Archive for the ‘Vermont Health Care’ category

Vermont Health Connect – be ready for a new way to pay for Health Insurance in 2014!

May 10, 2013

A new post based on my work with both the Medicaid and Exchange Advisory Board and The Green Mountain Care Board Advisory Committee:  Clarifying what’s next in Health Insurance for Vermont Residents.

VHC Logosizedforwebsite
Starting October 2013, all Vermonters who pay for Health Insurance themselves, Vermonters who don’t have Health Insurance, those who have Medicaid, Dr. Dynasaur, Catamount or Vermont Health Access Program (VHAP), and all Vermonters who work for a company that employs less than 50 people, can buy Health Insurance or sign up for Medicaid, etc. from Vermont Health Connect.

On October 1, 2013 the Vermont Health Connect (VHC) website will be ready for you! (If you don’t use the internet, no worries.  A call center and in person Navigators are also being set up.)

The first question VHC will ask, either on the website, or in person:  “Do you have health insurance though an employer?”

If you answer “No”, there is a second question:  “How old are you?”

If you are 65 or older, VHC will say:  “You are covered by Medicare.”  From the website, you will be able to click on a button and go to the Medicare application page.

If you are 64 or younger VHC will ask:  “How many people in your household?”

The website or Navigator will then tell you:  “If your household income is below a (it will spell out the specific amount based on your household size), you may qualify for a tax credit in 2014.”   Those with household incomes up to 400% of the Federal Poverty Level may qualify.

Some samples of who will qualify for the tax credits:  A single person making less than $45,960; a couple making less than $62,040; a family of four making less than $94,200. (These are based on 2013 estimates and may change slightly for 2014.)  How much you make is listed on your taxes as your modified adjusted gross income, this is the figure Vermont will use.

Starting May 15th, you can go to and see your tax credit/subsidy estimate on the website.  By the end of May Vermont Health Connect will also have a FaceBook page.

On top of the Vermont State tax credits, there will be some federal subsidies for out of pocket expenses for households making less than 250% of the federal poverty level.

Note: Tax Credits will be available for any person buying their own insurance whose household income is below 400% of the federal poverty level – but not for those who get insurance through their work.

By following website prompts, you will be directed to a page where you can compare Health Insurance plans.  After you input your modified adjusted gross income, the website will figure in the tax credits, and let you know your monthly bill for each plan. When you are ready, you can then choose and purchase your own health insurance.

All plans offer 10 categories of essential health benefits (see next paragraph) and the following applies:  Any person up to age 26 can be on their parents’ plan.  Preventive care does not have any co-pays.  There will be tax credits and out of pocket limits as noted above.

Essential Health Benefits:  Ambulatory patient services, emergency services, prescription drugs, rehab and chronic disease management, hospitalization, maternity & newborn care, mental health & substance abuse, lab work, preventive wellness and pediatric health including dental and vision.

There are four types of Qualified Health Plans (QHP):  Bronze, Silver, Gold, Platinum.  The higher monthly premium you pay, the more is covered and the less you spend on your own out of pocket costs and co-pays.

On the website you will be able to compare plans side by side and evaluate what is best for you and your family.

Because all plans will have the same benefits, the important choice is how you want to pay for health care. Whether you pay more up-front in premiums and less in out-of-pocket costs, or the reverse, it’s up to you.

For example, if you choose a platinum plan, your monthly premiums will be higher, but what you pay in out of pocket costs will be lower – about ten percent of the actual cost of the visit or procedure. If you choose a bronze plan, you will have lower monthly premiums, but what you pay out of pocket will be higher – about 40 percent of the actual cost of the visit or procedure.

There will be a lot of resources available to assist you with your health insurance purchase either by internet, phone or in person. If you have purchased health insurance through a broker in the past, he or she will still be able to assist you. In addition, “Navigators” will be trained and available to help you figure out which plan is best for you, and to help you enroll. There will also be a Vermont Health Connect call center to help you use the website and understand health insurance options.

You have from 10.1.2013 until  3.31.2014 to enroll in this plan.  If you don’t, there will be a tax penalty!

If you have questions now, please email:   You can also sign up for the Vermont Health Connect newsletter at:  (Click on:  “Information for You” on the left hand side, then click on “email updates”.)


Group prepares for health care changes coming in next two years

November 28, 2012
Deerfield Valley News Article
by Jack Deming
Participants in a panel discussion on health care included, from left, Robin Lunge, Kevin Goddard, Julie Lineberger, and Bram Kleppner.

Participants in a panel discussion on health care included, from left, Robin Lunge, Kevin Goddard, Julie Lineberger, and Bram Kleppner.

