By DAVE GRAM
MONTPELIER -- Vermont can move ahead with its plan for a public health care system following the outcome of this week’s presidential and gubernatorial elections and new assurances that the federal Affordable Care Act will not be repealed any time soon, senior state officials involved with health care reform said Friday.
"It gives us the green light to move ahead with our plan, so it is quite a relief in terms of having certainty about the federal framework, and certainty about some of the money that comes to us under the Affordable Care Act," Anya Rader Wallach, chairwoman of Vermont’s Green Mountain Care Board, said in an interview Friday.
Some on the left have criticized the Affordable Care Act, a centerpiece of President Barack Obama’s first-term agenda, as not going far enough to inject government into running a streamlined, single-payer health care system, similar to what is done in Canada and other countries, or, short of that, giving consumers the option of singing up for a government-run health insurance program.
A Vermont law passed in 2011, at the urging of Gov. Peter Shumlin, moves the state further in that direction than the federal law did. It uses the federal law as a springboard, and a big funding source, to help set up Green Mountain Care in the state by 2017.
Green Mountain Care is designed to put the vast majority of Vermonters under the umbrella of the same government-backed health insurer. Exceptions would include federal employees, and people who work for companies that are "self-insured," meaning they assume the financial risks tied to employee health problems.
The plan got an endorsement Tuesday from the 888 Vermonters who responded to an exit poll done for The Associated Press and television networks. Nearly three in five of those respondents said they liked the idea of a state-run health insurance system. Its leading supporter, Shumlin, was re-elected by a similar margin.
The upshot is that Vermont will remain on a path that, so far, has placed it in the lead nationally for those who would like to see the U.S. move closer to a sort of Medicare-for-all, nationalized health care system, said Heather Howard, a professor of health policy at Princeton University’s Woodrow Wilson School of Public and International Affairs.
"Vermont is really out front in their approach, in that they’ve mapped out a road to a single-payer system," Howard said.
Critics of the Vermont plan agreed that both the state and federal governments appeared likely to continue on the paths they were on before the election.
"The implications for those concerned about the direction of health care reform are relatively easy to sort out; nationally, the Affordable Care Act (ACA) will not be repealed, and here in Vermont, Governor Shumlin’s Green Mountain Care single payer experiment will continue apace," the group Vermonters for Health Care Freedom said in a statement Friday.
Vermont is preparing to comply with part of the federal law by launching a health care exchange -- a centralized marketplace in which most people will shop for health insurance at a common web site -- by January 2014. A key link between the federal and state laws is that up to $300 million a year in federal subsidies are expected to flow into the state in the form of tax credits to help people pay for the insurance they choose on the exchange.
Howard said 12 to 15 states are moving aggressively to implement the exchanges called for under the federal law, but Vermont is unique in seeking to push as far as it is beyond the federal law.
Washington also has pledged about $123 million to Vermont in planning and implementation grants to set up the exchange and get it through its first year, said Mark Larson, commissioner of the state Department of Health Access.
Just last week, the state issued requests for proposals for health insurance companies that want to offer their services for sale under the exchange, said Robin Lunge, director of health reform for the Shumlin administration.
Meanwhile, Lunge said state officials are drafting a series of options to present to lawmakers this winter on how to pay for Green Mountain Care when it is fully launched in 2017.
Lunge said she expected the state to try to give several different packages of options for discussion purposes and didn’t expect the administration to push a particular option at this stage.
"It’s very important to make sure we understand people’s different perspectives when we pick an option," she said.
Critics, including this year’s unsuccessful Republican gubernatorial candidate, Randy Brock, have charged that the uncertainty over the future of health care is hurting business development in the state. Shumlin has countered that what might be paid through taxes later is being paid through private health insurance premium now.