Vermonters for Health Care Freedom is a 501 (c) (4) organization of individuals and businesses who are deeply concerned about health care reforms being implemented by Governor Shumlin, and seek patient-centered reforms that protect the traditional doctor-patient relationship.

FAQ

What is Vermont doing with health care reform?

  • This is not a study.
  • Act 48 of 2011 created 1) Vermont Benefit Exchange, and 2) Green Mountain Care.
    • “Upon receipt by the state of necessary waivers from federal law, all Vermont residents shall be eligible for Green Mountain Care, a universal health care program that will provide health benefits through a single payment system.”

What is the Vermont Health Benefit Exchange?

  • Effective January 2014, individuals, associations and employers with less than 51 employees will be required to access insurance plans via the “Vermont health benefit exchange.”
  • “The purpose of the Vermont health benefit exchange is to facilitate the purchase of affordable, qualified health benefit plans in the individual and group markets in this state in order to reduce the number of uninsured and underinsured;
  • “The intent of the general assembly is to establish the Vermont health benefit exchange in a manner such that it may become the foundation for a Green Mountain Care.”
  • The health benefits exchange is being further defined through H.559 in the 2012 legislative session.

What is Green Mountain Care?

  • “The purpose of Green Mountain Care is to provide, as a public good, comprehensive, affordable, high-quality health care coverage for all Vermont residents in a seamless manner regardless of income, assets, health status, or availability of other health coverage.”
  • “Green Mountain Care is a universal health care program that will provide health benefits through a single payment system.”
  • This will be implemented between 2014 and 2017.

Will private insurance still exist?

  • Between 2014 and 2017 private insurance will be phased out. Under Green Mountain Care (Act 48), as of January 1, 2017 private insurance will cease to be legally available to Vermonters.
  • However, “supplemental insurance plans” will be considered later.
    • “The secretary of administration or designee shall make recommendations to the house committee on health care and the senate committee on health and welfare on the following issues: ... whether to allow employers and individuals to purchase coverage for supplemental health services from Green Mountain Care or to allow private insurers to provide supplemental insurance plans.”
       
  • As of January 1, 2014 private insurance will only be available through the state-controlled exchange for businesses with less than 51 employees and individuals. Insurance offered through the private market will be outlawed. These groups will therefore be forced to drop their current coverage and seek coverage through plans offered in the exchange. It is estimated that this will affect up to 100,000 Vermonters.

Is the elimination of private insurance outside the exchange required by the federal Affordable Care Act (ACA)?

  • No. Just the opposite. The ACA requires the continued availability of private insurance outside the exchange.
  • Of the 50 states only Vermont has decided to make the exchange mandatory and dismantle the private insurance market outside the exchange.

What is not disclosed or defined within the laws enacted to date?

  • The law does not address funding, benefits, coverage, administration, and technology.
  • Outstanding issues will be determined by the Green Mountain Board, the commissioner of health care administration, and the Vermont legislature at a later date.

What is the Green Mountain Care Board?

  • A five person part-time board appointed “to develop mechanisms to reduce the rate of growth in health care through cost-containment, establishment of budgets, and payment reform.” They will serve 6 year terms.
  • At a later date, this board will determine: benefits, coverage, funding, deductibles, co-pays, premiums, technology, provider payments, etc.

How many health plans will be available via the Vermont Benefit Exchange?

  • Two or three carriers are expected offering four comparable plan levels.
  • Currently there are 65 different plans offered by a handful of carriers in Vermont.

Can I purchase insurance outside of the Vermont Health Benefit Exchange?

  • No. This applies to employers of 50 or fewer individuals, individuals and associations as of January 1, 2014. It applies to employers of 100 or fewer individuals as of January 1, 2016, and it applies to everyone as of January 1, 2017.

Under the law, Green Mountain Care will determine:

  • “All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting.” The state will define the term “appropriate”.

How will Green Mountain Care be funded?

  • This will be determined at a later date. Under Act 48 the Administration must present the legislature with a Green Mountain Care budget and funding plan by January 15, 2013.
  • Based upon testimony presented to legislative committees in 2012 during consideration of H.559, the exchange bill, Green Mountain Care will depend upon substantial revenues from the federal government under the Affordable Care Act. 

How do federal dollars come to Vermont under the ACA?

  • The ACA provides federal subsidies and tax credits for low-to-middle income individuals purchasing insurance through the exchange to help make the premiums affordable in the absence of employer contributions. These revenues can be 'clawed' into the state treasury when the state becomes the sole insurer through Green Mountain Care single-payer.
  • To maximize these future revenues Vermont must encourage a great many businesses to drop their employer-based coverage and send their employees into the exchange as individuals, as well as outlaw private insurance outside the exchange so these individuals have nowhere else to go. This is what H.559, the exchange bill, effectively does.
  • Administration officials have indicated that they expect about $200 million will flow to Vermont annually through this mechanism. Other estimates put the figure closer to $80 million.

