Vermont health reform supporters cheer Supreme Court decision

VTDigger reporter Taylor Dobbs contributed to this report.

The U.S. Supreme Court issued an opinion Thursday morning upholding in large part the Patient Protection and Affordable Care Act, commonly known as Obamacare.

The decision means Vermont will likely be able to benefit from hundreds of millions of dollars in federal tax credits and subsidies under the federal scheme.

The court found a so-called “individual mandate” requiring Americans to buy health insurance was constitutional under the government’s power “to lay and collect taxes.”

The court also upheld a part of the law expanding coverage of Medicaid for Americans who make up to 133 percent of the federal poverty level.

In addition to the federal subsidies, the court’s decision also means a green light, at least for now, for the state to move forward with its goal of implementing a single-payer health care system in 2017.

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.

Gov. Peter 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,” he told supporters.

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, if the court had struck it down, Vermont would have been scrambling to fill that hole.

At what seemed almost like a pep rally, Shumlin poured on campaign rhetoric cheering single payer Thursday.

“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,” Shumlin said.

While the rest of the country looked to the decision upholding the health care law as a large step toward a more European-style, publicly funded health care system, single-payer advocates in Vermont say they want to go further.

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.

While health care reform advocates cheered the decision, or at least breathed a sigh of relief, critics of the reform effort called it disappointing.

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,” he 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 in Vermont issued a statement lamenting the decision also.

“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,” NFIB Vermont state director Shawn Shouldice said in a statement. “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.”

The national NFIB has said it will fight for a repeal of the federal law in Congress.

For now, it appears to be full-steam ahead for the Shumlin administration, which could be the first state in the nation to put into place a single-payer health care system. But with the November election looming, the battle at the state level may be just beginning.