By Louise Norris
March 6, 2013
By the first of February, 19,583 people had finalized their plan selections in the Vermont exchange – up more than 4,500 from the end of December. An additional 18,686 were eligible for Medicaid. 46% of enrollees are receiving no premium subsidies – far higher than the national average of 18% (the fact that there is no option to enroll in an individual plan off-exchange in Vermont is no doubt a factor in the large percentage of people who have enrolled in the exchange with no subsidies).
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), 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.
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 need to transition to Vermont Health Connect by March 15 in order to have new coverage that begins on 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.