Health Care

What might transitioning to the federal exchange mean for Vermonters?

Republican lawmakers are calling for the state to scrap Vermont Health Connect and join the federal health care exchange, but the implications of such a move are unclear.

Vermont Health Connect has never worked properly and is currently propped up by a number of manual processes. It was taken offline in mid-September, but is expected to relaunch Saturday for open enrollment, a three-month period in which consumers can buy or renew health insurance.

Vermont increases the value of the Affordable Care Act’s premium tax credits for people who earn between 100 percent and 300 percent of the federal poverty line. For a couple that would be annual income of $15,730 to $47,190, respectively.

Gov. Peter Shumlin and Democrats in the Legislature have said the federal government won’t allow those subsidies to be included if Vermont transitions to the federal exchange.

If joining the federal exchange means forgoing Vermont’s additional premium assistance, then low- and middle-income customers would be required to pay more toward their health insurance.

An individual making $23,340 would pay $350 more in annual premiums, and a family of four making $47,700 would pay $716 more in annual premiums. There are roughly 21,000 people receiving premium subsidies through Vermont Health Connect.

Vermont also currently reduces people’s out-of-pocket costs beyond what is available in states using the federal exchange.

For someone making between $30,000 and $35,000 a Standard Silver high deductible plan would have an out-of-pocket maximum of $5,750. With Vermont’s cost-sharing assistance, that out-of-pocket limit would be $3,400. A person with high medical costs would save $2,300.

House Minority Leader Rep. Don Turner, R-Milton, said at a news conference last week that Vermont should bring back the popular Catamount Health plans as a way to keep coverage affordable.

Don Turner. VTD/Josh Larkin
House Minority Leader Rep. Don Turner. VTDigger file photo
Turner clarified in an interview Monday that his proposal is not to restore the actual health plans offered through Catamount, which the Affordable Care Act would preclude and which insurance companies might not offer.

Instead, he wants to use state revenue that previously went toward subsidizing Catamount plans to make up the premium assistance that would be lost by transitioning to the federal exchange.

Catamount plans were private insurance products offered to low- and middle-income Vermonters with certain income levels and who were eligible for financial assistance.

The state subsidies were supported by an assessment on employers who don’t offer their employees insurance. In addition, cigarette and tobacco tax revenue and flexible Medicaid funds were also used to support the subsidies. All of that money now goes toward the state exchange.

Turner has not devised a framework for how those revenues would subsidize insurance for consumers.

It’s also unclear whether the Catamount revenue stream would cover the cost of subsidies lost in the proposed transition to the federal exchange.

Vermont lowered premiums for the roughly 21,000 people receiving subsidies by $460,000 in October beyond what the feds have paid, according to state officials. But officials did not have a figure for the total premium assistance counting state and federal premium subsidies.

Peter Sterling, director of the health care advocacy group Vermont Leads, was critical of Turner for being light on specifics when he announced the proposal last week.

“I think he should have come forward with a more fleshed-out plan,” Sterling said. “Give us the details of how you think this is going to benefit Vermonters before you call for it publicly.”

Turner said he’s working with the legislative Joint Fiscal Office and fellow Republican lawmakers to draft a bill creating a framework and timeline for transitioning to the federal exchange while still maintaining subsidies.

He hopes to have the proposed legislation on the governor’s desk before the budget address in mid-January. That effort would require support from Democrats who hold the majority of seats in the House.

If the Vermont Health Connect site relaunches Saturday for open enrollment and is working well, there won’t be the same urgency to join the federal exchange, Turner said.

“None of us want to shut it down during the middle of an open enrollment period if it’s working,” he said.

However, even if Vermont Health Connect is working well, the state needs to do a “cost benefit analysis” before it continues to use taxpayer money to complete the website buildout, Turner said.

State officials have said the website, when it goes back online won’t allow automated changes to personal information or coverage, and small businesses still won’t be able to use it.

