Vermont News Briefs

Supreme Court decision: Everyone’s got something to say

Editor’s note: Statements regarding the Supreme Court’s decision on the Affordable Care Act have been streaming in to VTDigger’s inbox. Here they are in their entirety. They appear in the order in which they were received, oldest first.

Rep. Peter Welch, D-Vt.

“This historic decision by the Supreme Court clears the way to get about the business of ensuring that every American finally has access to quality and affordable health care. The Affordable Care Act will remain the law of the land.

“Amidst the contentious national health care debate over the last two years, there has been widespread consensus on one thing: America’s health care system is broken. The only beneficiaries of the status quo are insurance companies and their executives. Working families need the peace of mind and that comes with quality and affordable health care coverage. And businesses need to compete in a global economy without the heavy burden of skyrocketing employee health care premiums.

“With this landmark decision now behind us, both parties should set political differences aside and make this law work for the American people. It won’t be easy, but it’s time to get back to work.”

Sen. Patrick Leahy, D-Vt.

“Today’s decision by the Supreme Court to uphold the Affordable Care Act is a win not only for the millions of Vermonters and other Americans who have long been victimized by a deeply flawed health care system, but for all Americans who will benefit as we continue to implement this landmark law.

“Over much of the last century, generation after generation has unsuccessfully grappled with how to answer complex and increasingly urgent questions about how to let every American have access to quality, affordable health insurance. Out of control costs were eating our economy alive and forcing many employers to drop insurance for their workers. The Affordable Care Act at last answered those questions. Though no bill is perfect, these are good reforms, long needed by the American people, by American businesses and by the American economy.

“The nation and every American household now would be best served if this historic decision puts an end to the years of partisan attacks and obstruction of efforts to help the millions of Americans who have fallen through the cracks, and millions more who worry with good reason that they may fall through the crack of our broken health insurance system. The Court has spared the American people a return to those decades of spiraling problems and uncertainty that reached into every American household.

“The Court’s decision reaffirms what I have believed since the Senate debated and passed this law: Congress has the power under the Constitution and the Court’s own, long-standing precedent to protect Americans from abuses by health insurers and to help give all Americans with access to affordable health care, including some of the most vulnerable among us like children and older Americans.

“In passing the Affordable Care Act, Congress built on the cornerstones of modern America like Social Security, Medicare and Medicaid, to strengthen the Nation’s social safety net and help protect hardworking Americans. I have served in the Senate for 37 years, through seven presidencies. I am one of the few people in the Senate today who can say that I served alongside representatives who voted to create our nation’s Social Security system, voted for the G.I. bill, passed the Voting Rights Act, and created Medicare, Medicaid, and Head Start. Congress has come together to refine the laws establishing these programs. We should similarly come together to further improve the Affordable Care Act where needed. It’s time to stop the political posturing. Congress works best for the American people when we are able to come together to solve national problems. America is stronger when we do.”

Paul Burns, VPIRG executive director

The decision is in, and it looks like good news for health care reform here in Vermont and across the country. The Supreme Court has upheld many of the key provisions of the federal health reform law.

Today’s decision means that the coast is now clear for Vermont to lead the way with even more ambitious reforms to deliver lower costs and better quality care for all.

At the federal level, the health reform law still has the potential to save billions of dollars and level the balance of power between consumers and the health care industry — driving the industry to cut waste and prioritize high-quality care.

The health care industry has spent millions to influence decisions on health care in Congress, and now groups are mobilizing to try to block reform in Vermont as well. Cleary, the industry knows how high the stakes are. VPIRG will stand with our many allies in countering this opposition on behalf of Vermont’s consumers.

The Court’s decision today will refocus attention on reform in the states. For Vermont, that means we have been given a giant green light to move forward with what may be the nation’s most ambitious health care reform plan. The result will be lower costs, better care and a model for other states to follow.

Vermont Businesses for Social Responsibility

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. Shumlin’s administration to ensure that our state has a sustainable health care system that is decoupled from employment.

Sen. Bernie Sanders, I-Vt.

“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.

“It is a good day for 30 million uninsured Americans who will have access to healthcare. 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.

“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.

