Report: Affordability largest barrier to health care access in Vermont

Affordability remains the largest barrier to consumer access to health care in Vermont, even for the insured, according to the 2013 Annual Report of the Vermont Health Care Ombudsman (HCO).
The HCO serves as a consumer advocate on state and federal health care issues and operates a free, statewide hotline to advise and assist all Vermont residents with health care and health insurance issues, regardless of income, resources or insurance status. The report provides an overview of the health care challenges Vermonters called about during the State Fiscal Year (SFY) beginning July 1, 2012 and ending June 30, 2013.
Access to Care and Affordability
Requests for assistance accessing care accounted for more than 25% of 3,167 calls to the HCO from Vermonters across the state in SFY 2013. Lack of affordability was cited as a problem by 527 callers - a 32% increase over SFY 2012.
‘Individuals increasingly have told us that they cannot afford the cost of medical care, their insurance premiums, or their plan’s cost-sharing,’ reported State Health Care Ombudsman Trinka Kerr. ‘Many told us they were foregoing care because they could not afford it, even though they had insurance.’
State Medicaid Programs
After affordability, the most pressing issue was the need for information about state Medicaid programs, which also relates to affordability in most cases. The number of callers seeking information about Department of Vermont Health Access (DVHA) programs increased 82% over last year.
Some callers had insurance they couldn’t afford and wanted to know if they qualified for state health plans, some needed health care services and didn’t know about state programs for which they were qualified, and some were having problems understanding the programs’ rules or navigating the eligibility determination process.
Mental Health Care
Calls regarding problems accessing mental health treatment increased 49% in 2013, compared with the previous year. The most frequently cited issue was the lack of affordable treatment for uninsured individuals, followed by difficulties finding psychiatrists and therapists and denials of coverage by insurers.
More Than $200,000 in Savings to Vermonters
HCO advocates intervened on behalf of callers to get claims paid, written off or otherwise covered in 153 cases; prevented 89 households from losing their insurance; and helped 178 households obtain insurance. Together, these actions saved Vermonters more than $200,000.
The HCO also reviews insurance company requests for rate increases that are submitted to the Green Mountain Care Board and appears before the Board on behalf of consumers to recommend lower rates when it feels that the requested rates are too high.
In SFY 2013, the HCO represented the public before the Green Mountain Care Board in 41 rate review proceedings, presenting detailed memoranda to demonstrate why the rates should be lower and, in some cases, appearing in hearings before the Board.
Created by the Vermont legislature in 1998 to provide advice and advocacy for Vermonters with health care and health insurance concerns, the Office of Health Care Ombudsman is not a state agency. It is program within Vermont Legal Aid, a statewide nonprofit law firm. There is no charge for HCO services.
For information on how to contact the Health Care Ombudsman’s office for assistance and for a broad range of consumer guidance regarding common health care access and insurance issues, visit the HCO website at www.vtlawhelp.org/health.