Baking the doughnuts

The past couple of weeks have seen a flurry of news on one of Vermont's most ambitious projects - the overhaul of the state's health insurance program in line with the federal Affordable Care Act of 2010.

First came the somewhat surprising resignation of Anya Rader Wallace as the chairwoman of the Green Mountain Care Board. This board was formed to help implement the state's health exchange, known as Vermont Health Connect, where businesses and individuals not covered through an employer will go to buy health insurance packages. Hopefully, this exchange will operate in as close to as open and free a marketplace as possible. The worry here is that it will instead be limited by Montpelier to only offering a handful of plans that won't offer consumers much choice. We'll have to wait and see. Currently the marketplace is starting off with two, possibly three, health insurance providers. But the state seems determined to move, by 2017, towards a system whereby the government pays all of its residents' medical bills and insurance companies are unnecessary. At least, that would seem to be the intent of the legislation passed in 2011, and would make the state one of the first, if not the first, to structure its exchange in that way.

Too much should not be read into Wallack's announcement, which she said had to do with personal and family considerations. In any event, she will still be a player in the process as an outside consultant, or so we understand. Still, the timing is awkward, because shortly afterwards, the first peek at the long awaited rates that health insurance consumers would be looking at in the brave new world of health insurance were unveiled.

At first blush, these rates don't seem much less expensive, if at all, than what private health insurance companies are offering, but state officials claim the coverage will be more comprehensive and less expensive, once the full measure of federal subsidies allowed under the Affordable Care Act kick in. Let's hope they're right, and that Congress doesn't decide in a fit of fiscal rectitude that maybe they need to rethink that part of it. The current sequester scenario now playing itself out may not be the only one. Or, a future Congress may change the rules in other, unforeseen ways.

One thing most Vermonters and Americans in general can probably agree on is that there's a lot to dislike about the present way we do health insurance. Whether we're talking about Medicare, Medicaid, or private coverage, the lament is the same. It costs too much. There aren't sufficient incentives built in to encourage hospitals to focus on wellness, instead of treating sickness. Sweeping health insurance reform was inevitable and desirable because the "system" had morphed into one that had everything backwards. Even those who have a visceral mistrust of anything that comes with a whiff of government diktat have to acknowledge it was a situation that could not continue, because no organization, be it public or private sector, can stand to see double digit health insurance premium increases every year. Not too far down the road, that would crowd out other spending on other items that are a little more future oriented, like education and rebuilding roads and bridges.

So if health insurance reform along the lines of what's been enacted so far is to succeed, it must bend the cost curve. If it's not more affordable for the small businesses - those with somewhere between 2 and 50 employees - who will be first up to the plate to participate in the health exchange by next year, then a good case could be made that it's time to go back to the drawing board, unless there's reason to believe it's the first step along that road, and some of the egregious practices, like putting doctors in the position of feeling that ordering up every imaginable test is the only way to protect themselves from possible lawsuits and hospitals charging ridiculous sums for routine services, will be reined in.

One date any individual or business or small business should circle on the calendar - or to update the metaphor, note in your Google calendar - is an information forum led by officials from Vermont Health Connect scheduled for April 30 at the Mark Skinner Library. There are still many questions, apparently, about how this new system is to work, what steps that need to be taken, and that ugly "C" question - cost. This would seem like the best chance most local individuals and businesses will get to have some of those questions addressed.


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