Vermont health insurance exchange
Vermont health insurance exchange
By Louise Norris
July 24, 2014
At the end of the 2014 open enrollment period, Vermont was the clear leader in terms of the percentage of eligible residents who had enrolled in the exchange (85%). This is more than double the second place state (California, with 42%), but Vermont is the only state that has required everyone to enroll through the exchange, with no off-exchange plans available, so it’s understandable that the exchange has enrolled such a high percentage of eligible residents. As of April 19, 38,048 people had completed their private plan Obamacare enrollments in the Vermont exchange – nearly 14,000 more than had done so as of March 1. An additional 41,704 were eligible for Medicaid.
Thanks to qualifying events and special open enrollment periods, exchange enrollment in Vermont has continued to grow in the two months since open enrollment ended, just as it has all across the nation. As of mid-June, Vermont Health Connect was reporting an average enrollment of 38 people per day, about 28% of what they were enrolling during regular open enrollment (about 135 per day). This percentage is about the same as other states are reporting as well, and indicates an increase of roughly 2,280 Vermont enrollees between mid-April and mid-June, meaning that total enrollment has likely surpassed 40,000.
In early June, Vermont Health Connect hired IT contractor Optum to help with the “change of circumstances” backlog stemming from a flaw in the exchange website. Enrollees have not been able to utilize the exchange site to notify carriers of a life change such as birth, divorce, marriage, change in income, etc., and the problem has impacted about 10,000 enrollees.
For much of open enrollment, premiums could not be processed online and instead had to be sent by mail. That was eventually resolved and starting on March 3, online payment became available through Vermont Health Connect. The exchange reports that 50 percent of new enrollees have been utilizing the e-pay feature.
There have been some concerns about the fact that enrollment in the Vermont exchange is skewing older than the national average (62% over age 45 as of the beginning of February), but that makes sense given that Vermont’s population is older than the US average too, and given that plans in Vermont are community rated, so older enrollees pay the same amount as younger ones. Since Vermont is switching everyone to exchange-based health insurance, it’s reasonable to assume that the demographics in the exchange roughly mirror the demographics in the pre-ACA individual market (Medicaid is counted separately). Thus, premium trajectories in the exchange should not be much different than they would have been in the old individual market. The exchange reported that as of mid-March, 18 percent of their enrollees were between 18 and 30 years old, but that included both QHP and Medicaid enrollments so it’s difficult to predict how private plan rates will be impacted based on age demographics.
State and federal auditors will likely audit Vermont Health Connect in late June or early July 2014, looking into the details of the troubled rollout of the exchange, the $180 million that was spent to get the exchange up and running, and the security of private information in the exchange’s online system. In April 2014, Vermont Commerce Secretary Lawrence Miller was appointed to oversee the state’s health care reform going forward and the eventual transition to the Green Mountain Care single payer system. There has been some tension between Governor Shumlin’s office and state lawmakers, and Director of Health Care Reform Robin Lunge made it clear to lawmakers in early April that they were asking for too many reports, too quickly.
Vermont created a health benefit exchange to comply with the Affordable Care Act, but the state has plans to go well beyond that. A 2011 state law envisions Vermont with a single-payer health care system as soon as 2017, although reports surfaced in April of a memo from consultant Ken Thorpe (hired by the Vermont legislature to help them wade through the ins and outs of creating the single-payer system) regarding the possibility of a less-robust system that would let people purchase supplemental coverage through private plans in the exchange rather than relying solely on a single-payer model. The state still has a long way to go before Green Mountain Care becomes a single-payer reality, and there will be many hurdles along the way. But if they’re successful, they will certainly be held up as an example for other progressive states to follow.
Vermont has received $172 million in four federal grants designated for creation and implementation of the exchange as well as outreach efforts to get as many people enrolled a possible. Vermont received more federal funds for its exchange than any other state. As of mid-June, the exchange had spent about $72 million of that money, leaving them with about $100 million to work with as they head into the 2015 open enrollment period.
For now, Vermont has implemented a state-based exchange, Vermont Health Connect. The exchange was authorized by the state legislature and signed into law in 2012. Vermont used a 2012 federal grant of $104.2 million to design a technology system that will support the state-based health insurance exchange in the short-term and the single-payer system in the longer term. The state plans to transition to Green Mountain Care – providing universal coverage – in 2017.
Two health insurance carriers - Blue Cross Blue Shield of Vermont and MVP Health Care - are offering nine plans each in Vermont Health Connect. Rates in Vermont’s exchange are the fifth highest in the nation, due in part to the low number of carriers participating, and also to the fact that Vermont has the second-oldest population in the country and utilizes community rating, with no variation in premiums based on age.
Vermont’s 2012 Act 171 required that all existing individual and small group policies terminate at the end of 2013 and be replaced with ACA compliant plans. Unfortunately, Vermont’s exchange was plagued with technological difficulties and was still not operational as of the beginning of November, a full month into open enrollment. As a result, Governor Shumlin opted at the end of October to utilize a contingency plan that was built into Act 171, allowing for existing policies to be extended into 2014 in order to avoid lapses in coverage. The Governor allowed existing individual and small group policies to be extended until March 31, 2014, and residents had until that time to enroll in a policy through Vermont Health Connect.
Vermont’s health insurance assistance programs VHAP and Catamount ended on March 31, and members needed to transition to Vermont Health Connect by March 15 in order to have new coverage as of April 1. There is concern that the new plans – even if the premiums are heavily subsidized – will be unaffordable for many VHAP and Catamount members, since the out of pocket costs on the new plans are significantly higher.
Vermont had intended for all new individual and small group policies to be purchased through the exchange beginning in 2014, but on January 14, the state announced that small businesses that had not yet purchased their plan through the exchange could buy one directly through Blue Cross Blue Shield of Vermont or MVP Health Care. The state has confirmed that small businesses will continue to be allowed to purchase insurance directly from carriers for 2015 plans as well. Individuals still must purchase their policy through the exchange. Open enrollment for 2014 has ended, but residents who have a qualifying event can still purchase coverage during their special open enrollment period.
According to Kaiser’s State Health Facts, 9 percent of Vermonters were uninsured in 2013; that’s about 56,340 people. Vermont’s report for 2014 won’t be out until early in 2015, so it will be several months before we know how much the first open enrollment period has impacted the percentage of Vermont residents who are uninsured.
Vermont health insurance exchange links
Vermont Health Connect