The Great Health Carousel

by Kevin Joseph Ryan

Round and round and round she goes, where she stops, nobody knows. That seems to be the future of Vermont health care policy.

The Federal Affordable Care Act (ACA), aka Obamacare, mandates that everyone in the United States purchase or have health insurance by 2014. By that same year, the State Legislature of Vermont has mandated that all insurance policies must be sold and benefits standardized in the Healthcare Connect exchange, a move not mandated by ACA and a move not made by any other state. Assuming that no changes in policy occur in Washington or Montpelier between now and 2017, $278 million taxpayer dollars will be spent to set up and operate this exchange. Then, after three years, Vermont will switch gears and head in a completely different direction. This is not due to unforeseen circumstances. This is actually planned.

The different direction will be towards Green Mountain Care (GMC), a single-payer scheme championed strongly by Vermont Governor Peter Shumlin. This plan has the goal of integrating all Vermont health care coverage plans into a unit. This does not happen at first, because Vermont cannot seek a waiver to the requirements of ACA to implement a state singer-payer program until the 2017 date and even if they do, the Legislature must pass a law financing Green Mountain Care before it goes into effect.

At the moment, approval of financing on any such law would be problematic, because until next week, the Green Mountain Care Board will not have yet voted on what benefits are included, and cannot predict the cost. Even when they do approve benefits, conditions not previously covered will only be subsidized by the federal government for a period of two years.

The cost alone on providing adult dental care under GMC, a move championed by Senator Bernie Sanders, the Vermont Interfaith Council and the American Dental Association among others, would add a minimum of $80 million dollars to the cost of the program. That number is just the cost to the state, assuming they receive federal subsidies for dental care coverage, which have not been approved and may not happen at all, thus making the state burden even more costly.

In other words, the State of Vermont intends to set up one system to handle health care, use it for three years, then trade it in for another system which theoretically unifies and merges all existing public health insurance systems, eliminates private primary insurance coverage, covers all people in Vermont, and may or may not cover all medical needs, depending upon whether Vermont decides if the state treasury can afford it or not. When we embark upon the single-payer plan, which isn’t really single-payer, but might become one, which will be determined three years down the road, unless it takes longer. Confused yet? You may not be the only one. There might be a few folks working down in Montpelier even more confused than you.

After all, most of you reading this didn’t vote all of this into law.