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Questions Remain on Territorial Health Insurance Plan

Dec. 16, 2005 – There are still a lot of questions surrounding a bill designed to provide affordable health insurance coverage for uninsured Virgin Islanders.
Called the Governor's Health Reform Initiative, the plan proposes to provide health insurance for every uninsured person employed in the private sector in the Virgin Islands. If the plan is carried out, it could reduce the $24 million debt incurred by local hospitals as a result of unpaid bills from uninsured patients, according to Dr. Jacqueline Hoop-Sinicrope, project manager for the initiative. (See Health Plan Aims to Help Uninsured).
Based on local data collected from the University of the Virgin Islands and the Bureau of Economic Research, local employers are cutting down on benefits such as healthcare coverage, Hoop-Sinicrope said at a recent meeting held with stakeholders in the insurance business.
"There are a significant number of smaller businesses in the territory where the employer isn't providing health insurance benefits," she said during the meeting. "These are the people we're targeting — the younger employees, the self-employed, people who work seasonally or part-time — these are the individuals who want health insurance, but just can't afford it."
Hoop-Sinicrope explained that through the plan, employers would team up to buy a core benefits policy for their employees, and split the cost of the $182 monthly premium. If employees can't afford to pay their share, the government will kick in to pay a third of the cost, she said. The deductibles would be $250 per individual or $750 per family.
A supplemental benefits policy would also be available for a higher per-month premium, and the plan also carries a $1 million lifetime cap per beneficiary on all services, Hoop-Sinicrope said. She added that the goal is to insure 10,000 out of the 26,500 uninsured Virgin Islanders.
"We know we can't insure everybody, but we're going to try and help as many people as possible," Hoop-Syncope said. "That's why we have made it mandatory that every [private sector] employer without insurance must provide a core benefits insurance plan for their employees."
When asked after the meeting, Hoop-Sinicrope and Lauritz Mills, Bureau of Economic Research director and lead investigator, said there has been no negative response from the community about making the policy mandatory. However, when asked, Mills did not say whether or not the government has the authority to make the policy mandatory, or how they would enforce the requirement.
"We will deal with enforcement after the bill dealing with this policy is passed," Hoop-Sinicrope said.
However, Hoop-Sinicrope did not say when employers or stakeholders would be able to see the proposed bill, or what exactly the bill contained. She did say the government plans to begin implementing the policy on Jan. 1, and has been advertising the initiative in newspapers and other media outlets.
During a subsequent phone interview, Mills said certain underwriting guidelines have not yet been included in the bill, but are being worked on by Banking and Insurance Director Deverita Sturdivant. Beside premium rates, Mills did not say which guidelines still have to be written.
When contacted last week, Sen. Roosevelt David, a champion of the new policy, said the bill is almost complete and has been assigned to the Committee on Health and Hospitals.
"Legal counsel is just putting on the finishing touches," he said last week.
David said a team of policy planners, including Hoop-Sinicrope, Mills, and Alric Simmonds, deputy chief of staff to Gov. Charles W. Turnbull, helped put the bill together. Representatives from Sen. Usie R. Richard's office —— chair of the Health and Hospitals —— said the bill is not scheduled to appear before the Senate until mid-January.
During last week's meeting, Hoop-Sinicrope said if the legislation is not passed by Jan. 1, then policy planners will still begin enrolling applicants for coverage. At the time of enrollment, she said, applicants will be required to pay the first month's premium.
"This is how we will fund the policy; this money will be put into an account which will be used to pay resident's claims," she said.
When contacted this week, Mills said the government would not be kicking in any start-up money because the policy is self-funded. Instead, Employment and Business Solutions, contracted by the government to provide trust administration services, will be setting up a trust that will fund the program in its beginning stages. Mills did not say how EBS would go about establishing the fund, where the money would come from or how much it would be.
Furthermore, Mills could not say whether this money would be enough to fund claims coming in from Virgin Islanders during the first year the policy is implemented.
"It should be enough," she said, "but we'll see what happens."
Calls made to the Office of the Lieutenant Governor to determine the dollar amount of claims processed last year under the government's policy with Cigna were not returned.
However, according to Mills, the V.I. government will be chipping in $10 million to set up the premium assistance program for local income residents who need help with paying their monthly premiums. She did not say whether the $10 million would be used to fund anything else related to the insurance coverage. And she did not explain how this differs from kicking in money to start the self-funding.
Mills said V.I. Equicare will be the provider network in the V.I., and will be working closely with EBS to ensure "that only the most trusted and preferred providers are available for all employers and employees enrolled in the EBS program."
John W. Edelman, director of Global Human Resource Consulting Services, which was contracted by the government to provide consulting for the project, said Munich Re-Insurance has been contracted by the government as the re-insurance company. Edelman said the contract has been signed.

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