Health Exchange Extended Coverage, But Also Was Too Costly For Many

Apr 30, 2014

Organizations paid to help Vermonters find insurance on the new health exchange are giving mixed reviews to the program. They say that while the new system has delivered coverage to thousands of previously uninsured Vermonters,  the arrival of the exchange has also put the cost of insurance out of reach for others.

It’s been four weeks since the deadline passed for Vermonters to buy insurance on the exchange. And the people responsible advising the public on the program have already begun their post-mortems. Donna Sutton Fay, executive director of the Vermont Campaign for Health Care Security, says that despite all the technological shortcomings in the new system, there’s a good story to be told.

"The out-of-pocket costs are completely unaffordable for many low and middle-income working Vermonters. And I think we all have examples of people who did not enroll because of the costs." - Donna Sutton Fay, Campaign for Health Care Security

  “We thought it would be a good time, now that we’re end of open enrollment for 2014, to take stock of the successes that have happened through Vermont Health Connect, and how it has helped thousands of Vermonters gain access to affordable health coverage,” Sutton Fay says.

Sutton Fay organized a Statehouse news conference Wednesday, where four “navigator” organizations gathered to share success stories of vulnerable clients who have, thanks to the Affordable Care Act and Vermont’s handling of the federal law, gained access to affordable insurance.

But Sutton Fay says those successes have been tempered by the experiences of Vermonters for whom the exchange ended up being more of an obstacle to insurance than a stepping stone to coverage. Middle-income Vermonters especially, Sutton Fay says, found the out-of-pocket costs for plans sold on the exchange were in some cases prohibitive.

The Shumlin Administration pushed for a mandate requiring individuals, and businesses with 50 or fewer employees, to purchase coverage sold on the exchange. Sutton Fay worries that the high costs of those plans means that previously insured Vermonters may now be going without.

“And the out-of-pocket costs are completely unaffordable for many low and middle-income working Vermonters,” Sutton Fay says. “And I think we all have examples of people who did not enroll because of the costs.”

Whether the arrival of Vermont Health Connect has been a net positive when it comes to insurance coverage in the state remains to be seen. The Shumlin Administration says it won’t know until next January whether the number of uninsured residents has risen or fallen since the advent of Vermont Health Connect.

That’s because results from the annual survey used to determine the insurance rate won’t be out until next year. Sutton Fay and others have lobbied the administration to expedite the survey.

“So when outreach and education is being planned for the next open enrollment, we would sort of know who’s uninsured, where they are,” Sutton Fay says. “But at this point the administration has said they’re not going to do that early.”

Officials at the Department of Financial Regulation say advancing the timeline would make for less accurate yearly comparisons of data.

Mark Larson, commissioner of the Department of Vermont Health Access, said he agrees that the cost of insurance is a barrier to access.

“So we continue to be concerned that health insurance is too expensive for many Vermonters,” Larson says.

But while Sutton Fay and others say the answer to the affordability problem lies in higher state subsidies for even middle-class Vermonters, Larson says the state can’t afford it. Larson says Vermont already offers some of the most generous assistance programs in the nation.

Larson says nearly 100,000 residents total have enrolled in plans sold on the exchange.

Federal funding for groups paid to help Vermonters navigate the exchange expires at the end of 2014, but Larson says the state will backfill at least a portion of that money to ensure help is available for customers in 2015 as well.

Sutton Fay says another drawback to the exchange is the limited open enrollment period. Non-Medicaid eligible Vermonters who didn’t sign up for a plan are now out of luck until next year. And people whose coverage is terminated due to late payments won’t be able to re-enroll until 2015.