Vermont Pushes to Be First State with own Healthcare System

By a 21 to 9 vote in its senate, Vermont took a step closer this week toward possibly becoming the first state in the country to enact its own public healthcare plan under a waiver offered by the Obama administration in the federal Affordable Care Act (ACA).

 

The Vermont senate voted April 26 to approve a bill (S.57) that would establish an exchange where the state’s citizens can shop for health insurance.  Under a waiver provision in the federal healthcare reform law known as the Affordable Care Act (ACA), the insurance exchange could become a state-sponsored healthcare plan called Green Mountain Care, which would offer insurance to all Vermont citizens. 

 

Under the ACA, states that want to create their own healthcare reform programs can begin doing so in 2017 if they obtain a federal waiver.  To qualify for the waiver, states must show that their proposed healthcare programs can provide comprehensive and affordable coverage to just as many persons as the ACA without increasing the federal deficit.  However, Vermont may not need to wait until 2017 to opt out of the federal healthcare reform program.  A separate bill now awaiting consideration in Vermont’s senate would accelerate the opt-out year to 2014.  Vermont also would need federal clearance to include Medicaid and Children’s Health Insurance Program (CHIP) patients in Green Mountain Care and to administer the Medicare program for Vermont seniors.

 

Passage of S.57 in the Vermont legislature now seems a distinct possibility.  The bill made it through the House easily last month, but then was amended in the Senate.  Because of the amendment, the bill now must pass through a legislative conference committee for rewording, and then go back to each chamber for a final vote possibly as early as next week.  The Vermont governor then would sign the bill into law.

 

Green Mountain Care has been touted in the press as “something akin to a single-payer healthcare system” and as “universal coverage”.  But those claims are not quite true.  The private payers aren’t going away.  Vermont residents who like their existing coverage would be able to keep it.  Those who change to Green Mountain Care would be able to purchase supplemental coverage from the private insurers.  Vermont also would contract with a private insurer to administer Green Mountain Care.  However, Green Mountain Care could squeeze private health insurers out of the low-income and small-employer group insurance markets.

 

While legislators like Green Mountain Care, Physicians for a National Health Plan (PNHP) criticize it on grounds that multiple payers would lead to higher administrative costs that could be eliminated by a single-payer plan.