By Louise Norris
April 14, 2013
Although 2014 open enrollment ended on March 31, Vermont Health Connect’s website still had a message on April 14 advising residents who had difficulty enrolling by the end of March that they can call 855-899-9600 for assistance with completing their application. The site notes that enrollment is now only available for people who started their application before March 31, or for people who experience a qualifying event, had coverage through VHAP, Catamount or as a sole proprietor, or who are eligible for Medicaid (Medicaid enrollment goes year-round in all states).
By early April, Vermont was leading the nation in terms of the percentage of eligible residents who had enrolled in the exchange (54%). This is far better than most states, 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. By the first of March, with another month of open enrollment left, 24,326 people had finalized their plan selections in the Vermont exchange – the second month in a row with an increase of more than 4,500 enrollees. An additional 24,266 were eligible for Medicaid.
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.
Online payment is now available in the Vermont exchange, certain to be a welcome change after months of relying on checks and mail delivery. As of March 3, enrollees will be able to pay their first premium online. Previously, enrollment could be completed on the exchange site, but payments had to be sent by mail.
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. The state 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.
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 has said that existing individual and small group policies may be extended until March 31, 2014, and residents have until that time to enroll in a policy through Vermont Health Connect.
Vermont’s health insurance assistance programs VHAP and Catamount are ending 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. Individuals still must purchase their policy through the exchange by March 31.
According to Kaiser’s State Health Facts, 9 percent of Vermonters are uninsured; that’s about 56,340 people.
Vermont Health Connect
Let your Vermont governor and legislators know how you feel about the state’s proposed health insurance exchange.