Health Care Advocates Worried About Increased Costs Under Exchange

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In his Budget speech last week, Governor Peter Shumlin said that Vermonters enrolled in Catamount Health Care won’t face additional financial burdens when the state’s new health care exchange goes into place next January.  But some health care advocates say the Governor is following through on only half of that pledge.

When the state’s new health care Exchange goes into effect next January, the Catamount Health Care program will be eliminated and enrollees will become eligible for federal subsidies in the Exchange.

But there’s an issue. The benefit package in the Exchange is not as comprehensive as the one offered by Catamount and so some Vermonters will face lower monthly premiums but higher out of pocket expenses.

For instance, a couple making roughly $46,000 a year now pay a $5,000 premium for Catamount coverage. When they enter the Exchange with federal subsidies, their premium drops by $1,000.

But at the same time, the cap on their out of pocket expenses increases by almost $3,000, so if they use medical services, their net financial obligation will go up by $2,000.

Peter Sterling is the director of the Vermont Campaign for Health Care Security.

"Do we really want to create an additional class of Vermonters who are underinsured meaning people who are paying premiums but can’t access the doctor because the other out of pocket costs are too high?"

And Sterling thinks some Vermonters will choose not to have health insurance if the Governor’s plan is implemented.

"I think it could really undermine the support for single payer if the Exchange is not seen as successful," said Sterling. "Because to the general public whether it’s the health care exchange or single payer it’s all government health care."

Robin Lunge is the director of Health Care Reform in the Shumlin Administration. She says the Administration’s plan is also designed to help roughly 25,000 Vermonters who currently buy their coverage on the individual market with very high deductibles.

"We think that our proposal creates a fairer program for more people and that while some folks in Catamount may pay more in a deductible or out of pocket maximum than they do today on average more Vermonters will be benefited."

Lunge says that under Catamount, all participants have the same deductible regardless of their income level. She says the Administration decided to change this policy.

"The proposal that we brought forward would have income sensitive both deductibles and out of pocket maximums," said Lunge. "So if you can afford to pay more when you use services you would and if you could afford to pay less you’d have a lower exposure."

Lunge says that only 30 percent of all Catamount enrollees ever hit their annual out of pocket cap, so she says the changes will have little impact on the majority of people in the Catamount program.

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