During his gubernatorial campaign, Gov. Phil Scott said that if he was elected, he would move to eliminate Vermont's health care exchange and bring the state into the federal system. But just three weeks into his term, the message from his administration has changed dramatically. That's because while it's likely that the Republican Congress in Washington will vote to repeal the Affordable Care Act, there's no consensus on how to replace it.
Human Services Secretary Al Gobeille says it makes no sense for Vermont to implement major reforms without knowing what Congress is going to do.
“I think we're talking about something that is a really, really lengthy planning and execution process if you're going to change,” said Gobeille. “You wouldn't want to do that and then have it disrupted by Washington, so we're going to keep doing what we're doing for now."
In the meantime, the Scott Administration is taking steps to reduce the number of Vermonters who purchase their coverage on the exchange. They're going to strongly encourage that all individuals who don't qualify for Medicaid, state premium assistance, or federal tax credits, purchase their coverage directly from the insurance companies.
It's expected that this move could take as many as 7,000 people off of the billing cycle of the exchange. Gobeille says the change will save the state $2.8 million a year.
"You wouldn't want to do that and then have it disrupted by Washington, so we're going to keep doing what we're doing for now." — Human Services Secretary Al Gobeille
"By pushing that from a state activity to the carrier, that is a really good thing for the state budget,” said Gobeille. “So that's why we want to do that ... if we know that we're not going to have X amount of thousands of people going through our billing process."
Michael Fisher, the chief health care advocate for the state of Vermont, supports the administration's decision to take a wait-and-see approach with the future of health care in the state.
"There's so much uncertainty on the federal level, it's hard to imagine how we on the state level, how the administration could possibly predict at this moment how to make changes in access to health care," said Fisher.
Fisher is concerned that some of the people who will now be required to buy their coverage directly from the insurance companies might develop problems if their income drops during the course of the year. He wants to be certain that these individuals will still be able to qualify for state subsides if this happens.
"There's so much uncertainty on the federal level, it's hard to imagine how we on the state level ... could possibly predict at this moment how to make changes in access to health care." — Michael Fisher, Vermont's chief health care advocate
Fisher is also concerned about proposals being discussed in Washington that would transfer funding for the Medicaid program into a state block grant. This approach would give states more flexibility in using Medicaid funds, but it would also cap how much a state could receive in any given year even if enrollment increased.
"Often the term 'block grant' is used as a euphemism for reduction in federal participation, and that would obviously be very concerning for us who are fighting to maintain the affordability of care,” said Fisher.
Fisher says his office is fielding numerous calls from Vermonters who are concerned that changes in federal health care policies will limit their coverage in the future.
Update: January 26 at 11:30 a.m. This story was clarified to reflect that the Scott administration is "strongly encouraging" people with incomes above 400 percent of the federal poverty level to purchase their coverage directly from private insurance companies. A spokesperson for Human Services Secretary Al Gobeille says the secretary misspoke when he originally said that this group of people would be "required" to buy their policies from the insurance companies.
