NEWPORT CITY – By Jan. 1, 2014, all states will need a Health Exchange program up and running. Sen. Vince Illuzzi (R-Orleans/Essex) of Derby spoke to business leaders at the North Country Career Center yesterday about the exchange.
The law came about when the individual and small group insurance market in America essentially collapsed, Illuzzi said. “If you did not have the opportunity to purchase insurance through a group, you were pretty much on your own."
At that time, there were many junk polices with high deductibles and high co-pays. Because of the The Affordable Care Act, known by critics as Obamacare, those policies are now gone.
Congress envisioned the Health Exchange as a robust market place where a person can go online and decide the type of coverage that best suites the person’s needs, the needs of an employer and his or her employees. The exchange is Congresses’ way to ensure that the individual and small group market would have access to affordable and quality healthcare.
Last year, Vermont began the journey of enacting the state’s version of the Health Care Exchange, but it was coupled to Gov. Peter Shumlin's single-payer effort, Illuzzi said. He said single payer is akin to Medicare where there is one provider, one set of rates and one set of forms.
Under Shumlin's proposal, businesses would be required to purchase insurance from the exchange; the state would set minimum benefits, which may be more than the employer can afford; there would only be three levels of insurance: platinum, gold or silver; and the resulting premium costs could result in employers dropping health insurance for their employees all together.
Before a single payer system can be enacted in Vermont, Congress would need to enact a number of waivers, because a single payer system is not allowed under current federal law.
Illuzzi is waiting on more information before he makes an official decision on a single payer system.
Some people are concerned medical services may become unavailable or may not be available on a timely basis under a single payer system. They are also fearful that specialists may only be available at larger medical centers because smaller hospitals may not have the volume to sustain the cost.
It's not clear what kind of single payer model would be used.
Speaking on the exchange legislation, Illuzzi told the group, “You will be required to purchase insurance only on the exchange and only on the three different levels, platinum, gold and silver.”
Under Platinum, the government would cover 90 percent of the insurance costs and the consumer would pay 10 percent in deductibles and co-pays. For gold, the ratio would be 80:20; and for silver, 70:30.
Illuzzi and Sen. Hinda Miller (D-Chittenden) introduced a bill that would allow Vermonters to buy insurance at the bronze level, with is not permitted on the federal program or the Shumlin plan. The bill would also allow Vermonters to buy insurance on or off the exchange and start with employers with 50 or less employees. The bronze level would apply to companies who have health savings accounts for co-pays and deductibles and would have a 60:40 ratio.