Tuesday June 19, 2012

LEBANON, N.H. -- A leader of the effort to revamp Vermont’s health care system said Monday the state will cope better than most if the U.S. Supreme Court guts President Barack Obama’s health care law, but its reform efforts could be hurt by a loss of more than $200 million a year in federal subsidies.

Anya Rader Wallack, chair of the Green Mountain Care Board, made the comments during an appearance before about 40 physicians, administrators and staff at the Dartmouth-Hitchcock Medical Center. The "grand rounds" meetings are designed to keep health professionals up to date on trends in their field.

The effort by Gov. Peter Shumlin and the Legislature to push Vermont toward a publicly financed health system in which as many claims as possible are processed through a single payer could have a big impact at the Lebanon teaching hospital, which is just across the Connecticut River from Vermont and gets about 40 percent of its patients from that state.

And the federal law’s fate likely will have a big impact on Vermont’s envisioned Green Mountain Care plan.

The state passed a law last year designed to move Vermont toward -- but not all the way to -- a Canadian-style, single-payer health care system by 2017. Likely exceptions include federal employees living in the state and those working for "self-insured" employers

This year, lawmakers designed a health care "exchange," or marketplace, that will be the Web-based, one-stop shopping portal for consumers to compare plans and buy health insurance beginning in 2014.

But a linchpin of financial support both for the exchange and for the Green Mountain Care system planned for later are tax credits to be available under the federal law that have been counted on to help people buy health insurance in the exchange.

Wallack said one early estimate put the value of those tax credits at between $200 million to $300 million per year in Vermont. Other hoped-for federal funding for things like new computer systems to process patients’ health records also could be in jeopardy, she said.

Much anticipation surrounded Monday’s release of Supreme Court decisions because it was believed the federal health care law ruling might be among them. It wasn’t, and the next time the court releases decisions is Thursday.

There’s been speculation that the court could leave the multi-faceted law intact, strike down its most hotly debated provision -- a mandate for individuals to buy health insurance -- or overturn most or all of it.

Twenty-six states are asking the court to overturn the law, arguing that it’s unconstitutional to require individuals to buy health insurance, and that the law curtails states’ rights to design their own health care systems.

The impact of the court’s decision on Vermont will depend on how broad it is, Wallack said. If it simply strikes the insurance mandate, she said, "I don’t think the impact on Vermont is particularly significant."

Among the reasons: Vermont has a relatively small number of residents without health insurance; most employers offer insurance to their workers; and the state has expanded its Medicaid program to cover many of those who work but don’t get insurance from their employer.

"I think there’s a whole lot we can do to just maximize coverage through Medicaid," Wallack said, pointing to estimates that half of Vermont’s uninsured population would be eligible for Medicaid, the publicly funded health insurance program for low-income residents, if they just enrolled.

The bigger fear, if larger parts of all of the health care are struck down, is the loss of the tax credits designed to help people buy insurance through the exchange, Wallack said. "We lose that money if the whole law goes down," she said.