Too much cost sharing in health exchange, advocates say

By Morgan True, Dec. 10, 2014

Alissa Carberry, 24, is an early childhood educator working at a nonprofit in Burlington’s Old North End. She has type 1 diabetes and employer-sponsored health insurance from Vermont Health Connect.

Carberry said she has become active with Vermont’s Health Care is a Human Right campaign because she can’t keep up with the cost of managing her condition.

“I’m lucky that my work does cover my premiums, but the deductibles and copays are simply outrageous,” Carberry said, speaking at a recent news conference in Burlington.

Managing her diabetes means that she needs health care services much more frequently than the average person. Her first bill this year was $2,100, she said. Carberry makes less than $30,000 per year and is working to pay down four years of student loan debt.

“It is simply not possible for me to pay all of my bills,” she said.

Her first three months of insulin pump supplies cost her $642 this year, after insurance, she said. She pays another $20 per month for strips to test her blood sugar and $50 dollars a month for insulin.

“So, if you’re doing the math, it adds up quickly,” she said. “These are the measures my doctor asks me to take to make a plan to grow old in good health.”

Her doctor also advises her to see a dentist and optometrist regularly. But her silver plan doesn’t cover those services and it’s not something she can pay for on her own.

“I’m struggling to make ends meet and take care of my health. As a person in my mid-20s, this should not be an issue that I have to face,” Carberry said.

There are thousands of Vermonters like her who don’t get the care they need or do so at the expense of good food, housing or education, Carberry said.

Deb Richter, a physician, said coverage through Vermont Health Connect leaves her patients who have chronic medical needs with expenses they struggle to afford.

Gold plans are the second-most generous on the exchange and cover between 78 percent and 82 percent of medical costs. Carberry’s silver plan covers 70 percent of her costs.

A plan that covers 80 percent of costs is the lowest value plan Green Mountain Care can offer, and sources with knowledge of Gov. Peter Shumlin’s forthcoming benefit proposal have suggested it will fall in the range of a gold plan.

“In my view, the gold plan’s out-of-pocket costs are still too high,” Richter said.

Carberry and the Health Care is a Human Right campaign are urging the governor to offer a plan for health care reform through which coverage is paid for by progressive taxes and Vermonters pay nothing out-of-pocket at the point of service.

Shumlin administration officials have indicated that Green Mountain Care, as the publicly financed program is known, will likely involve some amount of cost sharing. Not including any deductibles or copays would greatly increase the program’s cost.

Richter argues that cost sharing penalizes people like Carberry who have medical conditions that require regular care.

Like activists from the Health Care is a Human Right campaign, she said medical services should be treated as a public good.

“We don’t charge people whose houses burn down more money to cover the fire department,” Richter said.