• Down the ’pike
    September 07,2013

    In a year’s time, since the federal Affordable Care Act became the framework on which Vermont is building its health care “exchange,” a relatively short timeline has been put into place for such a massive undertaking. What has occurred in the months since Vermont agreed to be the guinea pig for an online marketplace has created unrest among business owners and individuals who still are trying to get their heads around the “why” of the push.

    Now, a month before the exchange comes online, an education blitz made up of hundreds of Navigators as well as public meetings and even advertising, is both attempting to clarify the state’s health benefit plan and also is highlighting the fast-approaching deadline.

    Nobody enjoys being forced into a decision, especially if it is made up of choices that many people do not fully understand. The state maintains that residents will have plenty of help enrolling in the coverage. And there will be new and easier ways to enroll — through the Vermont Health Connect website, over the phone, through the mail, or with in-person assistance. But many Vermonters do not seem convinced.

    Compounding the apparent anxiety is phase two of the health care discussion, which will be upon Vermont within months of the exchange going online: a single-payer system by 2017.

    A year from now, the anxiety that consumers here are feeling about Vermont Health Connect will be a distant memory compared with the larger, inevitable discussion of single-payer. Once the topic goes to universal coverage, and creating a funding mechanism to pay for it, a tremendous amount of political capital is going to have to be laid out on the table for the governor, his administration, and lawmakers, as well as lobbyists and special interests.

    This is a discussion of unknowns. It is revamping a system that represents a huge portion of our economy. There will have to be lots of compromise, and done effectively, that means no one gets exactly what they want.

    On The Times Argus’ “City Room,” a show aired on public access stations statewide, Gov. Peter Shumlin this week said he was satisfied with the timelines in place, as well as the education effort being made in the weeks leading up to the marketplace going live. He also acknowledged, candidly, that the price politically could be high. But the governor does not seem daunted by the hard decisions to come, especially as the single-payer model is revealed.

    The governor’s goal is clear: He will not be satisfied until a single-payer system will be in place that ensures everyone has access to affordable and comprehensive health care. He and the framers of this health care revolution know that the nation is watching. There is tremendous pressure being placed on Vermont to make the dovetail between the exchange and single-payer as seamless as possible. A lot can go wrong.

    But the discussion always will come back to either funding or equity. There is no easy way to make either happen. For example, one idea being floated has been increasing the payroll tax since health care premiums will have been removed from the equation, except that currently there are businesses opting not to provide health insurance. Single-payer forces them to pay. The same argument will be made for any levy or tax rolled out to pay for universal coverage. It is cost shifting or creating taxes.

    The governor told Times Argus Editor Steven Pappas that he was confident in the process and in the results to come. And he maintained that the health care discussion is happening in earnest, and that the right solutions will be presented to Vermonters in due time.

    But there is not a lot of time left, comparatively speaking.

    Shumlin does not shrink from these hard discussions and lofty goals, but in the coming months, it will be imperative for us to watch the effectiveness of the enrollment into the exchange. It will set the tone for what’s to come, and plot the course for the uncharted waters ahead. And then the real discussions must begin.

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