Wed, Aug 28, 2013 07:21 PM
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
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
"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
"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"
"I think that's what we're going to need to find out," said
"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
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
"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
The entire discussion, including Sichel's PowerPoint presentation,
can be seen on PEG-TV, or streamed on its Web site,