Exchange Could Drive Up Costs For Catamount Health Users

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Thousands of middle income Vermonters could see their health care costs spike when a new federal exchange goes into place in 2014. A group of advocates is urging the Legislature to create a special state subsidy program to make up the difference.

At the beginning of 2014, Vermont’s subsidized health care program known as Catamount Health will be shut down and the roughly 10,000 Vermonters who are enrolled in the program will purchase their coverage through a newly created market place exchange. Peter Sterling is the director of the Vermont Campaign for Health Care Security. He’s concerned because the federal subsidies that will be available through the exchange are not as good as the existing Catamount coverage.

For instance, a person enrolled in Catamount, who makes $22,000 a year, faces a potential out of pocket limit of just over $1,700 but their financial exposure in the Exchange will be twice as big.

Sterling said the out of pocket disparity triples for a person making $33,000 a year. He says this situation is not acceptable

"I know we’re stepping backwards because people who are making between $20,000 or $30,000 or $40,000 a year who are already probably pretty strained just trying to pay regular bills, most of them will see their premiums go up, some will see their out of pocket limit how much they’re ultimately exposed to when they go to see the doctor go up from let’s say a thousand dollars a year to over $3,000 a year,"said Sterling

And Sterling thinks some people who can afford the coverage will be reluctant to use it.

He said, "They simply won’t see the doctor they’ll wait until they’re really, really sick before going to see a doctor because they’re so afraid of trying to meet that deductible."

Sterling wants the Legislature to provide a state subsidy to make certain that Catamount participants aren’t put in a financial disadvantage.

It’s estimated that it would cost between $15 million to $20 million to pay for this program.

Robin Lunge is the director of Health Care Reform for the Shumlin Administration. She said she’s well aware of this problem.

"We think that for particularly for the out of pocket maximum that would adversely affect on a fairly small group of people but of course if you were in that small group of people the out of pocket maximums under federal law are quite large," said Lunge.

And Lunge said her office is looking at a number of ways to address this issue in next year’s budget.

She said, "We are actively engaged in analyzing some options and we’ll have hopefully some ideas of how to work on that as part of our budget process for next year."

The University of Massachusetts Medical School is in the process of conducting a detailed study of the Vermont health care system and this issue is expected to be addressed by this report.

The study is scheduled to be released in January.

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