“In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better. If we are serious about providing high-quality, affordable healthcare 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.

“I am proud that Vermont is making steady progress toward implementing a single-payer system. I hope our state will be a model to show the rest of the nation how to provide better care at less cost to more people.”

Cassandra Gekas, Democratic candidate for lieutenant governor

“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 conditions.
June 28th will forever be remembered as the day patients came before profits, and logic came before politics. I am proud of our President and deeply grateful to our Congressional delegation for leading the charge.”

“And in Vermont, it’s full steam ahead. The ACA will provide us with the critical resources we need to bring high quality, affordable healthcare to every Vermonter. I am proud to stand beside Governor Peter Shumlin and our legislative leaders in their unwavering commitment to justice, health, and prosperity for all in our great state.”

National Federal of Small Businesses

The Supreme Court’s decision today upholding the controversial Affordable Care Act and its heavy-handed individual mandate is a deep disappointment to small businesses everywhere, said the National Federation of Independent Business (NFIB) today.

“While we are certainly disappointed, NFIB respects the decision to uphold the individual mandate by the Supreme Court. Clearly this mandate has now become a tax on all Americans and a broken campaign promise from President Obama not to raise taxes,” said Dan Danner, President and CEO of the National Federation of Independent Business. “We are concerned about the precedent that this will set in Congress’ ability to mandate other aspects of our lives, but we will move forward from today to continue to fight, harder than ever, for real health-care reform for our membership.

“Under PPACA, small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses. We will continue to fight for the repeal of PPACA in the halls of Congress; only with PPACA’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.”

“This day will go down in history as the day when Americans lost a part of their freedom – the freedom to choose what to buy with their own money,” said Karen Harned, Executive Director of NFIB’s Small Business Legal Center.

Vermont Democratic Party

Today the Supreme Court confirmed that millions of sick, underinsured, and uninsured Americans matter more than insurance companies. The Affordable Care Act is groundbreaking legislation that, after decades of effort, paves the way towards a health care system that serves the country, not the insurance industry.

“Everyone here at the Vermont Democratic Party is pleased with today’s ruling. Obamacare is a lifeline to Vermont’s sick and they deserve to have the care and coverage they now receive validated by the Supreme Court. We now are ready to continue moving forward in creating a rational and fair healthcare system nationally and here in Vermont,” said VDP Chairman Jake Perkinson.

“The GOP has tried everything to stand in the way of progress. For the last two years, at the behest of Big Insurance, Republicans have wrongly claimed Americans are not entitled to affordable care. Today, with the validation of Obamacare, the Supreme Court stands with everyday Americans.

With this ruling, Vermont gains even more momentum behind our efforts towards creating an affordable and accessible health care system. With the Affordable Care Act providing millions in subsidies to expand access to low-income families and the uninsured, we will work hard to see the implementation of Green Mountain Care, the single-payer system that will be Vermont’s answer to the healthcare crisis,” he concluded.

Vermont Workers’ Center

Editor’s note: This was edited to keep the focus on the Supreme Court’s decision.

Leaders of the Vermont Workers’ Center’s Healthcare Is a Human Right campaign, in an initial reaction to the Supreme Court’s ruling on the Affordable Care Act, interpreted the decision as  a vindication of Vermont’s own path toward a human rights-based universal healthcare system.

With this decision, the Supreme Court confirmed government’s responsibility for ensuring healthcare for all, which the people of Vermont have been demanding for many years. Healthcare Is a Human Right campaign leaders pointed out that because the Affordable Care Act is expected to fall far short of achieving universal access to care, there is an urgent need for Vermont to continue its pioneering approach to health reform.

While the Affordable Care Act relies on mandating individuals to buy health insurance as a commercial product, Green Mountain Care will provide healthcare as a public good to all, financed through tax-based contributions.

“Vermont’s tax-based, public financing approach to health reform is well-placed to become a model for other states to follow,” said Vermont Workers’ Center President, Peg Franzen. “The Supreme Court is far from alone in finding the commercial treatment of healthcare questionable and in pointing to the government’s responsibility instead. Vermont’s treatment of healthcare as a public good can lead the way toward a truly universal healthcare system, in our state and nationwide.”