WEST DOVER-Vermont Businesses for Social Responsibility held their 20th annual fall conference at Mount Snow Wednesday, November 14, with an opening plenary panel session aimed at answering questions business owners have about changes coming to Vermont’s health care system.

VBSR’s mission as a nonprofit, statewide business trade organization is to advance business ethics that value economic, social, and environmental bottom lines through education, public influence, and workplace quality. This panel was an educational component, preparing business owners for the changes that come with the 2013 and 2014 federal mandates under the Affordable Care Act. As Bram Kleppner, co-chair of the Medicaid and exchange advisory board said, “VBSR has had a long-standing position to always advocate for changes in our health care system. Between Obamacare and Green Mountain Care, we’re moving in some very different directions, and some very positive ones. Now we are at the point where all of us as members, businesses, and organizations need to figure out how to execute and implement the changes that are coming to us.”

Kleppner served as moderator for a panel that included Robin Lunge, Vermont Director of Health Care Reform, Julie Lineberger, a member of the Green Mountain Advisory Board and Medicaid and exchange advisory board, and Kevin Goddard, vice president of external affairs and sales for Blue Cross and Blue Shield of Vermont.

Lunge began the session by explaining the health care exchange that Vermont is required to construct before January 1, 2014. With an exchange, Vermonters and small businesses will be able to shop for insurance on Vermont Health Connect, a website that provides apples-to-apples comparisons of different insurance products. “There are not many fundamental changes to health insurance under the federal law,” said Lunge. “It’s a way for consumers to have easier access to shopping tools.” Lunge also said that as of October 1, 2013, individuals and businesses could begin using Vermont Health Connect.

Insurance plans provided through the exchange will be required to feature essential health benefit packages, co-pays, and deductibles. People who do not purchase insurance beginning in 2014 will be fined with a tax penalty. Lunge said that individuals will still be allowed to purchase insurance through private brokers. However the exchange makes the process easier, and creates a more stable environment for companies to insure their employees. “For those of you who have been in small group insurance where you have small businesses clustered together and you have just a couple of really ill people in a year, it could really increase your rates, so the idea is a bigger pool stabilizes across a larger population.”

Lineberger, who is also a Wilmington business owner, thinks that it is important for business owners to talk to their employees individually, to hear their concerns, and know how the changes to health care will affect them. She also said that de-coupling insurance and employment is a direction health insurance must move toward. With the Affordable Care Act requiring subsidization of insurance premiums for individuals in households with incomes up to 400% of the poverty line, Lineberger says it creates confusion. “It’s important for us to provide insurance to our employees, but what does this mean?” said Lineberger. “It might be more responsible not to offer insurance on two levels. One, because it would be better coverage for our employees, and two, because health care should be de-coupled from employment. You shouldn’t have to be coupled to your employer to get the coverage you need.”

Small businesses, those with 50 employees or fewer, face a tax penalty should they not offer health insurance to their employees through the exchange. The panel spent time exploring the pros and cons of de-coupling insurance and employers. Kleppner asked, if the tax penalty a business is charged is lower than the amount it would cost to insure employees, and employees can purchase insurance through the exchange along with subsidies and tax credits, is it more sensible to not offer insurance? Kleppner says this issue has become more important with the federal definition of a small business going from 50 employees to 100 employees or fewer. Kleppner said that in Vermont, a business with 100 employees or fewer isn’t exactly a small business.

New out-of-pocket maximums, or the total amount an insurance company requires an individual to pay toward the cost of his/her health care, have also put the squeeze on businesses. “If we choose to stop offering insurance, the question we face is if we have been subsidizing employees’ insurance to some extent, do we continue somehow to subsidize their costs so that the individual costs don’t go away, even though the total costs may go down?” said Kleppner. “It’s a business by business decision, but it’s a complicated choice.”

Another feature of Vermont’s health care exchange that will benefit businesses is portability. If an employee purchases health insurance through an employer and leaves one job for another that does not offer insurance, they can keep their same plan as an individual. Lunge said instead of automatic disenrollment due to a change in one’s life circumstances, “Portability will encourage a continuity of care and make sure that people’s health conditions are kept under control and they don’t lose their insurance.”

Lunge says the goal of health care reform must focus on leaving a for-profit system where quality and quantity of care do not equal out. “If you look at the United States as compared to other developed countries, we spend in some instances twice as much as other countries but our outcomes are not as good, so we’re paying more and we’re getting less. What we’re focusing on is how we get to a more sustainable and cost-effective system.”

