Keep Calm and Carry On

The sentiment contained in today's editorial headline was popular in London during World War II, when the city was on the receiving end of the German air blitz. But it's a suggestion that might also apply well as Vermont, along with the rest of the nation, crosses the threshold into Obamacare this week. The sky is not falling because of the start-up of state health exchanges mandated under the Affordable Care Act. Even if here in Vermont, the information technology is not fully ready for prime time, and even if in other states there have been short-term glitches that have prompted delays, this is better than to rush headlong into the brave new world and have it crash and burn.

Not having Vermont Health Connect, as Vermont's health exchange is known, ready for insurance shoppers to plunk down their cash on Oct. 1 is not a "nothing burger," as Gov. Shumlin attempted to dismiss it as last week. Given the amount of money involved - with nearly $25 million of what will eventually be more than $172 million in federal dollars spent - some accountability is certainly in order if the contractors hired to create the system weren't able to meet deadlines or performance milestones. That's what would probably occur if this was a purely private sector play. Not having the system fully functional means less time for small businesses and individuals to hack through the complexities of the new system, of which there are several. In the long run, it all may sugar off, but given the deep philosophical issues and controversies surrounding the health exchanges, nothing involving the smoothest possible transition to them is a "nothing burger."

That said, we'd encourage everyone who has concerns or questions about the way the health exchanges and the Affordable Care Act will change the way they obtain health insurance to take a deep breath and a deep dive into the options that are now available. There is a lot to consider and simply pointing your web browser at - or the federal portal at - and expecting a short fly-by of the insurance options will lead to misunderstanding and disappointment. There are four basic plan levels, ranging from "platinum" to "bronze. The "platinum" plans have the highest premiums but the lowest out-of-pocket costs, and it shifts from there. Perhaps the thorniest questions, especially for small business owners (those with 50 or fewer employees) who have offered health insurance as a benefit to their employees up to now, is determining whether or not the available premium subsidies, doled out on the basis of income, justify continuing that or letting the employees shop for themselves on the exchange. For individuals, it's important to determine to what degree they are eligible for the insurance subsidies, which are intended to make adequate health insurance affordable for folks who felt priced out of the market before.

The health exchange will have so-called "Navigators" to help answer those questions as well as many more, and people shopping for their own insurance, as well as small businesses, should make use of them. Or they should see if they can tap into the services of an insurance broker. This is complex stuff. Unless someone brings a certain amount of expertise into the game, it will be easy - it's almost certain to happen - that the coverage an individual, a family or a business thinks it's getting may not cover everything they want. The devil's in the details with this one.

Given all of that, why are we suggesting that Vermonters, and those in other states, give this brave new world a try? It's not like the old system, born of a historic anomaly during World War II when wage controls forced employers to use health insurance as an inducement to obtain needed employees - was working all that well. Health insurance costs were on an inexorable rise year after year. A good argument can be made that those costs were helping throttle badly need pay raises for employees. And while the number of Vermonters who don't have some form of health coverage was relatively small, under the new system, those who feel it's too costly to purchase can't really argue that point as convincingly as before. And using the local hospital's emergency room as a clinic or the place to go for a minor injury or illness makes no economic sense. "Cost-shifting" those patients onto health insurance carriers was just plain dumb.

We would have preferred to see the state open up its exchange to more than just two providers and to offer more options, to make the market as "free" as possible. And there are many who see the advent of Vermont Health Connect as the camel's nose of a single payer program, which is a whole other ball game and one that requires some hard analysis around costs and cost control. A small state like Vermont doesn't seem like the most fertile ground for such an experiment. There are those who are convinced Gov. Shumlin's eager embrace of the Affordable Care Act and its exchanges is merely the stepping stone to the single payer plan he really wants. They may be right, but there are large hurdles to overcome. This is a story for another day.

For now, we'd suggest giving the exchanges a chance and working through the transition with some patience and good humor. We'd ask the same from state officials in charge of overseeing the change-over. All transitions are difficult, sometimes even treacherous. It may turn out in the end that the exchanges and the Affordable Care Act don't curb health costs, or provide the services they were intended to do. If that proves the case, they can be modified down the road.

To take the tack some Tea Party Republicans in Congress have been advocating - delaying the arrival of the new law, defunding it and shutting down the government over it - is totally wrongheaded. Let's give it some time and see how it works. It's not like we are leaving behind something magnificent and brilliant.


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