the Finance Committee to know enough about the issue.”
Sen. Sally Fox, D-Chittenden, vice chair of the Senate Health and Welfare Committee, believes her committee gave the proposal a good look.
“We spent a fair amount of time on the issue to make sure that there was pediatric dental in the plans and that it wasn’t going to be exorbitantly expensive,” she said. “It made it less compelling that we had to carve out something just for Delta Dental, and we thought there would be further clarification from the feds about dental. So, we figured since it was all covered, we’d leave it the way it was.”
