BRATTLEBORO — A round of applause echoed through The Works cafe on Main Street in Brattleboro on the morning of June 28.
“The Supreme Court upheld health care reform,” Lynette Lewis, a member of The Vermont Workers' Center, happily told her fellow cafe-goers. “This is cause for celebration.”
Most people paused from sipping coffees and eating muffins to cheer. One table of two shook their heads whispering, “I have no idea what they're talking about.”
Lewis said that she could feel confident telling her children that, sometimes, democracy works.
The Vermont Workers' Center organized its Health Care is a Human Right campaign in 2008, to provide education and marshall support for the state's own reform efforts designed to set the state on a path toward a single-payer health care system, where one government organization accepts all health care fees and pays out all health care costs.
The Vermont Legislature passed a health care reform bill, Act 48, in the 2011 legislative session.
However, Green Mountain Care, Vermont's new health care system, depends on federal funding made available through the Affordable Care Act.
The U.S. Supreme Court ruled that the 2010 Affordable Care Act, more commonly known as “Obamacare,” is constitutional. In a 5-4 decision, the court ruled requiring people to have health insurance or pay a penalty was within the government's scope of powers.
The justices, however, struck down the bill's requirement that states expand Medicaid coverage or lose funding for the entire program. Chief Justice John Roberts, considered conservative, was the swing vote on the ruling siding with the four liberal justices.
For health care reform advocates in Vermont, the decision meant a sigh of relief. Had the federal law been struck down, the state could have lost millions of dollars in federal money that will subsidize health insurance for low- and middle-income Vermonters, leaving it in the tight spot of having to raise that money through taxes.
Upholding the law, however, means the state will not be able to implement its publicly funded, single-payer system until 2017, when it can get a waiver under the act.
Proponents have said Green Mountain Care will provide benefits like extending health care coverage to an estimated 47,000 uninsured and 150,000 underinsured Vermonters and controlling unsustainable costs estimated at $5 billion a year and expected to rise. The cost saving estimate put out in health care informational sessions in 2010 ran about $580 million a year.
Opponents say the bill will thwart Vermont's already-struggling economy and deter new businesses from starting in or relocating to the state. Opponents have also questioned the prudence of passing the bill without first designing a financing structure.
Reaction was swift
Within minutes of the announcement of the Supreme Court's decision, organizations and politicians in Vermont blasted out their responses.
Vermont Businesses for Social Responsibility wrote in an email, “The Supreme Court made the right decision today in upholding the Affordable Care Act and ensuring that millions of Americans will have access to affordable, high-quality health care. But Vermonters know full well that our work is not done here and VBSR looks forward to working with the Legislature and Gov. Peter Shumlin's administration to ensure that our state has a sustainable health care system that is decoupled from employment.”
Democratic Lt. Governor candidate Cassandra Gekas wrote in a statement, “Millions of Americans breathed a collective sigh of relief this morning. The Court's decision means parents can keep their children covered, seniors can afford life-saving prescription drugs, and individuals can't be blacklisted because of a pre-existing condition. June 28 will forever be remembered as the day patients came before profits, and logic came before politics.”
Gekas, who has worked on health care reform, said it's now “full steam ahead” for Vermont effort. “The ACA [Affordable Care Act] will provide us with the critical resources we need to bring high quality, affordable health care to every Vermonter.”
U.S. Sen. Bernie Sanders, I-Vt., a strong voice on health care reform in Congress, issued a statement that made its way to social media sites.
“Today is a good day for millions of Americans who have pre-existing conditions who can no longer be rejected by insurance companies. It is a good day for families with children under 26 who can keep their children on their health insurance policies. It is a good day for women who can no longer be charged far higher premiums than men,” wrote Sanders.
“It is a good day for 30 million uninsured Americans who will have access to health care. It is a good day for seniors who will continue to see their prescription drug costs go down as the so-called doughnut hole goes away. It is a good day for small businesses who simply cannot continue to afford the escalating costs of providing insurance for their employees. It is a good day for 20 million Americans who will soon be able to find access to community health centers,” he said.
“It is an especially good day for the state of Vermont, which stands to receive hundreds of millions of dollars in additional federal funds to help our state achieve universal health care.”
Sanders, however, felt the country could do more, saying, “If we are serious about providing high-quality, affordable health care as a right, not a privilege, the real solution to America's health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.”
What's ahead?
Special Assistant to the Governor for Health Care Reform and Chair of the Green Mountain Care Board, Anya Rader Wallack said in a phone interview that the Supreme Court's decision, “Basically gives certainty we can move ahead as planned.”
The state now knows it can apply for the federal waiver from the ACA's exchange provisions. Vermont can implement a single-payer system by 2017 with federal permission, she said.
A bill is pending in the Congress to allow states looking to access waivers as early as 2014, she added.