Lineberger believes one way to ensure quality health care is to focus on individual needs. This includes making payment for services easier by combining multiple procedures in one bill in a system called bundling. “ Bundling puts the onus on care providers to work as a team to create the best outcome for each particular situation,” said Lunge. “A standard procedure for knee replacement may require 20 physical therapy appointments. But some people may need 12 and others may need 30. What this does is let providers create a package for the individual so they’re not wasting money, but providing better after-care because the worst thing for that entity would be if that person needed to be re-hospitalized.”

Kleppner believes the exchange will help businesses and the individual. “We all know people who need their jobs because of the insurance, and that’s just a terrible situation to force someone into. I’m very hopeful this reform will unleash a lot of entrepreneurial energy and creativity because people won’t have to be chained to an employer because of insurance.”

Read more: Deerfield Valley News – Group prepares for health care changes coming in next two years

Participating in Vermont’s Health Care Evolution

August 13, 2012

Honored to be appointed to two Advisory positions in relation to Vermont’s evolving health care system, I hope to share their workings with my neighbors.

The Green Mountain Care Board Advisory Committee (GMCBAC) is comprised of 41 Vermont residents.  We serve as a public sounding board for the 5 Board Members responsible for planning Vermont’s road map to a health care system that improves health and moderates costs.

The charge of the Medicaid and Exchange Advisory Board (MEAB) is to advise and inform Vermont’s Department of Health Access (DVHA) on policy development and program administration for the state’s Medicaid‐funded programs, and the Vermont Health Benefit Exchange that is being developed.  The Board is comprised of 30 Vermont residents, evenly divided between beneficiaries of Medicaid or Medicaid‐funded programs, individuals, self‐employed individuals, and representatives of small businesses, large employers, insurance carriers, brokers and agents, advocates for consumer organizations, health care professionals and representatives from a broad range of health care professionals.

As the only person to sit on both Advisories, my goal is to facilitate communication between the two groups as well.

Currently Vermont spends approximately 5.3 billion dollars a year on health care, and it does not reach all Vermonters equally.  Both GMCB and DVHA are charged with helping Vermont do a better job; GMCB by creating a path to health care for all Vermonters, DVHA by creating the Health Care Exchange as a step on that path.

Our current “fee for service” system rewards volume over value, often problematic with over diagnosing, over prescribing and over-treatment.  Without knowing the costs of various tests and procedures ordered in the name of preventing malpractice lawsuits, providers do not have the opportunity to weigh options and find the path that leads to the best health outcomes.  With this system, there is no intrinsic need to coordinate care.

GMCB is investigating and evaluating alternative systems including those of other states, other countries, and Vermont’s own IBM.  The focus of 2012 is to review both hospital and insurance rates, and establish pilot projects testing different methods to pay for and improve the quality of health care in Vermont.  These methods include “bundling”, “global budgets” and “population based payments” as well as Accountable Care Organizations.

Bundling is the process of having one fee for all costs associated with a procedure.  Rather than paying each the surgeon, anesthesiologist, hospital, physical therapist, all followup care, etc for their part in a hip replacement, there would be one fee, period.  This would incentivize the group of practitioners to collectively do their best for the patient.

Population Based payment gives a budget to a hospital, for example, for the number of people it serves with outcomes on limited services that must be met.  The hospital can then manage its funds accordingly.

GMBC is poised to submit a State Innovation Model grant application next month for federal funds to implement and test some of the above stated methodologies.

The hospital budget review process typically evaluates how much money was spent providing health care the previous year and projects into the next.  The GMCB goal is to ask, instead, how can better health care be provided next year?  This year a 3.75% targes was set to signal the need to moderate cost.

GMCB’s new Hospital Budget Review publication is available for download at    GMCB is seeking public comment until 31 August.  PLEASE check it out, add your comments, concerns or ask your questions.  Alternatively, email , GMCB Administrative Assistant.

GMCB is also working to establish Essential Health Benefits (EHB), per the federal Affordable Card Act, that will be universally available to all Vermonters once the Exchange is in place.  DVHA is making recommendations regarding EHB that include hospitalization, Maternity & Newborn Care, Mental Health, prescription drugs, etc.

The full focus of GMCB, DVHA with the assistance of GMCBAC, MEAB and others, is to assist Vermont in developing a culture of care by moderating cost and improving health.  It is a balancing act between making quality health care available to each Vermonter, and paying providers fairly.  It is also a process of changing our collective vision to focus on positive health outcomes rather than procedures performed or drugs prescribed.

My intention is to write periodic updates regarding Vermont’s Health Care evolution through these two groups.  Feel free to contact me with questions in between: