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Killington discusses effects of Health Connect changes

KILLINGTON - Changes in the health care system are on the way, and for guidance the Killington board of selectmen brought in an expert from the Vermont League of Cities and Towns to explain how it works.
David Sichel, deputy director of risk management services for VLCT recently spent an hour at the board's regular meeting discussing the new program and answering questions.
Essentially, the federal health reform law (popularly known as Obamacare) requires the states to set up health care insurance exchanges. The states have been given broad leeway in their approaches to these exchanges.
"In Vermont," Sichel said, "the state is going to operate an exchange called 'Vermont Health Connect.' That's going to be a marketplace where individuals and small group employers will be able to purchase health insurance. Some people have sort of described it as being something like Orbitz, where you go online, you can look at products, you can compare them, compare the prices, compare the features, and then make decisions about what you'd like to get and go ahead and make the purchase. It's a little more complicated than that, but that's sort of the general idea… the health exchange is intending to do is make it much easier for people compare health insurance policies like apples to apples," he said. "They will all cover the same essential benefits as defined by the federal government."
The plans come with several tiers and employers must decide first if they want to offer coverage and second, how much they are going to contribute to employee plans. , .
Employees will have the option of choosing, bronze, silver, gold or platinum level plans. Bronze plans have relatively low premiums with relatively high deductibles, where are platinum level plans offer the opposite: relatively high premiums with relatively low deductibles.
 "The more you're paying in premium, the more risk the health insurer takes on, and the less risk the subscriber has," Sichel explained of the options employees will face. "The lower out-of-pocket costs you have, because you paid money to the insurer to take the risk. That's true today, too. But here, you can compare one to the other and know what they are."
Vermont Health Connect, Sichel said, opens on Oct. 1, and residents have until Dec. 15 to decide which plan fits best with their level of need. The Vermont Health Exchange takes effect on Jan. 1, 2014.
"And when I say it's open for those folks, I mean it's going to be the only game in town," Sichel continued. "The state has decided that the exchange will be the exclusive market for those folks, and they won't allow a market outside of the exchange."
There are exceptions, he added: plans grandfathered under federal law (mostly school districts), and employers, which insure themselves, among a few others.
Town Manager Seth Webb summed up the effect on town employees, saying, "Employees will select the plan, not the town," he said. "The federal government defines who's eligible; some employees will be eligible for tax credits; and the cost sharing is very different.."
"You'll see two plans where the actuarial values are almost identical, but the way that those plans work is very different, and the worst case on one of them is much worse than on the other one" said Sichel.
"I think that's what we're going to need to find out," said Bianchi.
"In the long term, the state wants to separate health insurance from employment, and the exchange really isn't doing that But it's starting, and the state's using it to help that process along."
The system is designed to offer help: Sichel said there would be a call center for questions, federally funded navigators to offer personal assistance, and insurance agents.
"At VLCT, we're not going to be navigators, we're not really going to be consumer assisters, but we are going to work to help members go through the process," Sichel said. "We'll help you understand what's going on in the exchange, and, as an employer, make choices and get to a point where your employees can start enrolling in their health insurance. However, we're not really prepared to help each individual employee go through that process."
One member of the audience wanted to know if the employer or the employee would wind up paying more when the new system goes into effect.
"For an employer-offered plan, it will work the same way it does now," Sichel said, "which is the employer will make the payment. The employer will get one bill from Vermont Health Connect that has all the employees on, and the health plans they are on. If some of the premium has to be paid by payroll deduction, that can be taken directly out of your paycheck, and the employer would pay the bill. If new employees come on, or if people leave, it'll work the same way it does now, but it will go through Vermont Health Connect."
The entire discussion, including Sichel's PowerPoint presentation, can be seen on PEG-TV, or streamed on its Web site,