by Ellen Oxfeld, Middlebury

There has been a lot of discussion about the Exchange – about “bronze,” “silver” and “platinum” plans. Vermont is required by federal law to implement the Exchange in 2014. How can Vermont’s legislature best configure the Exchange?  Many people are wondering what this all means for them.

Let’s remember that the Exchange is just about a format to purchase private insurance. It is not the same as the single payer system that Vermonters will be allowed to implement in 2017.  Single payer is about financing health care for all Vermonters directly – without the waste and overhead of insurance company middlemen.  A single payer system guarantees health care, divorced from employment, funded directly by the public.  If you lose your job, you will still have health care in a single payer system.  If you are a small employer, you will not have to spend hours shopping around for different plans.  

We all know that if the Exchange was able to deliver health care to all Vermonters when they needed it, and to control costs, we wouldn’t need a single payer system in Vermont.  However, we can’t establish a single payer system until 2017, because we can’t get a waiver from the Exchange until then.  Therefore, we  have to think about the Exchange as temporary, and try to take advantage of the one thing the Exchange does have to offer, namely federal dollars to help people purchase insurance premiums and to subsidize some out of pocket costs.   Once Vermont establishes a single payer system, we will be able to access these same federal dollars, but put them directly into our new single payer system.

In the short run, we will have to devise rules for the Exchange that do the least harm.  We know that having plans with different levels is not what health care is all about!  But, we also know that many small employers are well meaning, and if they could afford private insurance plans with more coverage, they would have purchased them in the first place.

The House Health Care Committee and the Shumlin administration have been trying their best to wrestle with these issues.  I suggest that they let two guiding principles help them through this morass, and that they keep in mind that the Exchange is temporary.  First, despite the inclusion of bronze plans, there should be ways to create maximum incentives for “silver” plans.  I agree, you cannot force a small business to purchase a plan they can’t afford.  However, incentives can maximize the choices of silver plans, and this may bring in more federal dollars, as well as keep to a minimum the number of people who are left holding the bag with high out of pocket costs.   Second, it will be very important to make sure that people currently on VHAP and Catamount experience as little deterioration in their experience of cost and coverage as possible.  If the Exchange results in a sharp deterioration of coverage or increase in cost, this will create real hardships for people.  Such bad experiences with the Exchange may also poison the well for single payer, because people will be turned off to the very idea of reform.

As we go through this process, however, let’s remember that single payer is based on completely different principles than the Exchange.  With single payer we will no longer be talking about “bronze,” “silver” and “platinum” plans, but guaranteed health care for all Vermonters without the excess cost of the insurance company middlemen.  Single payer is the only real solution for individuals, for businesses, and for all Vermonters.