Health Care Reform in 2008 and 2009

This 2008 legislative session started with high hopes for expanding access to affordable health care—in December, House Speaker Symington and Senate President Shumlin announced this as a top priority. But, with multi million dollar revenue shortfalls and the insistence of the Governor and the legislature not to raise revenue (be it from the Rainy Day Fund, bonding or new taxes), drastic cuts were proposed to dozens of programs helping the most vulnerable Vermonters.

Catamount Health is offered by Blue Cross Blue Shield and MVP and has a pre-existing conditions clause common to private insurance products. So anyone who has had a gap in insurance coverage must pay out of pocket for all treatment related to a pre-existing condition for the first year they are in Catamount Health. While the hope was to permanently eliminate the entire pre existing conditions clause, advocates ran head on into the budget crisis and had to settle for an “amnesty period” whereby anyone who applies for, or is enrolled in, Catamount Health before November 1st will have their pre-existing covered. BCBS and MVP originally called pregnancy a pre-existing condition but this has permanently been removed so that any woman who enrolls in Catamount Health will always have their costs associated with pregnancy covered.

Fortunately, the legislature recognized that people with high deductibles are essentially uninsured and expanded the eligibility for Catamount Health so now any Vermonter who has been in a plan with a deductible greater than $10,000 for at least 6 months can enroll without a waiting period. The catch is that these individuals will not be eligible for premium assistance for 12 months. In reality, since most high deductible plans cost somewhere in the neighborhood of Catamount Health’s unsubsidized price of $393/mo, these people won’t pay too much more but will now have an out of pocket limit of only $800/yr.

In a victory, advocates for low income Vermonters prevailed and stopped the Governor’s proposed increases in premiums and co-pays for Dr. Dynasaur, VHAP and Medicaid. However, effective July 1st, Catamount Health’s monthly premiums are increased from the $60 level to $65, the $90 level to $110, the $110 level to $135, the $125 level to $160 and the $135 level to $180. There is no doubt that these new higher premiums will discourage many Vermonters from enrolling and cause others to drop the Catamount Health.

What’s next?

Even with Catamount Health, there are still tens of thousands of uninsured Vermonters and many, many more who are paying too much for inadequate health care. As an important next step to getting everyone in Vermont affordable health care, there needs to be some legislative action to allow businesses to buy Catamount Health for their employees. In addition, the next legislature must permanently eliminate the pre-existing conditions clause, lower Catamount Health’s premiums back to their original levels and lower the eligibility for those in high deductible plans from $10,000 to at least $3,000 so these people can buy into Catamount Health without a waiting period.

Finally, Catamount Health and VHAP have a waiting period of 12 months only for those who voluntarily choose to drop their private insurance. This waiting period must be eliminated. For those who have been uninsured for more than 12 months or lose their insurance involuntarily (e.g. they lose or quit their job, retire, get divorced, leave college, choose to end COBRA and some other reasons) there is no waiting period.