The Legislature will not be back in session until next January, but between now and then state government will be involved in one of the most ambitious new programs to be launched in many years.
Starting in 2014 Vermonters will be able to buy health insurance on a new health care exchange created and managed by the state.
A lot of people still donít know what the exchange is or what it might do for them. Those who do know about it have questions about how it will affect them. It is a huge topic, and policymakers in Montpelier are aware that the reality of the exchange remains murky for many.
Thatís why baseball fans have been hearing advertising on Red Sox broadcasts informing them about the exchange. It is an effective introduction to the topic for many people, with two bright and chirpy people discussing what the exchange is and how people can learn more about it. The ad is part of a concerted effort by state government to reach out to Vermonters to let them know what is coming.
State officials have been holding meetings around the state to talk about the exchange with the public. In Rutland last week the state commissioner of health access, Mark Larson, met with about 70 people to outline the kinds of health plans that will be offered, how they will be structured and what they will cost. Forums are scheduled in the coming weeks for Montpelier, Enosburg Falls and Waterbury.
Larson had to fend off questions from a few skeptics who oppose the entire reform enterprise. A lot of people worry that a state-run system will create long delays in receiving care. In Rutland, Larson noted that people already experience long delays, and coverage for many people comes with deductibles so high that their coverage is next to useless.
The exchange is expected to be especially useful for individuals who have trouble finding affordable insurance and for small businesses. At present many small businesses are able to afford only policies with high deductibles and high costs. Many individuals cannot afford insurance at all.
The exchange will offer affordable policies for both categories at prices that are meant to be affordable. Subsidies from the federal government, based on need, are a part of Obamacare that is meant to bring the cost of coverage within range of everyone.
The question of cost will be of paramount concern both to people managing the exchange and for people signing up for care. Some populations are likely to see higher costs. Vermonters presently enrolled in Catamount Health will be shifted to the exchange, but their premiums are likely to rise.
The Legislature has been wrestling with the problem of funding in to minimize the burden falling on the shoulders of former Catamount participants. Activists argue legislators havenít done enough to contain costs.
Keeping costs contained for the state is also a challenge. The horror that Gov. Peter Shumlin and the Legislature want to avoid is a monster that runs out of control, consuming the state budget. At the same time, foisting a system on consumers and forcing them to pay higher prices would also be a horror. They will be trying to steer the ship between those two perilous rocks.
And the exchange is only the first step. The ultimate goal of Shumlin, his administration and the Legislature is establishment of a single-payer system that would eliminate the role of insurance companies altogether. Single-payer is meant to be up and running by 2017.
Effectively managing the exchange will lay the groundwork, establishing confidence that the state will be able to run a system constituting one-sixth of the stateís economy. There are plenty of skeptics, and cost remains one of the big question marks.
The theory of single-payer health care is that by removing the costly drain on the system caused by insurance companies and by streamlining the system, enormous administrative savings can be gained. Containing health care costs will be key to the systemís expense, and gradually progress is being made. Accountable care organizations are taking hold; electronic medical records are being used more broadly; and management of chronic conditions is improving.
Shumlinís acute aversion to new taxes this year is due in part to the fact that the state is entering uncharted waters and will be taking on new and costly burdens in the coming years. Vermonters who want to learn how the first stage will be unfolding in the next few months can log on to healthconnect.vermont.gov. It is just the beginning.MORE IN Perspective
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