A healthy exchange of information

Officials explain the Vermont Health Connect

Central Vermont small business owners got their first chance to pepper officials with questions about the new state-designed health care marketplace in Waterbury last week. They did not hold back.

Starting next year, individuals without employer-based insurance will be required to purchase health care plans through a regulated online marketplace called Vermont Health Connect, which is the state’s response to the federal health care reform approved in 2010. Small business owners with 50 full-time employees or fewer, including municipalities and school districts, must also purchase their plan, if they choose to offer one, on the exchange.

“It will feel a little bit similar to buying a plane ticket,” said Lindsay Tucker, describing the process of shopping for insurance online. Tucker is deputy commissioner of the Vermont Department of Health Access, which designed the exchange based on state and federal guidelines.

Tucker invited interruptions and, among a crowd of roughly 60, several hands went up every few minutes during an hour-plus presentation at Thatcher Brook Primary School last Wednesday, June 12.

The presentation was among the first of more than a dozen being held across the state throughout the summer in anticipation of Oct. 1, when the exchange goes live and begins accepting enrollments.

Future forums nearby are scheduled for July 9 at the Moretown Town Hall; July 30 at the Richmond Free Library and on Sept. 11 at Harwood Union High School in South Duxbury. All three run from 6:30 to 8 p.m.

Officials estimate that around 100,000 Vermonters, roughly one in six, will be affected by the upcoming change. Even more will be impacted in 2016 when owners of businesses with 50 to 100 full-time employees will also be required to participate.

For individuals and families purchasing health care on their own, the process is relatively straightforward. All Vermont residents will be required to purchase a plan or pay a federal penalty, set at $95 a year per individual or 1 percent of income, whichever is higher. The penalty increases in subsequent years. Larger businesses that do not offer health plans also will face a federal penalty.

Lower-income residents currently eligible for the Vermont Health Assistance Plan (VHAP) will be eligible for Medicaid and will not need to purchase through the exchange. Children currently eligible for the Dr. Dynosaur program will also remain eligible.

For others, the exchange will offer four different standardized plans — Bronze, with the highest deductibles and co-payments and the lowest premiums, Silver, Gold and Platinum — from two different private insurers, Blue Cross Blue Shield of Vermont and MVP Health Care.

Depending on their household income, individuals and families may be eligible for federal tax credits to offset the cost of health care, and state assistance with the cost of premiums and deductibles. Coverage will begin on Jan. 1.

For small business owners, it is more complicated. First, they have to determine whether they fall under the state’s 50-employee cap. That number only includes full-timers, defined as people working 30 hours a week or more, and does not include seasonal employees, defined as someone working fewer than 120 days a year.

Small businesses that currently offer health care insurance to employees as a benefit have a difficult decision to make. Should they continue to offer insurance through the exchange? Or would employees do better purchasing on their own?

“There is no one right answer and we can’t tell you what the right answer is,” Tucker said.

Tucker’s main message to both groups is that help will be available during the transition. There are already resources online at vermonthealthconnect.com, and staffers to answer questions by phone and email. Also, starting in a few weeks, reinforcements — in the form of trained community-based advisors called “Navigators” — are on the way.

Eighteen organizations signed contracts with the state last month to serve as liaisons to different communities, to visit businesses and hold one-on-one tutorials. Statewide, the Vermont Chamber of Commerce and Vermont Businesses for Social Responsibility are reaching out to small businesses. For individuals in Washington and Lamoille Counties, Central Vermont Community Action Council and Community Health Services of Lamoille County, respectively, are taking on that role.

Mark and Holly Rochefort of Stowe, who co-own Vermont Tire & Service with his parents, said the presentation helped them. The company runs service and sales centers in Montpelier and South Burlington as well as a wholesale business to smaller service stations.

Holly Rochefort said she could see good coming from the program, despite the tough decisions.

“We’re going to be waiting to see how the costs shake out, but it seems like it will benefit some of our employees,” she said.