Let's not go backward on coverage

December 16, 2012

Rutland Herald


As director since 2000 of a program whose mission is to help the uninsured and underinsured stay healthy, I was concerned with Gov. Peter Shumlin’s comments in Sunday’s Rutland Herald and Times Argus saying that “state health care subsidies for working class Vermonters might be more generous than they need to be, and that some residents here could soon be facing higher insurance premiums and deductibles.”

Vermont has been ahead of the nation for years in providing affordable health insurance programs to its residents, but change is on the way, and I am afraid of what that means for many Vermonters who will experience those changes in real ways. I fear that for many the changes may be regressive instead of progressive.

When the exchange, mandated by the Affordable Care Act, begins in January 2014, programs like VHAP and Catamount will no longer exist, and for many on these programs insurance costs will go up substantially. I am afraid that if people don’t realize the consequences of these changes they will not let the governor and their representatives know about how they will be affected.

So what might these changes mean to the people in the “working class,” those in the so-called “middle class,” many who probably won’t be eligible for subsidies and have been on Catamount? These are the people we need to maintain their health insurance since they help support the whole system, but they are often just “making it.”

I asked someone who is in that situation. She knows that her premiums, co-pays, co-insurance will go up substantially. She said, “I will have to make a choice between paying for my health insurance increases and putting money aside for retirement. I can see myself putting off a test or procedure because I won’t be able to afford it.” She is very frustrated and feels like she is going backward.

Costs will also go up for the people who will lose VHAP and are not eligible for Medicaid. Weekly, I get calls from patients or a health care provider asking for assistance in paying a $33 monthly VHAP premium because there is no money. We have people going on and off VHAP all the time because they can’t afford their premiums. In the exchange, if premiums are not paid consistently, people will lose their insurance until the next January. If you make $1,400 a month and pay rent, a car payment, gas, insurance, utilities, food and other basics, you will likely come up short most of the time.

If you lose your insurance, how do you pay for your medications and doctor’s visits? Who pays the bill? The costs get shifted, and everyone pays. At a time when the whole “health care system” is looking for ways to contain costs while still providing quality care, we need to seriously evaluate what not providing sufficient subsidies would mean for the “working class” and all Vermonters. I feel that if we don’t offer state subsidies to supplement the federal ones, we will all be paying the price somewhere along the line in continuing or worsening cost shifts.

I do the work that I do because I have walked in the shoes of those worried about their health insurance coverage since my husband was self-employed. I have been with those who have struggled through serious illnesses without insurance and access to health care. Daily, I see the real life struggles people face because of their inability to pay for health care. These struggles exist now even while Vermont has some of the best health care insurance programs available. I know the health care system is evolving, and working toward universal access has always been my goal, but on the way there I hope we don’t regress by having insurance be less affordable than it currently is.

I encourage everyone to go to www.catamounthealth.org and http://hcr.vermont.gov/timeline/exchange to learn more about the changes that are coming.


Wilda Pelton is a resident of Springfield.