RutlandHerald.com - We Are Vermont

Study outlines health bill effect Discrepancies between state, federal numbers

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MONTPELIER – Tens of thousands of Vermonters will have access to health insurance under the health care reform plans being debated in Washington, D.C., according to a state-by-state study released by the federal government Tuesday.

The "Case for Change" report details the number of more Americans who would get health insurance coverage under President Barack Obama's plans, along with other proposed changes of coverage for senior citizens and small businesses.

Nearly all of Vermont's uninsured residents – along with about 25,000 who are underinsured – would have access to affordable plans as part of the health insurance exchange, the report states.

Additionally, more than 100,000 Vermont seniors would receive free preventative care and more than 18,000 would see their prescription drug costs through the federal Medicare Part D program halved when they hit the notorious "doughnut hole" – the point when the government stops funding drug purchases.

"Much of the debate over health care reform has centered on a few proposals, but mostly ignored the other 2,000 pages of the bill," said Rep. Steve Maier, a Middlebury Democrat and chairman of the House Health Care Committee. "What this summary does well is explain the ways that health care reform will affect Vermont."

Under the plans – which could change between now and whenever the U.S. Congress finally votes – an estimated 58,000 people will qualify for tax credits to purchase insurance, according to the report.

"They're talking about shrinking the doughnut hole, allowing for insurance portability so that your coverage is not tied to your employment, and cost reduction," Maier said. "These are all issues that we've been talking about in Vermont."

More than 11,000 Vermont small businesses would also qualify for tax credits to help pay for employee premiums. Those who receive coverage under Medicare – about 104,000 people in Vermont – would also get free preventative health services.

"Thirty percent of Vermont residents have not had a colorectal cancer screening, and 18 percent of women over 50 have not had a mammogram in the past two years," the report states. "Health insurance reform will ensure that people can access preventive services for free through their health plans. It will also invest in a prevention and public health fund to encourage prevention and wellness programs."

But health care advocates and lawmakers in Vermont – including many who are generally supportive of Obama's plans – said Tuesday that the federal report contains incorrect information, including drastically overstating the number of uninsured residents.

According to the federal Agency of Health and Human Services, there are 74,000 Vermonters without health insurance.

But state numbers – via a year-old survey by the Vermont Department of Banking, Insurance, Securities and Health Care Administration – show there are actually just over 47,000 residents without insurance, a number that slowly declined between 2005 and 2008.

Another error is noting that, under the health care reform plan, people with a history of health problems will have an easier time finding insurance options through the establishment of a "high-risk" pool.

Vermont already has a law that is known as guaranteed issue – a regulation that ensures that an insurance company cannot reject an applicant because of their medical history.

Nick Pappas, a spokesperson for Health and Human Services, said the report's statistics were taken from a recent study by the Robert Wood Johnson Foundation and the Urban Institute. He said the plan debated in Washington would save Vermont millions of dollars a year, including allowing Catamount Health recipients to move to other insurance options as part of the exchange.

"Vermont has done impressive work to help insure its residents and improve the quality of care," Pappas said. "Health insurance reform will further improve care for Vermonters and all Americans."

Susan Besio, director of Health Care Reform, a state agency that monitors health care programs and services, could not be reached for comment about the report Tuesday.

But Gov. James Douglas, in his weekly press conference Tuesday, worried that Vermont could be penalized for being ahead of the rest of the country in reforms. The version in the U.S. Senate would penalize two states – Vermont and Massachusetts – by not giving the states matching federal funds for Medicaid expansion.

U.S. Sens. Patrick Leahy and Bernard Sanders are aware of the issue and have been working to address it, according to their offices.

"I think it is important that Vermont get its fair share," Douglas said.

Despite some of the errors in the report, it does provide a first glimpse at how the multibillion-dollar plans under debate in Washington could affect the more than 600,000 people living in Vermont.

Still, the information didn't impress Peter Sterling, executive director of the Vermont Campaign for Health Care Security, an organization that promotes expanding health care coverage to all residents.

Sterling said he was hoping for more information on how national health care reforms would affect Vermont programs such as the Vermont Health Access Plan or Catamount Health, two programs that offer insurance to residents who don't qualify for other plans.

"There was no 'wow' moment when I read this," Sterling said.

daniel.barlow@rutlandherald.com