• A something-burger
    September 24,2013
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    As Oct. 1 approaches, people are raising questions about whether the state will be ready to enroll up to 100,000 consumers who will be looking for health coverage in the new insurance exchange called Vermont Health Connect.

    State officials have pushed back the date by a month when people will be able to start paying for their coverage ó from Oct. 1 to Nov. 1. Coverage will actually become effective on Jan. 1, 2014, leaving the state two months instead of three to receive initial payments and ensure that people are properly enrolled.

    Gov. Peter Shumlin, the stateís number one cheerleader for the new health care system, called these concerns ďa nothing-burger.Ē He acknowledges that there will be some glitches in the launch of Vermont Health Connect, but he sees little to worry about in the change in the dates.

    Worries about implementation are not nothing. Thatís because the creation of Vermont Health Connect is a costly, ambitious and far-reaching initiative with serious implications for the future. It is a something-burger.

    Then again, we wonít know how itís going to taste until we bite into it. Behind the scenes, those who are putting in place the information technology for the state exchange may at this moment be pulling out their hair. But allowing an additional month for testing the new system before it is up and running may be a useful safeguard.

    Another more significant concern was the topic of a story in The New York Times on Monday, though the problem addressed in the story may be minimal in Vermont. It turns out that one way the new exchanges around the country plan to contain costs is by restricting the number of authorized providers to a limited network of hospitals and physicians.

    For example, in New Hampshire 10 of 26 hospitals in the state will be excluded from coverage offered by Anthem Blue Cross and Blue Shield, the only insurer on the New Hampshire exchange. The CEO of a small community hospital excluded from the exchange warned that the limitation will require some consumers to travel 30 minutes or an hour to visit a doctor or hospital. At the same time the cost of coverage is expected to be about 25 percent lower in New Hampshire.

    Representatives of community health clinics say that insurers have been reluctant to include them in their networks, even though the low-income patients who use community clinics are the very patients whom the new system was intended to bring under the umbrella of the new exchanges. It is a way for insurers to save money, but it could come at the cost of excluding people from care.

    In California the exchange will include 53 percent of the stateís physicians and 78 percent of the stateís hospitals. One of the hospitals excluded from Californiaís exchange will be Cedars-Sinai Medical Center near Beverly Hills. A Blue Shield official said not many of the uninsured or low-income residents looking for coverage on the exchange would have been seeking care in Beverly Hills.

    Health reforms in the 1990s brought about the advent of health maintenance organizations, which tried to contain costs by creating a limited network of providers. Consumers resented the limits on choice that they encountered, and the HMO movement foundered. If the new exchanges create too many obstacles to care, they will defeat their own purposes.

    In Vermont, Blue Cross and Blue Shield of Vermont and MVP are the two insurers that will provide coverage on Vermont Health Connect. They have long histories in the state, and officials expect they will carry on providing the kind of broad coverage that they have provided in the past. Certainly, excluding the network of community health clinics that are integral to the stateís health care system would be a self-inflicted injury to the system. At the same time, providers are having to confront the fact that reducing costs may translate into limits on their income. In an era of belt-tightening for the health care system, it will not be consumers alone who will have to tighten their belts.
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