by Randolph T. Holhut
American Reporter Correspondent
December 12, 2013
NELSON MANDELA, THE INDOMITABLE
DUMMERSTON, Vt. -- I got signed up for my Obamacare last week.
My nonprofit newspaper, being a very small operation, can no longer afford to pay for our health insurance. I was splitting the costs with the organization, but we soon discovered that it would be cheaper for everyone to go out on their own and get insurance.
So, under the terms of the federal Affordable Care Act (ACA), I entered my state's health insurance exchange to buy a policy of my own.
Vermont, unlike many other states, has set up its own exchange. The Vermont Health Connect website has been balky and glitchy, which is par for the course for any big tech set up, but it has gotten better with each passing week and has had fewer problems than healthcare.gov, the federal site.
The other big difference between Vermont and other states is that Vermont has fully funded the positions of the people known as navigators - the trained folks who guide people through the process of signing up for health insurance.
I could have tried doing it on my own, but from what I was hearing, the best way to get enrolled was to use a navigator. After a 20-minute visit with a navigator based at my local hospital, I had my insurance and, with the state and federal subsidies, I was able to get coverage comparable to the policy we had through the local Chamber of Commerce, and have my total premium be roughly equal to my share of the cost for the current coverage.
The cheap high-deductible, low-coverage policies that people seem so desperate to keep aren't sold in Vermont. And almost all the insurance companies fled Vermont two decades ago when we passed the community rating law, which made it illegal to cherry pick healthy customers and deny coverage to the sick. Insurance companies had to cover everyone for the same price.
That's a big reason why two insurers - Blue Cross-Blue Shield and MVP Health Plan (an HMO) - are the only ones left in Vermont.
I am happy with my experience. For the first time in my adult life, my health insurance is not dependent on my job status. This is a big deal, as many Americans are beginning to discover that they no longer have to stay trapped in a crappy job just to keep their insurance, or pay at the market rate for coverage through COBRA if they lose their job.
They are getting a taste of the Vermont style of coverage, too, with the ACA's ban on denials of insurance based on pre-existing conditions. Now health insurers have to insure everyone, regardless of age or health.
It would've been easier for everyone if we extended Medicare to all Americans, which is how the rest of the industrialized world provides health coverage to its citizens. What ultimately became the ACA was, sadly, the only politically feasible system. It still leaves private insurers in the game. It still leaves millions without coverage. It still leaves a system in place where the quality of care is determined by one's wealth.
But even with all its imperfections and needless complexity, the ACA is a significant step forward.
Forget the overblown anecdotes flogged by conservatives of people who are not benefiting from the ACA. There are far more people who discovering for the first time that is possible to get health insurance without going broke.
Of course, this terrifies the Republican Party. If the ACA works, they are pretty much finished as a political force in America.
That's why 26 states, most of them dominated by Republicans, rejected the federal government's offer to pay for expanded Medicaid coverage. That's why some states, like Texas, have thrown up bureaucratic hurdles to make it more difficult for navigators to do their jobs. That's why the Republicans in Congress refused to fully fund the technology that was needed to make online enrollment on the federal exchange site work smoothly.
All the Republicans in Congress can do is delay, defund, and generally throw a monkey wrench into the process of implementing the ACA. They think they will win elections in 2014 and 2016 on this strategy.
They are deluding themselves. Reform is coming, and coming faster than they think.
Vermont is also doing its part to show that a single-payer system can work in this country. It is taking advantage of an ACA provision to use the available federal funds for expanding Medicaid to set up a system that will cover all Vermonters by 2017.
Pooling the federal health care dollars that come to the state, together with a slight increase in taxes, will fund a non-profit, single-payer health care system that will have no more premiums, co-pays or hospital bills. By having just one administrator to bill for services, paperwork and administrative overhead costs are reduced, and that money can used instead to pay for coverage.
How much can saved with single-payer? According to Dr. William Hsaio, a Harvard health-care economist who is helping Vermont design its system, the state will end up saving about 25 percent per capita compared to the current system.
And if Vermont can make a single-payer plan work, it can be a model for the rest of the country. That should really have Republicans terrified.
AR's Chief of Correspondents, Randolph T. Holhut, holds an M.P.A .from the Kennedy School of Government at Harvard University and has been an award-winning journalist in New England for more than 30 years. He edited "The George Seldes Reader" (Barricade Books). He can be reached at firstname.lastname@example.org.