Wednesday December 12, 2012

Just because Vermont is a leader in health care reform does not mean the state can step backward and hide behind the budget when it comes to people’s lives. Politics and the games that are played in that realm are generally driven by budgets. That is a fact of life.

Unfortunately, almost all health care reform is done in the political arena and that means budgets rule. But should the budget battles have the same priority when they have to do with roads and health insurance?

Politicians need to look at health insurance in a different context. If the state is in the business of providing health insurance and controlling the health insurance industry then it has not only a fiscal obligation, but also a moral obligation to all citizens.

If the governor, his staff, all appointed officials and all legislators do not assume moral as well as fiscal responsibility for health care reform, then we will be pushing many of our citizens over a cliff that will not be as imaginary as the fiscal cliff.

The reason that I make this argument is because about 7,400 current VHAP enrollees and 10,700 Catamount beneficiaries are about to be tossed off the cliff in January 2014. They will see all of their costs go up if the legislature does not come up with about $20 million, depending on whose numbers you use.

When asked how he will deal with shortfall this is what Governor Shumlin told Peter Hirschfeld of the Vermont Press Bureau.


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"Obviously, we don’t have that kind of money around," Shumlin said last Tuesday. "But we’re going to find a way to come up with a proposal that addresses some of the problem." Shumlin said he doesn’t think the cut in aid will in all cases impede access to medical services. He said Vermont’s assistance programs might be doling out money to people who don’t really need the help.

"You could also argue there are parts of our existing program that are more generous than they need to be, and that’s what we’ll be looking for," Shumlin said. "We want to find a way to ensure that everybody can move into the exchange without much financial challenge and duress, and we think we can."

Governor, you can’t have it both ways. If Shumlin is seriously heading toward a Vermont single payer system he has learn how to find the money so that he doesn’t take away what people already have. I’m not sure which benefits he thinks are too generous. If he wants to have a discussion about rationing, then let’s have that discussion, but he should not ration without first engaging the public.

Part of the problem that Vermont government faces is a result of having to abide by federal rules relating to health care exchanges. We are being penalized, in a sense, because of our progress on health care reform.

According to projections by Donna Sutton Faye of the Vermont Campaign for Health Care Security, "For example, an individual living at 200 percent of the poverty level -- about $22,000 annually -- will see out-of-pocket exposure jump from $1,770 per year under Catamount to nearly $3,500 in the exchange. The disparity only widens as incomes rise.

For a couple making $45,300 per year -- 300 percent of the federal poverty level -- out-of-pocket expenses could more than double, from about $7,000 in Catamount to more than $16,800 in the exchange."

Many of the subsidy increases will affect those people in the $20-$30,000 income range. They live life fearing a catastrophic event. Health insurance increases will be a catastrophe for them. If they need to use their insurance because of illness or injury, the next catastrophe will be worse than the first.

The proposed increases will force people not to use their insurance and many will not even apply when they find out the cost. As a result, more Vermonters will become sicker and cost all of us more in the short and long run.

Can we be comforted by the governor’s team when we read statements such as this from the Vermont Press Bureau? "Shumlin aides have indicated that the administration’s proposal, to be unveiled in January, will take care of the desperately poor, and seek modest increases in cost-sharing from Catamount and VHAP beneficiaries on the higher end of the income eligibility scale."

We can hope that politicians do the right thing but, for my money, the only way that will happen is if Vermonters speak out loudly and often and tell their elected officials to find the money so that Vermont continues to be a humane and fiscally responsible leader in health care reform.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.