Problems aside, health care changes help many

December 15, 2013

Times Argus

MONTPELIER — Much has been made of all the tumult surrounding the rollout of the federal Affordable Care Act.

But for a significant swath of the Vermont population, the arrival of the new law has brought with it the solution to many of their health care problems.

Revised income eligibility limits mean that about 40,000 residents of the state have become newly eligible for Medicaid, the federal health care subsidy that provides free insurance to the poorest citizens in the nation.

The ACA increased the income eligibility cutoff for Medicaid from 133 percent of the federal poverty level to 138 percent — still less than $35,000 per year for a family of four. In real dollars, that percentage jump doesn’t amount to much.

But for many of the clients served by advocates like Peter Sterling, executive director of the Vermont Campaign for Health Care Security, the changes will mean the difference between having insurance or not.

“We know from years of serving Vermonters that the number one reason they don’t enroll in a public health care plan is because of cost,” Sterling said. “And now those low-income Vermonters, instead of having to pay a premium, now they are getting free health care.”

Vermont has long sought to keep premiums as low as possible for people living just beyond the limits of Medicaid eligibility.

A program known as the Vermont Health Assistance Program, Sterling said, has provided subsidized insurance for what to most Vermonters would seem a nominal fee.

“But for people living at these income levels, even that $25 per month premium can be a barrier for folks,” Sterling said.

Robin Lunge, director of health care for the administration of Gov. Peter Shumlin, said it’s difficult to pinpoint precisely how many new residents in the state will become Medicaid eligible under the new guidelines.

But 33,000 residents previously enrolled in VHAP and Catamount Health will be automatically enrolled in Medicaid, thanks to the expansion in the ACA. And Lunge said the state is projecting that the heightened enrollment will bring about $135 million worth of Medicaid dollars into the state annually.

Lunge said more than 100,000 Vermonters will be enrolled in Medicaid when the eligibility threshold changes at the beginning of 2014.

“So what it means is for folks who are struggling financially and who are every month thinking about how to make ends meet, they don’t have to worry about that health insurance premium and don’t have to worry about what bill to pay that month,” Lunge said.

Sterling said the state will need to conduct outreach if it hopes to enroll the Medicaid-eligible Vermonters who weren’t already on VHAP or Catamount. He said that about 8,000 of the state’s 42,000 uninsured residents are eligible for Medicaid.

“So 8,000 doesn’t sound like a big number, but for our little state that’s a gigantic number, and if we can find them and enroll them, then it’s something that could result in an improvement in the health of those Vermonters, and financial security for these people,” Sterling said.

Lunge said she thinks it could be a three-year project to find and enroll every Medicaid-eligible Vermonter, since it’s a population that tends to be among the toughest to reach.

While hospitals and other health care providers have long assailed Medicaid reimbursement rates as insufficient to cover costs, Bea Grause, head of the Vermont Association of Hospitals and Health Systems, said the expansion is a positive development.

“It’s always good when people get coverage, so to have people who have previously been uninsured to now go on Medicaid is a good thing, and I think that that should be celebrated,” Grause said.

Republican governors in some states have rejected the Medicaid expansion, turning away federal money they fear will become a responsibility of state taxpayers if Congress later cuts the program.

Darcie Johnston, executive director of Vermonters for Health Care Freedom, a group opposed to many of the state and federal health care reform initiatives now underway, said that by accepting the federal money now, Vermont risks shouldering additional financial burdens in the future.

“The federal government’s got a pretty good track record of not keeping its promises,” Johnston said. “I think Vermont needs to be cautious. We want people covered. The question is, is this going to be something that the state is suddenly going to have to pony up for somewhere down the road.”