We knew that 2012 was going to be a confusing and frustrating year on the road to universal healthcare in Vermont. When Vermont passed its groundbreaking universal healthcare law in 2011, it included a long transition process, starting with the problematic step of setting up an insurance exchange, a marketplace required by the federal Affordable Care Act. Such an exchange potentially benefits private insurance companies, which stand to gain a large amount of federal subsidies.
But the Shumlin Administration proposed that we use the exchange and related federal funds as a platform for the universal healthcare system we want. The plan is to first build the required infrastructure and then get the federal waivers necessary to move beyond the exchange and replace it with our universal system, Green Mountain Care, as soon as we can. It is important for us to remember that Act 48 includes the human rights principles of universality, equity, transparency, accountability and participation, and that we can demand at every step during the transition process that our legislators, the Administration and the Green Mountain Care Board adhere to these principles.
What’s the healthcare bill (H.559) that Vermont legislators are debating now?
The current healthcare bill (H.559) in the legislature was proposed by the Shumlin Administration to take the first step on the road to universal healthcare. The bill seeks to implement some provisions of our universal health care law, Act 48, starting with setting up an insurance exchange - a regulated marketplace for buying health insurance plans. This is required by the federal healthcare reform law.
Much of H.559 is rather technical, and nothing that happens with this first step will actually give us universal healthcare. Nevertheless, if we take a step in the wrong direction now, it will put roadblocks in the way of universal healthcare, and our task will become more difficult in the future. Insurance companies know this, and that’s why they have mobilized opponents to weaken H.559. They want to undermine the reform from the start, beginning with this bill.
Even though the exchange will be a marketplace that won’t meet human rights principles and won’t provide universal care, it is important that this exchange is set up with strong regulations, so that it can be used as a platform for Green Mountain Care, which is what Act 48 requires. But insurance companies have already acted to water it down: the Administration recently gave in and allowed them to sell skimpy high-deductible plans - so-called bronze plans - in the exchange. Such plans are a great risk to our bodily and financial health: Vermonters with bronze plans won’t get coverage for their regular healthcare needs, and if they have an expensive emergency, they will be left with many thousand dollars in medical bills. This is a sure way to undermine our path to health reform.
Another way to weaken the exchange is to reduce the number of people and businesses participating in it and to allow a private insurance market to operate outside of it. Opponents seem to have persuaded the Administration to make the exchange and its risk pool smaller, and thereby less affordable and sustainable, by excluding employers with more than 50 workers. This would needlessly burden smaller businesses who may have to pick up the tab. So it’s even more important now that the Administration and legislators stay firm when it comes to eliminating the sale of private health insurance outside the exchange: we will only have a chance to build our new universal healthcare system if once and for all we get rid of the individual and small group market pushed by private insurance companies. This market has always sought to maximize corporate revenue at the expense of policyholders with no other options. These companies place financial gains ahead of the needs of Vermonters. This practice of largely unregulated profiteering stands in stark contrast to the recognition of health care as a public good in Act 48, and must stop with the establishment of a more regulated marketplace, the exchange.
(see VWC testimony here: http://www.workerscenter.org/blog/peoplesteam/healthcare-human-right-campaign-testimony-h559-february-7-2012-0 )
Eyes on the prize: our struggle for Green Mountain Care
It has been easy to confuse the debate over the exchange and H.559 with the goals of universal healthcare reform. We must remember that the exchange is only a new marketplace for selling healthcare as a commodity; it does not provide healthcare for all as a public good. So we need to ensure that the Exchange becomes a viable stepping stone for a smooth and early transition to the universal system we all want. H.559 must not erect barriers that would impede progress toward Green Mountain Care (GMC), a true human rights based health system.
The most important decisions for universal healthcare lie ahead of us: for the rest of 2012 and in 2013 we’ll have to engage in a struggle over the way in which Green Mountain Care will be financed, and over the kind of healthcare benefits we will all get in the universal system. Our role must be to ensure that financing will be equitable, and that we will all get access to comprehensive care. Our universal healthcare law, Act 48, confirms the principles of equity, and universal access to comprehensive, medically necessary care, but the law also left the specifics to future decisions to be made in early 2013. The debate is already in full swing.
Many people participated in listening sessions about healthcare financing, organized by the Administration. And more listening sessions will happen soon, about the so-called health “benefits” we will receive in Green Mountain Care.
Regarding financing, the Healthcare Is a Human Right Campaign has called on the Shumlin Administration to commit to using the most equitable financing mechanism to replace the unfair insurance premiums and out-of-pocket expenses that Vermonters are currently struggling to pay. For the 2013 legislative session, we will submit our proposal for equitable, public financing, and we will demand that the Administration and legislators act on our proposal.
One of the most important decisions about Green Mountain Care will not be made in the legislature, but by the new GMC Board. The Board is responsible for deciding what treatments, services and drugs Vermonters will be able to get in the new universal healthcare system. It is critical that we mount a serious grassroots effort to ensure that the promise of Act 48, which guarantes universal access to all medically needed care, becomes a reality. We have called on the Shumlin Administration to lead the “benefits” discussion by shifting the focus from insurance benefit packages to people’s health needs.
Watch for more listening sessions and hearings across the state this Winter and Spring, and support the Healthcare Is a Human Right Campaign’s demand for equitable financing and comprehensive care for all!
Read the VWC statement on the financing and benefits debate: http://www.workerscenter.org/news/statement-green-mountain-care-financing-and-benefits-debate
Join us for Feb 21 Statehouse Day of Action: http://www.workerscenter.org/calendar/statehouse-day-action-healthcare-human-right-0