“The Supreme Court’s ruling should motivate other states to follow Vermont’s path toward a tax-funded, universal healthcare system. Now, more than ever, our state can lead the way for states across the country to do the same,” said Vermont Workers’ Center Director, James Haslam.

Haslam also pointed to the urgency of protecting the implementation of Vermont’s universal healthcare system in the face of attacks by anti-health-reform groups. Haslam said, “The people of Vermont started on the road to universal healthcare long before the ACA was passed, and we will continue to work together until we cross the finish line. Through our grassroots organizing, we are building a broad-based, independent movement for the human right to healthcare in Vermont. This effort is increasingly gaining national recognition. Together we will hold our governor accountable for shepherding the implementation of a truly universal and equitable healthcare system.”

TJ Donovan, candidate for the Democratic nomination for attorney general

“I am proud that the United States Supreme Court upheld the Affordable Care Act so we can move forward here in Vermont toward having a universal health care system for all. As Attorney General, I look forward to engaging with Governor Shumlin and the Legislature, to make sure the law stands up in court and passes legal muster, so that Vermonters can be certain they’ll have access to affordable health care.”

MVP Health Care

The Supreme Court’s decision today allowed the Affordable Care Act (ACA) to remain in place. MVP has been prepared for this decision. All along the company has complied with the ACA and is actively moving forward with the next steps in the health care reform process, including preparing to sell individual market policies through the state health insurance exchanges in 2014.

The Court’s decision on the Medicaid expansion in general will not have an effect in the markets MVP serves—New Hampshire, New York and Vermont—which currently maintain Medicaid eligibility for the most part at thresholds that meet the ACA requirements.

“Now that the ACA has been upheld by the Court, it is time to continue the work of reforming the health care system. This includes addressing America’s real health care problem by introducing legislation to reduce the unsustainable increases in the cost of health care services and products,” said David Oliker, MVP’s President and CEO. “Some of the most promising ways to control costs are to incentivize providers for delivering quality outcomes in a cost efficient way, to promote the use of evidence-based medicine, and to encourage the meaningful use of Health Information Technology/Electronic Medical Records and e-prescribing.”

MVP supports many of the goals of the ACA, such as making sure all Americans have meaningful, affordable health coverage and access to high-quality health care. However, MVP has told policymakers throughout the process that there are parts of the ACA that will not work as designed.

Specifically, these aspects of the ACA should be reconsidered:
The “Small-Business Health Insurance Tax” (HIT) should be repealed. It is counterproductive to the goals of health care reform as it will significantly increase the cost of health care. The Congressional Budget Office (CBO) estimates that the HIT will impose an $87 billion tax on health insurers from 2014 to 2019. The tax would likely have to be passed on to consumers and is estimated to cost families hundreds of extra dollars a year.

The ACA also includes new taxes on pharmaceutical manufacturers and medical device manufacturers that will raise the cost of health care and health coverage for individuals, families and employers. New taxes, including HIT, will increase premiums by approximately five percent more than current cost trends in 2014 and will similarly increase costs in subsequent years.

MVP is concerned about the impact of significant funding cuts to Medicare Advantage (MA) health benefit plans included in the ACA and believes MA program funding should be returned to pre-ACA levels. MA programs are working for consumers and the scheduled cuts equate to $145 billion nationally over the next 10 years. These funding cuts will likely force many older adults to face higher premiums and/or reduced benefits, particularly in later years when the funding cuts are fully phased in and have a devastating impact on older Americans around the country, including the more than 100,000 older adults MVP serves.

The individual mandate is not strong enough to motivate everyone to have health insurance. The goal is not to punish people, but to create a market that works. Experts agree that the key to making premiums more affordable is to create a system in which everyone—young and old, healthy and ill—is effectively motivated to have coverage.

The timeframe for building the exchanges and getting products approved for sale is very compressed. For consumers to be able to purchase insurance through the exchange in time for coverage to begin January 1, 2014, products would need to be approved and available for sale during the fall open enrollment period of 2013. The concept of this kind of individual market/small business market product comparison tool will help drive transparency and innovation in the industry, but there are a number of significant hurdles to getting it up and running according to the deadlines in the ACA.

