Editor’s note: This commentary is by John Franco, a Burlington attorney who has been active in health care reform for over 25 years.
[L]ost in all the deconstruction of the gubernatorial election and the angst about its effects on legislative support for a $2 billion single payer system is that due to a confluence of factors, now presents the best historic opportunity we have ever had to achieve universal health insurance coverage.
In the past universal coverage confronted two objections. The first was that we needed to get the explosive growth in health care spending under control because it was crowding out any ability to finance universal coverage. The second was that we needed significant assistance from the federal government because a single state could not do it alone.
Well both have now materialized.
For a very small investment, especially compared to the $5 billion plus we are already spending on health care, we can finally grab the brass ring of universal coverage, and do so in the enrollment period that begins in the fall of 2015.
Starting in 2011, the brakes were slammed on runaway health care spending. From 1999 to 2010, health care’s bite out of the economy doubled from 10 percent of GDP to just under 20 percent. In 2010, the state was predicting that Vermont health care spending would hit $5.9 billion by 2012. But it didn’t. Instead it barely nudged over the $5 billion mark. Private health insurance premiums grew from $1.85 billion to $1.886 billion – statistically insignificant. This reduction in the growth of health care spending is unprecedented. It ain’t gonna get any better.
Starting this year, oodles of federal money have become available not only to Vermont to cover everyone but to relieve small employers if we’re smart about leveraging it. Significant premium subsidies available to those with at or below 400 percent of the federal poverty level. That’s a family income of nearly $100,000. Sixty percent of all Vermonters have income at or below that level. Obamacare, coupled with Vermont’s premium assistance program, are together now picking up over two-thirds of the overall premium cost for individuals enrolled in the health insurance exchange. But this leaves individuals in the exchange on average still paying more than that by those who get their coverage from work, a hurdle in getting the uninsured signed up in the exchange. Vermont needs to subsidize that gap by significantly enhancing its premium assistance program. For a very small investment, especially compared to the $5 billion plus we are already spending on health care, we can finally grab the brass ring of universal coverage, and do so in the enrollment period that begins in the fall of 2015.
Consider where we have come. From the year 2000 to 2011 Vermont managed to increase health care spending 250 percent — from $2 billion to $5 billion — and still not cover everyone. What a business plan! The question presented is whether we will continue to repeat this insanity, or once and for all recognize it for what it is.
I am reminded of the scene in the movie “Lincoln” in which the president angrily rejects the counsel of his advisers to withdraw the 13th Amendment by slamming his hand on the table — eyeglasses sent flying — insisting slavery must be abolished “Now, now and now!” We have been debating universal coverage for over two decades. The time to call the question is now.
