occupy
Free from the tyranny of health insurers combined with the unity of coverage for all sounds a lot like Vermont’s ethos. “Freedom and Unity” is the state’s motto, so it should come as no surprise that they are taking the lead in transitioning to a single payer healthcare system in 2017. In the meantime, they have announced, as reported in the American Medical News, their legislature’s passage of a state health insurance exchange, named Green Mountain Care. The bill is now on its way for consideration in the Senate, and the governor has indicated his support.
Under the current national health system reform law, each state must create its own exchange by 2014 or the federal government will operate one in its place. If employees can’t afford the coverage their employers provide, they can opt for the state’s exchange, and be eligible for federal subsidies. For the next four years, employers with 51-100 employees would be exempt from participating in their exchange. All employers with less than 50 employees would have to participate, while employers with more than 100 employees are exempt. The funding mechanism for this program will likely come in early 2013, after the November elections.
According to insiders, the health exchange is a bit of a diversion on the way to a single payer system because there is no added negotiating power with health care providers. It simply gives people subsidies to buy health insurance. According to the Rutland Herald, 85% of privately insured Vermont residents will be exempted because their insurance comes from large employers. Basically, smaller employers and individuals will be subsidizing the administrative overhead (estimated at $9M to $11) of the exchange. Other beefs relate to employer-sponsored plans not being eligible for tax credits.
Vermont has always gone its own way, serving as a bellwether in many respects, as in allowing gay marriage, developing the first bottle deposit bill, and in consistently picking Presidential winners. This is the state to watch as it lurches toward true universal health care under one umbrella. The earliest it can be granted a waiver from its exchange is in 2017, leaving it free to actually build a single payer system. Until then, it will be awhile before everybody is in.
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Endnotes
- Vermont Adjusts Path Toward Universal Coverage, American Medical News, March 2, 2012, http://www.ama-assn.org/amednews/2012/02/27/gvse0302.htm
- Compromise is Bad Policy, Rutland Herald, Feb. 23, 2012, http://rutlandherald.com/article/20120223/OPINION03/702239964/1039/OPINION03
- Vermont for Single Payer, http://vermontforsinglepayer.org/index.php