Burlington, Vermont - April 6, 2011
"Certainly it can't get any more complicated than it is now," Donal Dugan said.
For the Dugan family in Burlington it's an evening of homework for their two teen sons and fresh baked cookies for Mom and Dad, too. That's pretty simple, but the family says even without major medical issues their health insurance is not.
"There's a lot of paperwork involved," Donal said.
The Dugans get insurance through Nancy's job with a nonprofit. Donal is self-employed. They are watching the health reform debate, hoping for streamlined, affordable care for all Vermonters.
"Things can happen. So I think, you know, it's important for us all to be covered," Donal said.
Lawmakers don't have many specifics in place yet. But by 2014, coverage for the Dugans and thousands of families like them will probably be very different.
The bill that passed the House sets up what's called an insurance exchange. Vermont is using the one already working in Massachusetts as a model. Residents there go online to buy their insurance coverage from a government-run site where they can compare prices and plan features. The federal health reform law says every state must have an exchange in place by 2014.
"What we are proposing in Vermont is that this be the mechanism through which most Vermonters purchase health insurance in order to realize administrative savings and simplify and make more comprehensible how you choose health insurance options," said Anya Rader Wallack, the special assistant to the governor on health care.
What that means for families like the Dugans is in 2014 they will still get their coverage through their employer. But most employers will have to choose from private plans selected by the state. And families will have to go online to register.
The price a family would pay for coverage will be decided by their income. For example, federal and state subsidies will help lower the cost for individuals making up to $43,000 and families of four making up to $88,000.
Your price will also be impacted by the options the employer wants and what choices the state makes available.
"I think the risk is that when 2014 rolls around there might be one carrier left in the state and one insurance plan. And whether you can afford it or not-- that's what you've got," said Jeanne Keller, who consults small businesses on maximizing their health care dollars. She says the bill in the Legislature does not make clear which businesses will be required to use the insurance exchange.
Companies with fewer than 50 employees will have to use the exchange. Lawmakers will decide sometime before 2014 if businesses with between 50 and 100 employees will have to use the exchange or will be able to shop around for coverage. Large businesses and self-insured businesses will not have to use the exchange.
She says either way most Vermonters work for small businesses and will probably be using this exchange.
But details about what will be available to Vermonters at what cost will not be decided until after the bill becomes law and a newly formed Health Reform Board gets to work.
"You could end up having to pay a higher premium share," Keller noted. "You could end up with an employer saying, 'I'm out of this, I don't want to help you pay for premiums anymore,' because there is no employer mandate. Or it could turn out stars and roses."
Asked if this will be affordable for people, Rader Wallack answered, "No. There's no way it will be more expensive that it would have been without the exchange."
The Shumlin administration says that the Health Reform Board's first job is to find cost savings to make sure that the plans offered in the exchange are affordable and get more Vermonters covered.
"This bill is aimed at stemming the flow of insured folks from good coverage to not as good coverage," Rader Wallack said.
The exchange is designed as a temporary step on the way to a single-payer system. But some critics worry that if the single-payer system is never put in place we will be stuck with the exchange. And that's more reason, they say, to take more time creating it and offer Vermonters more plan choices. Single-payer advocates say fewer choices make comparisons easier for patients and will be easier to roll into a single-payer system.
Kristin Kelly - WCAX News