Another consideration for Vermont in joining the federal exchange is the U.S. Supreme Court announcement last week that it will hear another legal challenge to the Affordable Care Act. The suit challenges whether the federal exchange can offer subsidies at all.

A ruling against the Obama administration would eviscerate the Affordable Care Act, and require people in the three-dozen states using the federal exchange to pay the full cost of the insurance they purchase.

Editor’s note: This article was updated at 3:05 p.m. Tuesday.

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Morgan True

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  • Meg Streeter

    Most instructive: the paragraph that begins ” Vermont Health Connect officials were unable to say how much customers had received in subsidies……” If basic questions can’t be answered what confidence does anyone have that this failed experiment should continue?

    • Linda Baird-White

      Morgan True and Meg Streeter:

      If the current administration did not know those facts at that point in time and *did not offer to present that information in the very near future, Prior to the deadline of November 15th, it punches yet another (transparency & accountability) hole in the dam.

      *If this was the case then it’s quite safe to assume transparency is non-existent. If those figures are not available and/or worse, not known, it only further proves they Do Not Know what ta hell they are doing.

      • Kathy Callaghan

        True. But they’re doing it anyway! It’s like “trust us – and when we figure out what we’re doing with your health care, we’ll let you know”. Sorry – my health care it too important to me to buy that one.

        The lack of competence is breathtaking – the lack of transparency is audacious. It astounds me how “single payer” proponents can sit through one fiasco after another and still believe that this cast of characters can pull off a government-run health care system that is affordable taxwise, will be financially viable in 5 or 10 years, will not ration care, and is the utopian dream that they are convinced it is going to be.

        • Walter Carpenter

          “will not ration care,”

          How will single-payer ration care any more than it is already rationed? Tens of thousands of Vermonters without health insurance is, I suppose, not rationing care. Should exclude more of them?

  • Bob Zeliff

    I believe New Hampshire has a Federal run exchange. It has only one insurer, so there is no price competition. Also As such it does not include all of NH providers or hospitals. So some one on that State exchange may have to drive a very long way to get to a Doctor or Hospital to get covered care.

    The as mention, there is the conservative case before the supreme court which is pushing hard, yet again, to remove all Federal subsidies for that type of exchange.

    It is curious that Vermont conservative republicans are pushing Vermont toward a Federal exchange that might have ALL it’s low income subsidies removed???

    Could it be a tactic to kill it?. Go back to the old ways….which gave us double digit cost increases?

    • Walter Carpentwr

      “Could it be a tactic to kill it?. Go back to the old ways….which gave us double digit cost increases?”

      And back to 50 million uninsured around the country and 40,000 here in Vermont alone. Without the subsidies, everyone pays these double digit increases and no one can get health care — exact.y what the insurers want.

    • Darcie Johnston

      NH will have 5 insurance providers and 60 different plan options on the federal exchange. Also, the insurance plans will be more affordable then any option on VHC (if and when they tell VTers the full cost of the 2015 plans).

      • James Mason

        Hi, Darcy!

        You don’t address the fact that rural NH is short on hospitals and even with multiple insurance carriers, people will potentially need to still drive hours to reach their covered hospital.

        How does that compare to single-payer where you can go to your closest hospital without worry of massive bills not covered by insurance, like this poor WI resident?

        Please, Darcy, please! Explain to us all how the old system was better. Since you’re one of the most “preeminent” “experts” on this, I’d really like to know how nearly 10% of Vermonters being uninsured is a good thing, or how it’s best that hospitals and doctors can turn away low income patients.

        Or better yet, Darcy, what’s YOUR plan to ensure every Vermonter can get quality medical care? You’ve spent countless hours on TV and other media haranguing and sermonizing about how the new system is awful, but I can’t recall you ever presenting an alternative. I can’t wait!