Gov. Peter Shumlin

Vermont Senate President Pro Tem John Campbell and House Speaker Shap Smith

“Today’s Supreme Court opinion upholding the Affordable Care Act was a great step forward in the ongoing battle for universal health care. This decision may be a national policy issue, but it is incredibly important to the State of Vermont. We have already worked hard towards the implementation of a single-payer system, with the goal of providing citizens with affordable health coverage. With the Affordable Care Act in place, Vermont stands to receive more federal funding as we continue to work towards this goal, acting as a model for the rest of the country.

“While we celebrate today’s landmark victory, it is important to note that while one battle is over, there are more to be fought. We must remain vigilant and work hard as we continue on the path towards universal health coverage.” Stated Sen. John Campbell.

“Over the course of the last two years, Vermont has made great progress in reforming its health care system. The Supreme Court decision to uphold the Affordable Care Act will support Vermont in its continuing effort to ensure that all Vermonters have access to high quality, affordable care,” stated Speaker Smith.

Wendy Wilton, Republican candidate for state treasurer

The court’s decision illustrates the difficulty in arriving at a centrist decision amidst the influence of the far left or the far right. It also reinforces the need to develop fiscal projections alongside the health care policy decisions to ensure that reforms will make healthcare accessible and affordable for every Vermonter.

As state treasurer I will focus on ensuring healthcare reforms are affordable and sustainable over the long term–whether it’s a single or multi-payer system. I will work to ensure Vermonters and the policymakers have all the fiscal facts. The reality is, regardless of which payment system is selected we must apply a fiscal responsibility standard or all of our pockets will be empty and our bond rating will suffer.

As state treasurer I will be an honest, independent voice that will communicate to Vermonters and our creditors what will be required to achieve fiscal sustainability as we move forward with reform.

Vermont Physicians for a National Health Program

The U.S. Supreme Court has upheld the bulk of the Patient Protection and Affordable Care Act, including the individual mandate. They affirmed that health care may be financed through taxation. The worst insurance abuses are being curtailed. Americans will benefit from reforms Vermont has enjoyed for years. Many people without insurance, especially young adults and people with low incomes, will gain health care coverage.

Unfortunately, the PPACA institutionalizes “unaffordable underinsurance” at taxpayer expense. Millions will have to buy overpriced policies with limited coverage and high deductibles and copayments. Ignoring the root of the problem—private health insurance—this legislation hands them an estimated $557 billion in taxpayer money through 2020, strengthening their ability to block future reform. And over 26 million people will remain uninsured.

Insurance companies currently add cost to the health care system: more than ten percent in direct costs and additional millions due to administrative burdens on Vermont patients and providers. Green Mountain Care will replace them with a single, non-profit payer. Health planning, resource allocation, care coordination, new payment methodologies, and drug price negotiation may all help to control costs. Vermonters will get the care they need without risking bankruptcy. Business, town, school, and state budgets will find relief.

In contrast to the PPACA, there was never any debate over the constitutionality of Medicare. In its 47 years, this publicly funded system has allowed millions of seniors and people with disabilities to access health care that would otherwise have been unaffordable. What we need is a Medicare expansion, not the Medicaid expansion of the PPACA. We urge Congress to extend Medicare coverage to every American, regardless of age. And Congress should support state innovation like Vermont’s.

The Affordable Care Act provides some funding for Vermont’s health reform effort. Like other single-payer systems, Green Mountain Care will provide universal coverage, improve access, and control costs. Patients will choose which clinicians will care for them; medical decisions will be in the hands of patients and clinicians. On the downside, without the PPACA, Vermont could have done a single-payer system at its own pace; now we must delay up to six years.

The members of Vermont PNHP know that a system dominated by private insurers and Big Pharma—as envisioned by the PPACA—cannot be universal and affordable. Polls have repeatedly shown that a solid majority of Vermonters and Americans favors single-payer. Our federal representatives should continue their efforts to gain appropriate waivers so that Vermont’s vision of Green Mountain Care can be realized as soon as possible. And Congress should extend improved Medicare coverage to every American.

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