Al Gobeille, the chair of the Green Mountain Care Board, says additional tax revenue will be needed in order to make a publicly-financed health care system affordable for all Vermonters.
And Gobeille says he won't shy away from the challenge.
While the Legislature will make decisions about how to finance a new health care system and how to design its basic benefit package, it’s the Green Mountain Care Board that will decide if the plan is in the best interests of Vermont. The system can’t be implemented without the board’s approval.
Board chairman Gobeille says one of the biggest problems with the current system is that the cost of coverage is much too expensive for many people.
“In our country we have some people paying 24 percent of their income, some people paying 36 percent of their income and some people that receive it as a benefit at work and don’t even see it as a percentage of their income,” said Gobeille. “And so I think we can do a better job building a system that’s fairer and more equitable for everyone.”
The federal Affordable Care Act provides subsidies for individuals and families within specific income limits. Even with the subsidies, Gobeille says these policies are still too expensive.
"That is the question that everybody runs from, but I have never run from it. It is going to come from a tax, and the question is, 'What is the best tax?'" - GMCB Chair Al Gobeille on how to make health care coverage affordable
“I would argue that it didn’t go for enough and so we have this disparity,” said Gobeille. “And in Vermont, in big bold strokes what we’re really trying to do is bring the two together. And that’s my point about single payer, is if you accomplish that, that’s profound.”
Gobeille readily admits that in order to keep coverage affordable for middle income people, some other revenue sources will be needed to help finance the system. He says he’s willing to deal with this issue head on:
“That’s the question that everybody runs from, but I’ve never run from it,” said Gobeille. “It’s going to come from a tax, and the question is, 'What is the best tax?'”
Ten years ago, health care costs were increasing by more than 10 percent a year – a level that many officials said wasn’t sustainable. But in the past three years, these costs have averaged around 3 percent a year.
Some lawmakers think that the reduction in the growth rate shows that it’s not necessary to totally change Vermont’s health care system. Gobeille does not agree.
“If you don’t fix the way in which people purchase these services so that it’s affordable for all then you’ve just left a large portion of the population in a position where it may not rise as quickly but they still can’t afford it,” said Gobeille. “That’s not the Vermont we want to live in.”
In about a month, the Shumlin Administration says it will release a menu of tax options that could be used to finance their single payer plan. But these are just options to generate discussion and lawmakers aren’t expected to vote on a specific financing plan until the 2015 session at the earliest.
