As a member of the House Health Care Committee it has been a tough few weeks. H.559 puts into state law the requirements set out by the Affordable Care Act (ACA) passed with great fanfare by Democrats in Washington. I summarize the ACA as Catamount on steroids. It will help make health coverage more affordable for many Americans. It won’t attack the underlying problems within our system. That is especially true in Vermont where we already have community rating and guaranteed issue – two features copied and put into the ACA (both good things).
The Shumlin administration has taken the ACA and tried to make it work as a stepping stone for our larger health reform efforts. There are a few good pieces that will help us, although on balance the timing is certainly frustrating.
As passed by the House last week, the Federal Health Exchanges will help us separate employment from health coverage and draw down more federal money (in the form of refundable tax credits) so that health care is more affordable. Estimates range from $100-300 million of subsidies, no small sum. These tax credits are only available to individuals buying insurance if they earn up to 400% of the Federal Poverty Level (almost $90,000 for a family of four). It is our assumption that many businesses will drop their high-deductible coverage and help employees buy coverage as individuals by setting up pre-tax accounts to be used for health expenses. Let’s hope this will become the most amicable divorce ever seen.
In the end the most controversial part of the bill was the inside/outside question: that is, would small businesses (50 or fewer employees) have the option to buy outside of the exchange or not. The administration kept saying the exchange would be a good deal for people, so I reasoned we could keep it voluntary so people come in by choice. It wasn’t until I was called into the Governor’s office that I saw the flaw in my logic.
After wondering why I was making such a stink about this point, Gov. Shumlin explained the timeline for seeking a waiver. Under Federal law, the date waivers can take effect is January 1, 2017. What I didn’t know was that we can apply much sooner. And we should, so we are early in the queue. When we submit that application we need to demonstrate that Vermont is getting $x million in tax credits because that becomes a baseline amount as we move forward under a waiver. We don’t have the luxury of waiting for people to slowly come to the Exchange if we want to move forward as quickly as possible with Green Mountain Care.
That was the piece I needed. Green Mountain Care is the goal and any interim steps must advance us toward that goal. H.559 isn’t our dream plan, but it doesn’t hurt our larger efforts. And in fact, it begins the cultural shift necessary to make a truly universal system possible at the same time giving us a good deal of new Federal money so that health care becomes more affordable for low and middle-income Vermonters.