    • Karen McCauliffe

      Bob, NH had one insurer in 2014 in the exchange, but they will have five insurers for 2015. Also all the NH hospitals will accept three out of the five insurers’ exchange insurance for 2015. Please see the two links below to note the changes in NH’s exchange for 2015. Also Vermont’s exchange insurance has hefty premium increases for 2015. BCBS’s exchange insurance has an average premium increase of just under 8% and MVP’s exchange insurance is just under 11% for 2015.

      “Federal officials said they were pleased to see increases in states with few options this year. In New Hampshire and West Virginia, the federal exchange had just one private insurer this year, officials said. The number is expected to increase to five in New Hampshire and two in West Virginia.”

      “All 26 hospitals in the state will accept coverage from at least three of the five carriers next year, a change that will likely be very popular with the state’s residents.”

    • Kathy Callaghan

      BobZ, a recent article showed that in its second year, the New Hampshire exchange now has many more insurers, and a choice of 60 health plans, and competitive premium rates! I will try to find the cite and post it. I’m sure you won’t be happy about this, but it appears that the free market does work after all……

      • Walter Carpenter

        “’m sure you won’t be happy about this, but it appears that the free market does work after all……”

        But it works for whom? That is the real question.

  • ron jacobs

    Typical GOP manipulation of the people’s unfamiliarity with web scenarios. The problem with VHC is the website, not the program. The solution is to fix the website, not give up the control of the program. If the state had hired web designers and put them on the payroll so there was some accountability, this would not have happened and the cost would ahve been less. Unfortunately, everybody in modern government wants to privatize services that should NOT be privatized.

    • ” The problem with VHC is the website, not the program. The solution is to fix the website, not give up the control of the program. ”

      Exactly. Some don’t seem to know the difference. That said, VHC is still an overly expensive, complicated insurance program that still won’t achieve universal health care. Universal health care based on one’s ability to pay won’t happen until 2017 as long as our politicians have the courage to follow through with Act 48.

    • Kathy Callaghan

      “The problem with VHC is the website, not the program.”

      The problem with VHC is the state’s inability to create or manage it, not the website. Which will repeat itself if or when single payer ever comes to pass. People need to realize THAT.

  • Ross Laffan

    So, the people who whined or years about not knowing details, have offered no details of their own plan. Maybe they could stop playing politics with people’s lives.

  • Jamie Carter

    Turner is almost as bad as Sunderland for the VTGOP… when we are able to get some competent leadership then the right can’t start to regain some balance in the Legislature. As long as we have the level of incompetence we do now the status quo will continue.

  • Karen McCauliffe

    How is Vermont going to “fund” the estimated annual cost of $18 million per year just to run its state exchange? Many states did not set up a state exchange as they were concerned about the annual cost of maintaining the state exchange. $18 million per year funded by Vermont taxpayers for a currently non-operational website. $18 million per year for “no hands on health care”.

    “Larson said it was not for the roughly $18 million a year needed to run the exchange, which the state will be liable for paying in 2015.”

  • Peter Yankowski

    Peter Sterling, director of the health care advocacy group Vermont Leads, was critical of Turner for being light on specifics when he announced the proposal last week.

    “I think he should have come forward with a more fleshed-out plan,” Sterling said. “Give us the details of how you think this is going to benefit Vermonters before you call for it publicly.”

    • Peter Yankowski

      In regard to the comments from Peter Sterling (cited above) demanding more details from Don Turner…….shouldn’t Mr. Sterling have directed those “more detail” demands to Gov. Shumlin?

      Isn’t it Gov. Shumlin with his massive staff and who has spent years and hundreds of thousands of dollars researching single payer, the one who owes the people more details?

      • Paula Schramm

        He does indeed, and we will be hearing them soon.
        who were always complaining about how we were “rushing into things”, going “too far, too fast”, while also complaining about how long Gov.Shumlin was taking with his financing information, can’t seem to figure out which way they really want things ( other than to destroy single-payer, that is.)
        Now, suddenly they want to push something obviously inadequately thought-out, onto the governor’s desk practically before another week goes by. ( see Phil Scott & Republican Senators VTDigger press conference ). Yikes…

        • Peter Yankowski


          So you say we be getting the details soon.

