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Looking Ahead:Community Awareness of Vermont Community Awareness of Vermont

Health Connect and the Changes to Come

Presented by:Presented by:Jessica Morrison, R.N., and Rachel Sooter, R.N.

Kelley Groll, R.N., Katherine Amey, R.N., Jon Bourgo, Hendrika Maltby, Ph.D., R.N., FRCNA

Outline

1. Background of health care reform2. Survey and results3. Study recommendations4. Update

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In partnership with the Community Health Centers of Burlington•Federally Qualified Health Centery Q•Navigator organization•UVM MEPN Public health nursing class project

The current state of coverage in Vermont

Medicare

VHAPCatamount

8% Medicare 20%

Medicaid 14%

Private29.6%

8%

2011

Military 1.5%

Uninsured 7.6%

Self-funded private19.8%

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Provisions of Health care reform

• Affordable Care Act (ACA) passed in 2010▫ Cannot be denied coverage based on pre-existing

conditions▫ Under 26 covered by parents insurance▫ Minimum standards established for insurance

coverage▫ Medicaid expansion▫ Medicare restructuring to move from fee-for-

service towards bundled payment▫ Employer mandate if over 50 employees

Affordable Care Act continued

▫ Sliding scale subsidies to purchase insurance in exchange marketplace based on income

▫ Individual mandate to purchase insurance $95 or 1% of income in 2014 $695 or 2.5% of income in 2016

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ACA changes in Vermont

Timeline of Reform• Enrollment: October 1 - March 31, 2014• Coverage does not begin right away

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Goals of Study

• What do people know about Vermont health connect?

• What do young people know and think?

• What are people’s attitudes about insurance and the penalty?

Wh t ti d d l h ?• What questions and concerns do people have?

Methods• Survey drafted by Master’s Entry Program in

Nursing (MEPN) studentsNursing (MEPN) students

• Revised by CHCB staff

• Second revision after one day piloting

• July 2013

• Purposive, geographic sampling

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Subjects

• Target demographic: g g p▫ Young, middle income people▫ People on VHAP/Catamount▫ People who are currently uninsured▫ Those who are purchasing private insurance

personally

• n = 318, 53% female, average age = 34.6 3 8, 53% e a e, a e age age 34.6▫ 115 from CHCB▫ 117 from FAHC▫ 86 from other community locations (coffee shops, bus

stops, food shelf, laundromat, CVOEO, worker’s center)

Results:Have you heard of:

Yes No

82% 17%Affordable Care Act/ Obamacare

42% 58%Vermont Health Connect

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How do you think the new health insurance program will affect your life?

60.00%

20.00%

30.00%

40.00%

50.00%

Under 30

Over 30

0.00%

10.00%

A lot better

A little better

No effect A little worse

A lot worse

It will make things:

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Do you think having a penalty is fair?

57% No43% Yes

“The penalty is not fair unless they actually [make healthcare] affordable for everyone/universal (included/assigned as a basic human right)”

43

Are VHAP/Catamount clients aware that these programs are being phased

out?

Yes28%

No

“When does it start? Can I carry over my catamount plan to it? Cost? Coverage details?”

“How will it differ from VHAP?”

72%

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Are you planning to sign up for Vermont Health Connect?

Yes No I don't know*

VHAP/

Catamount 63% 21% 13%Cata ou t

Uninsured 52% 37% 11%

* Write-in response

Comment Themes

Confusion

“? never heard of it”

“I don't know anything about it, and if I don't then a concern would be that I doubt others of my age are aware of it either.”

“Unsure exactly what it entails. How it'll affect my insurance which is a necessity for my treatment and prescriptions ”which is a necessity for my treatment and prescriptions.

“If VHAP is being phased out why haven't I heard about it and how do I go about reapplying for new health insurance?”

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Themes Continued

Concern about cost

• To Individual:

“I have not heard about this I think my concern would be that it is affordable”would be that it is affordable

“How much will it cost? What is and isn't covered? Its making some people nervous and some very angry.”

Themes Continued

Concern about cost

• To Society:

“Who is paying for it?”

“I don't know how much it will cost taxpayers- my feeling is as long as I am not paying to fund it- fine”

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Concern about coverage

Themes Continued

“Lapses in care during transition?”

“Not convinced the coverage is variable enough to meet all the people’s needs.”

Don’t agree with mandatory insurance

Themes Continued

insurance

“I work 20- 40 hrs per week, part-time, minimal wage and cannot afford to have half my paychecks go to pay for insurance for them "what if" situations. It's like mandatory car insurance for someone driving for 30

h d dg

years with no accidents and never uses it -money wasted for people that can't afford it.” – 30 years old, uninsured

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In Favor of Health Reform

Themes Continued

In Favor of Health Reform

“…it's about time. I've dealt with people who were uninsured and lacking in health care. My adult son was a part-time employee with no insurance until changes allowed him to be covered under my insurance until age 25- which he will be soon.”

“Everyone should be allowed to have insurance, it costs single people a lot even when they work 2 jobs.”

“Step in the right direction for the country overall.”

Themes continued

More health reform needed

“It is not doing enough to reduce the bottom line cost of healthcare and especially pharmaceuticals.”

“That we passed law in 2011 (act 48) that says we must consider healthcare a public good. Health connect is more of the same… health care as a

dit ”commodity.”

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Summary

Low awareness about Vermont Health Connect and phasing out of VHAP/Catamount

Many under 30 covered by parents’ insurance

Summary

Under 30 apathetic b t iti b t but positive about change

Over 30 more concerned, skeptical about benefits of change

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Summary

Only about half of uninsured plan to sign uninsured plan to sign up

Comments revealed confusion about changes and concerns about cost and mandatory insurance

Recommendations for CHCB

• Focus efforts on outreach, branding

• Under 30 - fight apathy

• Over 30 - sell it as positive change

• Short survey for everyone checking in for • Short survey for everyone checking in for appointment

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Implementation Update from CHCB

• Attitudes are tied to the national program

• Website problems

• VHAP/Catamount/Medicaid clients

• Navigators

• Many have wait and see approachMany have wait and see approach

• Under 30 finding plans costly

• Behind enrollment goals

Acknowledgements

• Kate Amey and Kelley Groll

• Rycki Maltby

• Jon Bourgo, Outreach Program Manager

E i Ch UVM M di l S d• Eric Chang, UVM Medical Student

• The Community Health Centers of Burlington

Eligibility Staff

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