The Shumlin administration has been banking on drawing down hundreds of millions of federal dollars through a health benefits exchange that the state will create in 2014 under the federal health care law. The “exchange” will serve as an online marketplace where Vermonters in the individual and small group markets will have to buy health insurance under state law.
Low- and middle-income Vermonters who buy their insurance on the exchange can get the tax breaks. Although the administration has said it could implement the single-payer system without the federal law, Vermont would have been scrambling to fill that hole if the court had struck the law down.
Wallack said the ruling also guarantees the state access to federal resources like tax credits for individuals to get insurance and federal monies for infrastructure.
Wallack confirmed that Act 48 requires the administration have a plan for financing Green Mountain Care by January 2013. The Green Mountain Care Board also plans to roll out some examples of real-to-Vermont cost savings over the next several months.
At a recent Vermont Press Association meeting, Shumlin cautioned that well-funded groups would ramp up their opposition to Vermont's health care changes.
“Today's decision will not change what we know about Vermont-based opposition,” Wallack said.
Shumlin, who campaigned on single payer (where one government organization accepts all health care fees and pays out all health care costs), praised the Supreme Court decision.
The governor spoke Thursday at the launching of a group called Vermont Leads: Single Payer Now!, a political nonprofit that aims to support the idea of single payer through a media ad campaign.
“Single payer has been my top priority, and I can assure you that nothing will make me waiver from that commitment to deliver on single payer in Vermont as quick as I know how,” Shumlin told supporters. “Vermont is going to be the first state in the country to be a place where health care is a right and not a privilege, where it follows the individual, isn't required by the employer and where no one goes to sleep at knowing that if they wake up not feeling well, they will lose all financial security.”
Peter Sterling, who started the Vermont Leads group, said he and others will try to move toward single payer no matter what happens at the federal level.
“What the Affordable Care Act is going to do for Vermont is not nearly as good as what single payer is going to do for Vermont,” he said.
In a statement, the group Vermont Physicians for a National Health Program said the federal law will still allow for “unaffordable underinsurance.” Since private health insurance companies will still be offering insurance through state “exchanges” and reaping the federal subsidies, the statement says, “this legislation hands them an estimated $557 billion in taxpayer money through 2020, strengthening their ability to block future reform.”
Although the Shumlin administration does not have to shift its sails to deal with a decision striking down the entire law, as some expected, the goal of single payer is still a long way away.
For one, the administration has yet to release a financing plan for the universal health care system. That is due out in January, after dust settles from the November election.
Shumlin told reporters at a press conference Thursday that he would not push forward with single payer if the state cannot find a way to control the ever-increasing costs of health care.
Randy Brock, the Republican gubernatorial candidate, held his own press conference in Burlington.
Brock has been an outspoken opponent of Shumlin's health care reform plan. He introduced legislation as a senator during the 2012 session that would have required the financing plan for Green Mountain Care to come out before the November election.
“Today's Supreme Court decision postpones the day of reckoning for Governor Shumlin's Titanic Care health care law,” Brock said. “Federal dollars can now temporarily plug the huge holes the governor's plan will generate in Vermont's budget.”
Brock plans to unveil his own health care plan soon.
The National Federation of Independent Business (NFIB) expressed concern in its statement pledging to help repeal the ACA saying the act could hurt small businesses. The organization also cautioned the act's existence diminished Americans' freedom.
Dan Danner, President and CEO of the NFIB, said, “Under ACA, small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses,” he said. “We will continue to fight for the repeal of ACA in the halls of Congress; only with ACA's full repeal will Congress have the ability to go back to the drawing board to craft real reform that makes reducing costs a number one priority. The power and control of health-care decisions should be in the hands of the consumer, not the government."
NFIB Vermont State Director Shawn Shouldice said, “the ruling is especially disappointing to Vermont small businesses because it gives a green light to the controversial health care reform experiment to which the state is now committed.”
“Individuals and small businesses who choose to offer coverage to their employees will be forced to purchase it from the government run Vermont Health Insurance Exchange with limited choice over insurance plans, benefits and out of pocket costs, said Shouldice. “The Shumlin Administration has consistently touted the costs savings this reform will reap. Small businesses across Vermont will be watching closely as our policymakers continue to push their reform measure forward.”
Vermonters for Health Care Freedom, a 501(c)(4) organization aimed at educating the public on the pitfalls of Vermont's own health care reform, called on Shumlin to release his plan for funding Green Mountain Cares before the fall elections.
“The Supreme Court's decision on the Affordable Care Act is a mixed blessing for Governor Shumlin and single payer advocates. On the one hand, the federal subsidy funding that Green Mountain Care so desperately needs was preserved. On the other hand, the Governor's desire to implement his government monopoly health care system prior to 2017 appears to be beyond reach, since the ACA prohibits the issuance of waivers - which Green Mountain Care requires - until then,” said Executive Director Jeff Wennberg.