          You are undoubtedly aware that MIT professor Jonathan Gruber, who is preparing the single payer financing plan details for Gov. Shumlin was heavily involved with the the development of Obamacare.

          You are also most likely aware that Professor Gruber has said “aspects of Obamacare needed to be concealed from the public due to the “stupidity of the American voter.”

          Now, what sort of expert advice on single payer do you think we will be getting soon from Professor Gruber, an individual who believes that the American voters need to be kept in the dark because they are stupid?

          One has to wonder if Professor Gruber also believes that the Vermont voters are are also stupid…….after all look how Gov. Shumlin has treated us.

          Lets not forget that Professor Gruber will be paid $400,000 of hard earned Vermont tax payer money…… we’ll see the details soon from someone who thinks the people are stupid.

          Can’t wait!

          • Paula Schramm

            Peter -“so we’ll see the details soon from someone who thinks the people are stupid.’

            Your argument so nicely deflects from the actual point made : that Vermont
            Republicans seem to be desperately trying to throw out everything they can think of at the last minute as an alternative solution to the health care challenge we all face : how to have access to actual, affordable health CARE for all Vermonters that is paid for in an equitable way…a sustainable system where costs can be controlled. They’ve had all this time, while Gov. Shumlin has been delaying coming out with the financing plan….but they’ve come up with no well-thought-out ideas that will even begin to meet these criteria.
            Accuse your opponent of calling people stupid ? How Republican of you.

          • James Mason

            @Peter Yanks:

            By the way, the “architects” of the ACA was the Heritage Foundation (in 1989), Newt Gingrich (in 1994), and Mitt Romney (2006). Here’s a great article from Forbes (that notorious Communist rag):

            But that’s OK….you can keep spreading lies and misinformation. I’m sure nobody else will ever call you out on your FUD.

          • Peter Yankowski

            James Mason:

            I do understand that this issue is complicated and you may be confused and missed the point.

            The issue I raised as to do with Professor Gruber’s attitude toward people he believes are stupid and thus unable to comprehend the nuances of Obamacare. This would include you along with most of the rest of us.

            Professor Gruber is now all over the media apologizing for his thoughtless comments and past behavior.

            So what in the world has this got to do with me spreading lies?

      • Jim Christiansen

        Mr. Sterling, your rebuttle please?

        • Peter Yankowski


          No deflection in my comment….only the painful reality that the remarkably arrogant individual chosen by Gov. Shumlin to figure out the financing for a Vermont single payer system, by his own words, believes the voters are stupid….that should very worrisome to you and all Vermonters.

          Now what can we expect from him for Vermont? In my book, Professor Gruber’s low opinion of regular folks is a real problem. A problem for his own sorry self, Gov. Shumlin, you, me and the rest of Vermonters, who finally want some honesty and transparency in health care reform.

          As far as the Republicans are concerned, they’re as frustrated as any of us. They want Shumlin to stop wasting our money, trying to be first in the nation so he can look like some sort of hero and get things done.

          Sometimes simple is better. Maybe a re-look at Catamount along with appropriate adjustments should be considered. Such thinking can’t be much worse than where we are today and it won’t take a $100 million to do it.

          • Paula Schramm

            “Maybe a re-look at Catamount along with appropriate adjustments should be considered.”

            Or, Peter, instead of back-tracking to a partly successful but unsustainable program that helped lead the Legislature to the conclusion that we needed to try a whole different way of doing things….

            We could :

            Maybe look at the financing plan Gov. Shumlin will put before the Legislature in January, for a lively and hopefully sensible and serious public discussion and debate process on a universal, equitable, publically financed system that gives affordable health care to all Vermonters.

            We’ve come this far – the GMC Board, established by Act 48, has been working diligently, and has already slowed the rate of increase in costs…let’s really work for a true Vermont solution to the health care challenges we face.