What happens to the needed funds if the ACA is struck down by the Supreme Court?

  • The legislature has not addressed this possibility. 
  • It is also possible that a change in Congress and or the president subsequent to the November elections could affect the status of the ACA or its funding. This has not been addressed or anticipated by the Vermont Legislature either.
  • Given that all of these Vermont laws have been passed without a budget or funding plan it is impossible to anticipate the actual effect of such events.

Can I choose to receive care at Centers of Excellence in places such as Boston?

  • The law does not address this question.

Can the government of Vermont successfully lower costs?

  • For comparison, between 2009 and 2010 (the most recent years for which figures are available) Vermont's total health care spending increased at a rate of 4.8%. National health care spending increased at a rate of 4.0%. The economy grew at a rate of 4.2%, and total spending of Vermont state government grew at a rate of 7.0%.
  • VT represents only 0.2% of the U.S. economy. California’s economy is 750 X larger than VT.
  • Based on this scale of economy – can the government negotiate or force lower costs?
  • No – we cannot.

What happens if Vermont fails to lower health care costs?

  • The bill states that “health care costs must be contained”.
  • It will become the law that healthcare costs cannot outpace the growth of the economy.

By law, Vermont would have to stay within the health care budget. Failure to do so would mandate the following choices:

  • Increase revenue into Green Mountain Care (more taxes).
  • Lower payments from Green Mountain Care to providers.
  • Provide fewer services (ration).
  • All of the above.

What about large employers and self-funded plans (ERISA)?

  • At this point the state cannot compel self-funded employer insurance plans under ERISA to drop their plans and participate in the exchange or Green Mountain Care.
  • Also, under the ACA large groups such as the VT NEA have the option of staying with their current coverage as long as no major changes are made to the plans. This grand fathering provision applies only to the exchange, and not to participation in Green Mountain Care.
  • There is no prohibition against the state assessing taxes against ERISA businesses for the purpose of funding Green Mountain Care. If this is done these businesses will be effectively paying for employee health insurance twice (but receiving it only once). How Green Mountain care will be funded has not been decided.

What about Medicare?

  • At this point there is neither the means nor desire to roll Medicare into the Green Mountain Care single-payer insurance pool, so no changes in Medicare's plan design or participant costs are expected. The state is, however, expected to request permission to administer Medicare through the single payer system.
  • The status of Medicare supplemental insurance plans is still unknown.

What about Medicaid? VHAP? Catamount?

  • It is expected that all three of these programs will be wrapped into Green Mountain Care, starting in 2014. 
  • Due to federal ACA requirements the exchange plans will place additional costs in the form of premiums, co-pays and deductibles on many of those currently enrolled in VHAP and Catamount, totaling an estimated $14 million in 2014. The Administration and legislature intend to address this issue through the funding plan to be released in January 2013.

Is there a backup plan?

  • No.
  • By outlawing the existing private insurance market for small businesses and individuals as of January 1, 2014, Vermont has eliminated the option of staying with the existing system as the experimental new system is put in place.

Employers fund 40% of healthcare costs. This will not go away.

  • Should employers fund via premiums (defined) or taxes (variable)?

Will this bill attract and retain employment?

  • This is the million dollar question. At this point no clear answer is possible but analysis of the health benefits exchange and Act 48 indicate that employers who pay low wages may see an advantage under the new system and employers who pay middle-to-higher income wages will face a financial penalty. More information is needed about the ultimate funding plan before this question can be answered with certainty.
  • How will we fund Green Mountain Care?
  • The state’s only revenue source is taxation. Will we fund the plan via a payroll tax as proposed by the author of the study which recommended Green Mountain Care?
  • IMPORTANT - If employers & wage earners decide to leave VT, the system will collapse.

"Any person who believes that they have the fundamental right to determine what is best for them in their life...what healthcare to receive, what medications to take, what immunizations to have, what food to eat, what behavior and thoughts to express.... should reject this attempt by the State of Vermont to regulate their bodies and minds. Vermont's "Healthcare Reform" is legislation about power and control based on the unconstitutional and immoral assumption that the state knows what is best for the people that it rules."

Edward Pomicter, MD
Diplomate, American Board of Anesthesiology

  • Employers pay 40% of the healthcare costs – and were never consulted.
  • An appointed board will determine benefits, coverage, funding, deductibles, co-pays, premiums, technology, provider payments, etc.
  • Under this law, you will not be allowed to purchase insurance outside of the Vermont Health Benefit Exchange.