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

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42 Comments on "Details emerge on health care exchange extension"

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Patricia Crocker
3 years 26 days ago

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…

Dave Bellini
3 years 26 days ago

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.

Patti Komline
3 years 26 days ago
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… Read more »
Rev. Lyle M. Miller, Sr.
3 years 26 days ago
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… Read more »
Jeanne Keller
3 years 26 days ago

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?

3 years 25 days ago
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… Read more »
James Sault
3 years 20 days ago

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
3 years 25 days ago

“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
3 years 25 days ago

” 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.

Craig Powers
3 years 26 days ago

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
3 years 25 days ago

“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
3 years 25 days ago
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… Read more »
walter carpenter
3 years 25 days ago

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
3 years 24 days ago

Walter,
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
3 years 23 days ago

“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.

Ralph Colin
3 years 26 days ago

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.

Jim Christiansen
3 years 26 days ago

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

Ruth Gaillard
3 years 26 days ago

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
3 years 25 days ago
Ruth, 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… Read more »
Lee Russ
3 years 24 days ago
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: http://www.civitas.org.uk/nhs/download/netherlands.pdf 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… Read more »
Walter Carpenter
3 years 24 days ago

“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
3 years 24 days ago
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… Read more »
Lee Russ
3 years 24 days ago
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… Read more »
Dan McCauliffe
3 years 24 days ago

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
3 years 23 days ago
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… Read more »
3 years 25 days ago

Amen, well said Ruth.

David Dempsey
3 years 25 days ago

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

David Dempsey
3 years 24 days ago

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?

Kathy Callaghan
3 years 25 days ago

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
3 years 25 days ago

“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.

rosemarie jackowski
3 years 25 days ago

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
3 years 24 days ago

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!

Walter Carpenter
3 years 24 days ago

“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!”

The question should be how many of the 45,000 Americans who perish annually from lack of health insurance would have lived if they had been able to get at least public health care?

http://mediamatters.org/research/2013/09/27/because-fox-asked-here-are-examples-of-people-w/196139

Dave Bellini
3 years 25 days ago

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.”

3 years 25 days ago

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
3 years 25 days ago

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
3 years 25 days ago

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

And how so?

Walter Carpenter
3 years 25 days ago

“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.

Jim Barrett
3 years 24 days ago

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.

Todd Taylor
3 years 24 days ago

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.

Pat McGarry
3 years 23 days ago

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.

3 years 22 days ago
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… Read more »
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