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Vermont Officials Skeptical Of Congressional Republicans' Health Care Plan

Peter Hirschfeld
VPR File
Al Gobeille, the secretary of the Agency of Human Services appointed by Gov. Phil Scott, says state officials are doing a "deep dive" to understand the implications of a Republican plan in Congress to replace the Affordable Care Act.

Vermont’s top health care official says the Scott administration is working quickly to assess the impact a GOP health care plan in Washington would have on the state if enacted.

Agency of Human Services Secretary Al Gobeille said his team is reviewing the Republican plan to replace the Affordable Care Act, widely known as Obamacare or the ACA. At first glance, Gobeille said, the new plan could have significant negative impacts on Vermonters.

After years of failed attempts to repeal and replace Obamacare during former Democratic President Barack Obama’s tenure, the GOP now controls both chambers in Congress and the presidency. President Donald Trump and Republicans in Congress campaigned on dumping the sweeping health care reform law Democrats enacted early in Obama’s presidency, and now the GOP has put forth a plan to do so.

The new health care proposal would eliminate the federal subsidies available for health insurance premiums and replace them with a tax credit based on a person’s age. In Vermont, Gobeille said that could mean insurance would be more expensive for many.

“The difference between the two is really important. One is a subsidy of an insurance premium, the other is simply a tax credit based on your age,” he said in a telephone interview Wednesday.

The administration of Republican Gov. Phil Scott does not yet have enough details to provide Vermonters with declarative statements about how the Republican plan will impact them. Officials hope to be able to brief the public and reporters later this week in more detail.

“We’re doing deep dive here at AHS [the Agency of Human Services]. We’ll sit down with reporters as soon as we can because we want to communicate to people what’s in here,” Gobeille said. “We plan to be detailed and transparent with that because … I don’t know how anyone would read the coverage on this and know how it would affect them. So we need to do that as a service.”

Vermont’s recent governors, including former Republican Gov. Jim Douglas and former Democratic Gov. Peter Shumlin, have focused on expanding health care coverage to more Vermonters. Gobeille, a former chairman of the Green Mountain Care Board, said the Scott administration will review the new health care proposal through that lens.

“Phil is the third in that vein, meaning we don’t want to step back from where we are. Anything that undermines coverage we feel is bad, and that’s either coverage from Medicaid or coverage from the commercial side. At first glance, we think this could do that and we would not support that,” Gobeille said.

"Anything that undermines coverage we feel is bad, and that's either coverage from Medicaid or coverage from the commercial side. At first glance, we think this could do that and we would not support that." - Al Gobeille, Secretary of Human Services

The GOP proposal would continue funding for states that expanded Medicaid coverage, like Vermont, under ACA through 2020. But after 2020, the plan calls for a per-person cap on Medicaid spending. Gobeille said the Scott administration is concerned with what would be included in the cap.

“Medicaid as a program is something that we’ve worked on for years. We just signed a new waiver in the fall and we are very concerned that this will mean less money for the states and we’re trying to figure out if that’s true and what it means,” he said. “Common sense would say that’s true, but how much money is that really and how would that look?”

“What becomes really important is: What’s in the base?” Gobeille added. “We have concerns about that, making sure that Medicaid is properly funded with our federal partner and that, with this new way of doing it, things are not left out of the base that would have a tremendous impact on Vermont.”

Additionally, Vermont is in the process of implementing a new health care payment system under the so-called all-payer model. It seeks to end the fee-for-service payment structure in favor of one that pays health care providers based on health outcomes. Gobeille said the GOP health care plan does not address that.

“The idea that we’re going to continue with the same sort of structure with Medicaid, Medicare, commercial … and pieces that would make it segmented, how does this help reform the delivery system? That’s something that we would want to see,” he said

Democratic Rep. Peter Welch also noted that Vermont’s all-payer model could be adversely impacted by lower Medicaid payments from the federal government.

“It’s very unclear what it will do to our all-payer waiver. It won’t cut it directly, but it’s going to cut Medicaid benefits significantly by 2020,” the congressman said in a telephone interview.

Welch said he opposes the plan because he believes it will cause people to lose their insurance and lead to hospitals once again providing care they are not paid for.

“It’s a very bad bill because, bottom line, millions of people are going to lose access to health care. It’s going to have very adverse consequences on our community hospitals. A lot of people are going to be showing up for free care so our hospitals could go from the black to the red very quickly,” Welch said.

In addition to that, Welch said the bill would cause problems in the insurance business as well.

“It’s very disruptive of the insurance market. What we know for absolutely certain — the plan is designed to give people less access to health care. It’s designed in a way that will make health care more expensive. It’s designed to shift the burden to the states. All of that is very ominous,” he added.

Democratic Sen. Patrick Leahy is also opposed to the health care proposal. He said it falls short of the promises made by Trump and Republicans in Congress to improve the health insurance system.

“Instead this bill will only unravel the progress we have made, while kicking millions off their health insurance plans. This proposal would eliminate affordable health care access for millions of patients and their families, and it would also derail key Medicaid provisions that currently offer coverage to seniors, children, and individuals with disabilities,” Leahy said in a statement. “It would return health care decisions to big insurance companies, and it would penalize patients who cannot afford coverage by charging them more when they can finally access care.”

Leahy promised to oppose the “rickety, hodge-podge scheme if it comes before the Senate.”

This story was originally published at the Vermont Press Bureau, and is reposted here through a partnership with the bureau.

Neal is a a reporter for the Vermont Press Bureau. He also files reports for Vermont Public Radio.
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