MANCHESTER - The clock is ticking on when upcoming changes to Vermont's health care system will introduce wide-ranging effects on businesses, individuals and other organizations.

The way in which the new system will work was one of the points of discussion at a health forum held last week at Maple Street School, sponsored by the Bennington-based Southern Vermont Medical Center (SVMC).

The panel, made up of doctors from both SVMC and the Dartmouth-Hancock Putnam Physicians, addressed concerns directly from residents in attendance as well as from a powerpoint presentation that addressed the main points of the change.

"An average family of four, in 2002, was spending $9,200 a year on healthcare," Tom Dee, president and CEO of Southern Vermont Healthcare Center's health system, read from a slide. "But in 2011, the most recent figures we have, the same average family of four was spending around $20,000 a year... out of pocket."

The graph projected that if things continued the way they were headed, the same family would be paying $42,000 a year for healthcare by the year 2021.

The biggest way to change these numbers involves Vermont potentially becoming the first state in the country to implement a single-payer health care system.

Under a single-payer system, a single body using a single fund, such as a state or federal government body, would pay for the healthcare costs, rather than multiple private insurance companies.

Until the single-payer system is implemented, however, employers and individuals who do not receive insurance from their employer will need to purchase insurance through an exchange program.


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Starting October 1, small businesses with fewer than 50 employees, and individuals, will be able to access and select plans through Vermont Health Connect (VHC), the state health insurance exchange. This was set up in the wake of the passage of the federal Affordable Care Act in 2010 and is a website that helps employers and employees can shop for what plans best suit them and their business.

The federal government considers one employee to be someone who works more than 30 hours per week, and the total number of employees will be determined by the average number of employees on working days during the calendar year. Seasonal and part-time employees will not be counted.

However, these small businesses will not receive a federal penalty if they decline to offer insurance at all; their employees will be able to use VHC to find a plan for themselves.

The new system will take effect on Jan. 1, 2014 and will force some changes for organizations, such as local chambers of commerce and municipalities, which used to offer health insurance as a benefit to attract members or employees.

Executive Director of the Manchester Chamber of Commerce Berta Maginniss explained that prior to this change, the Chamber was able to facilitate the purchasing of health insurance to local businesses.

"If you became a member of the chamber, we would tell you about the benefits, which included health insurance," Maginniss said. "You were then sent to the insurance company... with a Chamber discount."

The 34 chambers of commerce in Vermont have been facilitating this process with 13,000 businesses, but starting January 1 this will no longer be a service provided by the Chamber.

"There are so many businesses impacted," she said, "and it's unknown how we'll be able to help them [after January]."

Their new lack of involvement in small business' health care decisions have been mandated by the implementation of the VHC. Enrollment in the exchange begins in October, but those who have utilized insurance through the Chamber will be able to continue to do so until January 1, even if they have enrolled in the exchange.

In Sunderland, the question of where their town's insurance will be coming from was an item on their most recent selectboard agenda.

"We're trying to find out if we have to join the [Vermont Healthcare Exchange], or if we can renew what we have through MVP," said selectboard chairman Mark Hyde.

Hyde explained that they authorized their insurance liaison, John French, to speak with their insurance company to figure out their role in the upcoming change. They hope to have an answer by their next meeting in August, which gives them time before the October enrollment period begins.

The Vermont League of Cities and Towns (VLCT) is working to help municipalities throughout the state to make sure they make their transition smoothly; according to their website, they will not function as state-funded Navigators or insurance brokers, but rather as unbiased consultants.

They describe Navigators as trained consumer assistance specialists, contracted by the state, to help anyone who needs assistance enrolling in VHC; however, they cannot also be insurance agents and receiving commissions from an insurer.

According to VLCT, if a municipality employs fewer than 50 employees, by the federal guideline for counting employees, they will not be exempt from utilizing the state's exchange for purchasing insurance. However, municipalities with between 51 and 100 employees may continue to use the private market through 2016, and municipalities with over 101 employees may use the private market until 2017.

VLCT does point out, however, that all of these dates are dependent on the potential implementation of the Single Payer Healthcare system.

Southern Vermont Healthcare Center (SVHC) has already begun educating Vermont residents on what this all means and what they need to do.

Last Wednesday, SVHC and Dartmouth-Hancock Putnam Physicians held a forum on how they, and the Health Connect, are planning on helping residents adjust to these changes.

In addition to working with Vermont residents as they figure out the changes in their insurance, SVHC is preparing to reconfigure the inside of the Northshire Campus to better serve their patients.

According to Kevin Robinson, Communications Director at Southwestern Vermont Medical Center, they will be adding five exam rooms, three consultation rooms, and a second check-in window designed for more privacy.

There will also be some cosmetic upgrades, such as some automatic doors, upgraded bathrooms that are more handicap accessible, and some aesthetic changes.