By Marianne Apfelbaum
September 26th, 2013
“There are a million, gazillion variables,” said Holly Spence, owner of Cornerstone Physical Therapy in Williston, in summarizing the health insurance options available through the state’s new health insurance marketplace, Vermont Health Connect.
Administered by the Department of Vermont Health Access, the marketplace, also referred to as the “Exchange,” was created after the 2010 passage of the Affordable Care Act, also known as Obamacare. Starting in 2014, VHC is the “one place where individuals and small businesses in Vermont can get health insurance,” its website states.
Lindsey Tucker, Vermont’s Deputy Commissioner of the Health Benefit Exchange, gave a presentation on Saturday in Williston to help residents and small business owners better understand the implications of the mandatory health care program. Billed as one of a number of events across the state “to spread the word about the new insurance marketplace,” the presentation drew a crowd of about 40 people to the Dorothy Alling Memorial Library.
Tucker, a former middle school teacher, worked the crowd with a fast-paced PowerPoint presentation that was frequently interrupted by audience questions, many of which came from small business owners unsure of what to do for their employees.
Small businesses, defined by VHC as those with 50 or fewer full-time employees, are scrambling to find time to learn about the myriad health insurance options for their employees and how to determine what will best fit their and their employees’ needs. “We have spent hundreds of hours trying to understand,” said Todd Warren, owner of Otter Creek Awnings and Sunrooms and Vermont Custom Closets in Williston, which has 20 full-time employees. “I still don’t know what we’re going to do.”
“Today, most Vermont small businesses only offer their employees the choice of one or two health plans, if any at all. Starting in 2014, small businesses that offer health insurance will be giving their employees the choice of 9-18 health plans,” according to a press release from VHC sent to the media on Wednesday.
All plans in the U.S. must offer ten categories of essential health benefits, which include: ambulatory patient and emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
In addition to the plans offered through VHC by Blue Cross Blue Shield and MVP with levels including bronze, silver, gold and platinum, there is a catastrophic coverage option for certain individuals.
There are also variables affecting a small business owner’s decision on which plan to select including a possible state supplement and the option of federal subsidies to help pay for premiums for those whose household income is below a certain level. However, employers are not legally able to ask employees about household income. This has made it difficult for some small businesses to determine if it is more beneficial to offer employees health benefits or to have them purchase insurance directly through the Exchange.
In reviewing the VHC website, Warren said he feels like the exchange is “pushing employers not to offer health insurance and not to purchase through the exchange… we pride ourselves on our benefits to employees, but I’m fearful that our ability to do that might be going away.”
Selecting the best plan
VHC is a web-based program, but Vermonters can also get assistance and information through a designated call center or through the Navigator Program, an in-person assistance program in which the state “contracted with 18 different organizations,” Tucker said.
More than 200 Navigators are available in communities throughout the state to help Vermonters understand their health care options and assist them in completing paperwork and accessing financial help, according to the VHC website, which lists 13 organizations in Chittenden County offering the free service.
Warren will be meeting with a Navigator next week to try and get his questions answered. “I want to keep an open mind. It feels like there is so much grey area so it’s hard to understand what potential positive outcomes there will be,” he said.
Spence has set up an appointment with her insurance broker. “I got most of my information from the (VHC) website, but I still have a lot of questions,” she said. “I’m still trying to figure out what is best for my employees and the business.”
For more information
Vermont Health Connect is web-based, but Vermonters can also learn more and complete health care enrollment through a toll-free Vermont-based call center (855-899-9600) or with in-person assistance from Navigators or brokers.
Live forum: Ask your questions at a live forum on Thursday, Oct. 3 from 6:30 to 7:30 p.m.at the Channel 17 Studio. If you cannot make it in person, you can follow along on Channel 17/Town Meeting TV or stream it live on the web: CCTV.org/live_events