individuals and The Exchange

February 16, 2015

With the 2015 open enrollment period to purchase health insurance through Vermont Health Connect (aka, “the Exchange”) having just ended, it might be timely to share an update.  The Exchange is possibly the most frustrating state government mechanism ever, surpassing even the longest waiting line at the Department of Motor Vehicles.  Many people have shared their Exchange horror stories: perpetual inaccurate billings, a website that doesn’t work, and hours long wait times on the phone.  If you have had a “change of circumstance” in adjusting your health insurance policy midyear, very likely you have suffered frustrations only Kafka could have dreamed up on his darkest day.

 

When the Exchange opened for business in 2013-14, with concerns about its functionality, the legislature gave the governor the option to permit small businesses to purchase group health insurance policies directly from health insurers.  In other words, instead of winding their way through the Exchange labyrinth to purchase policies from either Blue Cross/Blue Shield or MVP, a group policy could be purchased directly from the insurer.  With the Exchange functioning extremely poorly at its rollout, the governor exercised that option and allowed small businesses to sidestep the Exchange to purchase policies directly.

 

So, why are individuals purchasing health insurance still required to go through the Exchange?  Approximately two-thirds of policies purchased through the Exchange are tied to some sort of Medicaid health insurance coverage – insurance for lower income citizens.  Of the other one-third non-Medicaid policies purchased on the Exchange, a significant number qualify for federal tax subsidies.  The only way the qualification for Medicaid and these tax subsidies can be determined is to go through the Exchange.  Because such a high percentage of people seeking health insurance qualify for subsidies, policy makers have been reluctant to let individuals sidestep the Exchange and miss out on benefits that make health insurance policies more affordable and accessible.

 

With the continued frustration suffered by people signing up for health insurance on the Exchange in the recent enrollment season, the House Health Care Committee is re-examining the possibility of allowing individuals to purchase insurance directly from insurers.  This week we drafted legislation similar to what was allowed for small group policies back in 2014.  It provides for the possibility of individuals purchasing health insurance directly from health insurance companies if the functionality of the Exchange has not been corrected by this summer.  Open enrollment for 2016 begins on October 15, 2015.

 

A couple of pictures to share with you from the Statehouse this past week:

 

On Friday, it was Eagle Scout day in Montpelier, and I saw Matt Borst and his mother (Tracy, the Thetford Town Clerk) and grandmother.  There were so many Eagle Scouts and their families crammed into the gallery in the House chamber, there was no room for Matt and his entourage.  So, we found a spot for them to sit in one of the window seats on the House floor instead.  Jim did a nice job introducing Matt to the chamber. 

 

 A friend from Chittenden County forwarded this picture of the House Health Care Committee from the February 7th front page of the Burlington Free Press.  Room 45 is where I spend 80% of my time in the Statehouse.  While it’s not a newsworthy picture, I thought it might be interesting to folks who have never seen a committee room in the capitol building.  Unlike what you see on television of a congressional committee room with a big dais, table for witnesses, and chairs for the audience, committee rooms in Montpelier aren’t much bigger than a generous sized living room.  Representatives sit around the table with the Chairman (Rep. Bill Lippert) at one end and the testifying witness (Robin Lunge, Director of Health Care Reform, with her back to the camera) at the other end.  The public attendees shoehorn themselves into the hearing sitting around the outside of the room.  If you really squint, you can see a chart Robin is sharing with the committee analyzing the elements of the “cost shift.”

 

 

 

 

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