There are roughly 12 states in the country that are moving aggressively to implement the provisions of the federal Affordable care Act.
Vermont is one of them and it’s the only state to mandate participation in the proposed consumer marketplace Exchange program. This requirement is likely to emerge as a key issue in this year’s race for governor.
The Affordable Care Act calls on states to create their own exchange by January of 2014. If a state fails to take this step, the federal government will move in to set one up.
The exchange is designed to provide consumers with a direct comparison of different health care policies with various deductible levels. Federal tax credits will be available to subsidize coverage at certain income levels – the cap for an individual is roughly $44,000 and for a family of four it’s $92,000.
While some governors are refusing to have anything to do with the creation of an exchange, there are about a dozen states where governors and lawmakers are moving full steam ahead.
Vermont is going one step further. At the urging of Governor Peter Shumlin, lawmakers this year passed a bill that makes participation in the exchange mandatory for all small businesses and individuals. This means these groups won’t be able to purchase a policy outside of the exchange.
The Governor says the mandate will help move the state towards a publicly financed single payer system and he says the federal subsidies will help make this approach more affordable.
"So that’s the first reason we’re going to pull down federal dollars," said Shumlin. "The second is we’re trying to build a single payer system that has a single pipe and the more people we have in this plan the easier it is to convert to a single payer system."
Shumlin is encouraging small businesses with low and middle income employees to drop their health coverage beginning in 2014 to allow these workers to get subsidized polices as individuals on the Exchange.
"It’s my belief that employers shouldn’t have to provide health insurance to their employees any more than we ask them to provide car insurance, fire insurance, or life insurance for their employees, said the Governor. "If we remove health care from employment it’s a huge jobs growth opportunity for Vermont."
Republican gubernatorial candidate Randy Brock has a very different approach to health care. He likes the idea of the consumer exchange but he wants participation to be voluntary and he strongly opposes Shumlin’s single payer plan.
"The concept of providing a uniform marketplace that’s logical so that people can go in like an Expedia website in order to choose from a wide variety of plans to fit a particular individual or particular employer’s needs that makes a great deal of sense," said Brock. " What we’re doing is we’re creating this on line supermarket with the goal to ultimately have only one product on the shelf."
Brock thinks the best way to reduce health care costs is to provide more competition in the marketplace and his plan includes the availability of very high deductible, low premium policies that would be offered outside of the exchange.
"I want the ability of individuals to make a decision as to the policy that bests suits their needs and that policy may indeed be a high deductible policy and an individual may be able to cope with a high deductible policy," Brock said. "The real issue is the availability of choices."
Retired Middlebury College political science professor Eric Davis thinks Brock could have some success in challenging Shumlin on the governor’s signature issue
"There are some things that Randy Brock could bring up which may help swing public opinion," said Davis. "If Brock says that he accepts the idea of the Exchange but would like to implement it in a different way from the Shumlin Administration that’s something where he may be able to get some traction."
The U.S. Supreme Court will rule on the constitutionality of the Affordable Care Act by the end of the month. State officials say this decision could have a major impact on the debate over the future of health care in Vermont.