by Jennifer Brandt Vermont Business Magazine Many questions still loom as the deadline for the Vermont Health Care Exchange as mandated by the federal affordable care act draws near. The federal mandate states that the system must be implemented by January 1st 2014, but the Department of Vermont Health Access (DVHA) hopes to have the new website for Vermont’ s new healthcare services up and running by October 1st. The DVHA plans on public media campaigns to get the word out to all Vermonters about the new system during the summer of 2013.
Estimates say that there will close to 30 different plans to choose from through the Vermont Exchange. A goal of the new system is to reduce the complexity of purchasing health care for Vermonters. Health coverage will not begin until January 1st 2014, and open enrollment ends for individuals on March 1st 2014. According to the Vermont Campaign for Health Care Security Education Fund, the following Vermonter’ s will be eligible.
Individuals currently in the individual (non-group) market’ currently 16,500 including 13,000 Catamount enrollees
Small businesses with 50 or less full time employees
Legal immigrants (even if they are unable to qualify for Medicaid)
Uninsured Vermonters (currently about 47,000 people) can purchase insurance through the Exchange if they don’ t have access to employer insurance that is ‘ affordable’ according to the ACA or that doesn’ t provide ‘ minimum essential coverage’
Health care will be considered unaffordable if rates are higher than 9.5% of that individual’ s income, and minimal essential coverage consists of rates of 60% paid by benefits, and 40% of the co-pay paid by individuals. The Vermont Health exchange will offer tax credits based on income to qualifying individuals provided by the federal government. The credits are available only through the exchange, and households under 400% of the Federal poverty level will qualify. Cost sharing subsidies will be available for households up to 250% of FPL.
Currently 47,000 Vermonters lack any coverage at all, and a further 160,000 are defined as underinsured. The state of Vermont hopes that the new plan will increase coverage for all Vermonters regardless of pre existing conditions and employment. Under the current system, health care in Vermont is primarily paid by the federal government (34%), employers (29%) and individuals (23%).
The current plan is to pay for the Vermont exchange using a combination of taxes and individual payouts for benefits. According to Vermont Campaign for Health Care Security Education Fund, enrollees currently in VHAP at 150% of the FPL paying $33 a month, could see their premium increase under the new plan to $56 a month. Enrollees with Catamount health at 200% of FPL could see premiums rise from $60 to $117 a month, and those at 300% FPL could see rates rise from $208 a month to $265 a month.
Contributing to the difficulties in understanding the new Vermont Exchange are the unanswered questions the State of Vermont still cites. Among the unresolved issues are what the actual savings will be, how to integrate public and private coverage, and how to incorporate self-insured employers. Governor Peter Shumlin released single payer numbers last Thursday, and he said the cost of the new plan would cost $1.6 billion dollars. The Governor has been criticized for his lack of specificity in the plan At this point, he State of Vermont is also unsure how much they will be receiving in tax dollars from the federal government to implement the new health care mandates.