            You are ranting on about something that Prof. Gruber said, that, now that I’ve looked at the actual video, I can understand as an effort to be honest about the difficulties with passing the Affordable Care Act. He didn’t say he thought people were stupid….he was explaining a string of related elements and said a hypothetical like “you can call it the people’s stupidity”…
            I said this was so “Republican” of you, because that’s what they are so good …grab something out of context and spin, spin, spin it to death ….so people no longer care what was actually trying to be expressed, what the motivation was, or any other aspect of the whole truth about it. No – just label the person with a simple label- stamp it on their forehead if you can – and you don’t even have to present a coherent argument anymore.

          • Peter Yankowski


            I’ll be the first to admit that I don’t have all, or anywhere near most of the answers to these complex issues.

            On the other hand, I can recognize a potentially troubling situation when it arises. In this case, its the person selected by Gov. Shumlin to provide the needed answers, Professor Gruber.

            But let’s recall that you stated that we would soon be getting details on single payer.

            I simply pointed out that the source of the details would be Professor Gruber.

            As far as coherency of argument is concerned, you should be much more alarmed with what Gov. Shumlin says and does as you and all of us will have to live with his actions.

          • Jon Corrigan

            “grab something out of context and spin, spin, spin it to death”

            Apparently, Paula, we’ve seen different videos. If it was truly out of context, why is Gruber on the apology circuit?

  • Kelly Cummings

    Do you understand that you are ultimately fighting for returning to the days of health insurance that is cost prohibitive for Vermont, causes our property taxes to go up, denies us coverage because of pre-existing conditions, is unaffordable to many, can be rescinded at anytime, is lost when someone loses or changes jobs and is the cause of the majority of bankruptcies?

    Does anyone have the guts to explain the reason they want this?

    • Chet Greenwood

      It really takes more common sense than guts to explain.

      1. The cost of insurance was/is escalating but there is no evidence that ACA nor GMHC is going to stop the increases. Why do you think Shumlin delayed the 2015 healthcare rates until after the election? How many Vermonters are going without insurance now because of cost? More than before GMHC, but our $100+ million website probably can’t tell us this information.

      2. My property taxes are not tied to heathcare cost but they are tied to Education cost- unless you are referring to the teacher’s healthcare which comes out of Education funds.

      3. Pre-existing conditions, terminations and portability have all been addressed in the Republican fix if people would only take off their blinders and see what has been offered.

      4. Catastrophic coverage, interstate options and tort reform have all been addressed by the Republicans which will lower the cost considerably but all attempts of compromise have been blocked by the Democrats.

      5. Unfortunately, affordable coverage to some means “free” coverage and that is part of the problem.

  • Paula Schramm

    Don Turner is presenting a “not-ready for prime-time” plan that raises more questions than it solves, and his timing smacks of desperation : “Let’s try this !! Anything rather than look at an Act48 proposal “.

    For sake of brevity will look at just 2 of your points-

    “there is no evidence that ACA nor GMHC is going to stop the increases. ”

    It is a (unfortunately common ) mistake to lump the ACA, & it’s Health Exchange, together with Vermont’s own health care reform and the Green Mountain Care Board.

    It’s true that the ACA doesn’t really have a way to control costs much, though there has been some decrease in spending reported country-wide.

    But the GMC Board already has lowered the rate of increase with it’s hospital global budgets, and that’s certainly not the only savings a new universal system will bring.

    It’s just cavalier to make the above statement in regard to the GMC

    “Unfortunately, affordable coverage to some means “free” coverage and that is part of the problem.”

    This is just the usual right-wing emotional-garbage talking point. “Affordable” means people pay according to their means- we all pay in just like Medicare payroll deductions that we are all used to. It means we don’t cost-shift the emergency-room expenses of a person who can’t pay the bill by raising someone else’s insurance premium. It also means that someone who can’t work because of their injury or illness doesn’t suddenly lose their health care because they can’t afford their insurance payment.

  • ray giroux

    Left, Right. liberal, Conservative.

    Divide and Conquer……………