Highlight on Vermont: GOP Pushing for Alternative to Vermont Health Connect

Republican legislators in Vermont unveiled a series of bills in hopes of replacing the current Vermont Health Connect Marketplace. These lawmakers hope to provide more flexibility and a wider range of options to Vermont residents while mitigating waste of taxpayer money. Vermont Health Connect was implemented following the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) to allow individuals and families who do not have employer-sponsored insurance coverage to compare and purchase plans. Enrollment on the site began October 1, 2013.

Issues

Enrollees have encountered serious billing issues since the Marketplace opened. One beneficiary paid her premiums on time, yet received multiple incorrect bills including one for over $4,000. Most worrisome was a notification from her insurance provider threatening to terminate her coverage due to unpaid premiums, especially because she had received a cancer diagnosis. The state’s chief of health care reform and Vermont Health Connect spokesman admitted to billing issues, including enrollees not receiving invoices and late bills being sent out. Trinka Kerr, who operates a special health insurance project of Vermont Legal Aid, stated that the problems go further than received bills. Callers have been unable to get billing errors corrected or their payments don’t appear in the system. Others have failed to see coverage activated. Despite these problems, Vermont reports new enrollments within the expected range and over 23,000 coverage renewals.

Legislation Goals

The ideas presented have been brought up multiple times, both prior to and after the October 2013 Exchange launch. Vermont is the only state that requires the purchase of exchange products by individuals and the small-group market. Last year, Governor Shumlin allowed small businesses to purchase plans directly from insurers, but previously Vermont was the only state to require purchase through the state Exchange’s website. The new agenda seeks to provide more flexibility in the system, and some ideas seek to abolish the Vermont Health Connect system. Representatives are also concerned that current plans aren’t affordable for constituents, taxes to pay for certain coverage are unsustainable, and that doctors are too vulnerable to lawsuits, which result in increasing health care costs. Representative Doug Gage pointed out that the design of the current Exchange ate up $190 million in taxpayer money, and wants to reduce taxpayer burden. Representative Cynthia Browning, a Democrat, hopes to see state citizens able to freely choose their health care providers regardless of their doctor’s affiliations.

Bills

Bills taking several different approaches to the Vermont health care system have been introduced this session.

  • H. 78 would provide purchasing flexibility by allowing both individuals and groups to make purchases both outside of the exchange and the state.
  • H. 188 also allows purchases outside of the exchange.
  • H. 177 eliminates the Vermont Health Connect exchange completely.
  • H. 181 establishes exchange coverage as supplemental to beneficiaries’ Medicare coverage.

Support

Support for these bills has been mixed. Last week, Democratic House Speaker Shap Smith supported finding alternatives to the Vermont Health Connect Exchange due to the extensive problems with the website and difficulties in finding swift resolutions. Lawrence Miller felt that Republican solutions were incomplete and the proposed adjustments to the exchange would add complexity, not reduce it. Miller pointed out that the proposals only involve private insurance purchases, and since Vermont’s exchange also encompasses Medicaid coverage, these ideas fail to address a large coverage group.

Next year, businesses with fewer than 100 employees will be required to join the market and in Vermont, they must purchase coverage plans through the Marketplace. Due to the problems with the website and the coverage options available, these business owners are urging representatives to support new options. Lawmakers hope that this will result in bipartisan support of the new direction.