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Seven Days, Four Navigators: One Small Business Owner's Search for the Ideal Insurance Plan 

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Obamacare can’t come soon enough for Megan James. Our associate arts editor is pregnant, her baby’s due in May and under Vermont’s new health care plan, the birth could cost her as little as $500 instead of $2500 — the deductible for an individual on our current plan. Almost every one of her pregnant predecessors at Seven Days has paid $5000 — the family deductible — for the pricey privilege of reproducing.

Delivering a new way to purchase health insurance is proving to be painful indeed. Talk about complications! Six agonizing weeks after the nationwide launch of the health care exchanges, the fruits of the Affordable Care Act have yet to emerge. Closer to home, the Vermont Health Connect website — on which Seven Days and other Vermont small business employees were supposed to be able to shop for health care — has been plagued by problems since it went live on October 1.

As a result, we’re in health care limbo. Like many other companies too small to engage a full-time HR person, Seven Days finds itself caught between the hell of a mandate we can’t carry out and the vague promises of more choice now and “single payer someday.”

Most vexing: We can go on the Vermont Health Connect website and register our employees, along with the amount we’re contributing toward their monthly premiums — or so I’d been told. But the website won’t let employees complete step two of the process: They can’t log on, comparison shop among the 18 plans and buy one.

No click, no coverage.

In a meeting at our office last Thursday, Jessica Holcomb, an “exchange specialist” from Blue Cross Blue Shield, told us that, to her knowledge, no one has successfully completed the employee portion of the online sign-up.

Acknowledging that major mess-up, Gov. Peter Shumlin recently announced the small-business enrollment deadline would be extended three months, to March 31, 2014. Companies like Seven Days now have four choices: We can hold out hope that the exchange will be functional in time to get our employees enrolled for the first of the year. We can hang on to our current health care plan for three more months, which puts off the pain but also subjects us to the potential HR nightmares of a mid-year changeover.

Or, irony of ironies: We can ask someone like Holcomb to help us pick one of the new plans and sign all qualifying Seven Dayzers up for it. That means: Instead of having the “KAYAK.com” experience of customizing their health care adventures, as the president pitched it, our employees would be on the same plane for a group trip booked by a travel agent.

If we pick none of the above, Blue Cross will assign us a plan that most closely resembles the one we currently have.

All summer long, I tried to ignore the mounting hysteria about Vermont’s health care exchange, deleting countless email invites to info sessions and webinars. I just didn’t have the bandwidth to dig in and figure out if it could really be worse, as some business interests were saying, than what we have had for years: a plan with ever-escalating premiums announced too late in the year to shop around for another one.

I was hoping some other CEO — one with more time and stronger opinions about health care — would fight the good fight, and all of us small-business owners would benefit from his or her carefully considered analysis and conclusions.

But no pearls of wisdom ever emerged, and the argument divided — unhelpfully — along political lines. In August, I noticed the two employees charged with researching our options were getting really anxious about it. Everybody else in the company, too, was starting to fret over what we intended to do.

Then came Ken Picard’s September 18 cover story, which looked at how the exchange would affect the health care of five different Vermonters. It was a crash course for Ken. Editing the article had the same effect on me. In the process of peppering Ken with questions, I learned about subsidies, deductibles and out-of-pocket maximums, standard and “nonstandard” plans, and, just before they were to disappear, the differences among Catamount, VHAP and Medicaid.

I came away thinking: How hard can it be to figure this thing out?

Hard enough that it took four “navigators” to lead me to a place that looks a lot like where we came from. Of course we’d continue to insure our full-time employees — on average, they earn too much to qualify for subsidies — and we’d pay the same amount toward premiums as last year.

But what about the health savings accounts to which we contribute as part of our current coverage? Not all the new plans have them. We’d start “health reimbursement accounts” instead. They’re not pre-tax cash in the bank but a promise to pay an employee’s medical expenses up to a certain amount.

Similar concept, different acronym.

No navigator was on hand last Friday to help me and Seven Days business manager Cheryl Brownell explore the webby wilds of Vermont Health Connect. Holcomb expressed confidence that we could at least get the company’s 32 qualifying employees registered on the website. Then, in the event the exchange starts working before the end of November, they can buy into Obamacare as it was originally envisioned.

We were ready to do our part.

After clicking on the “start here” box for employers, we got a login prompt. Since we didn’t have one yet, we pushed “register,” which generated a form that looked as if it was designed for an individual. Call No. 1 to the help line reassured us to keep going.

Cheryl filled in some of her personal information, and more still as part of the identity verification and security processes. She had surrendered her birth date, Social Security number, address, childhood street name, the town in which she got engaged and the name of the hospital where her eldest child was born before the computer abruptly announced:  “An unexpected error occurred. Please contact administrator.”

Call No. 2 to the help line instructed us to close out of the web browser and log in again. But the website didn’t recognize either the login or password we had just set up. The guy on the phone told Cheryl he’d refer the problem to the IT department and to expect either an email or a call. He didn’t say when.

Three days later, we’re still waiting.

So what are we going to do as a company?

The reason we met with Holcomb was to learn more about health reimbursement accounts, or HRAs, which are harder to budget for than health savings accounts. If all of our employees use the maximum amount Seven Days promises each of them, we’ll spend twice as much as we did last year on their HSAs.

No less a gamble are the health plans themselves, nine of which Holcomb went over in great detail — down to the double asterisks. Cheryl observed that they aren’t really much different from each other in terms of the total cash outlay: You can save money paying a lower premium — unless you get sick or hurt. The high-premium plan takes your money up front.

But there’s still no beating the house.

Holcomb directed us to a plan — the nonstandard “Gold” — that costs about the same as our current one but covers more preventative care. The amount of the deductible will equal the value of the HRAs we plan to set up. An individual employee could potentially rack up another $3000 in medical expenses after that, but only in a slow drip of accumulated co-pays: It’s $20 to see a primary care doc or therapist; $30 for a specialist; $250 for an emergency room visit; $500 for a hospital stay, no matter how long. Megan’s baby should cost her no more than that.

If we never hear back from Health Care Connect, we’re all going for the Gold.

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About The Author

Paula Routly

Paula Routly

Bio:
Paula Routly is the cofounder, publisher and coeditor of Seven Days.

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