[L]awmakers hoped that by their return to Montpelier this week, federal health care changes that have been in flux since last summer would have been resolved. But major policy and budget issues that would have an impact on Vermont remain in play.
Proposed reductions in spending for several key programs could total $36 million in fiscal year 2019.
Some changes are already in the works — the tax bill Congress passed in December, for instance, repeals a mandate requiring Americans to have health insurance or pay a penalty. Other federal supports are set to expire unless Congress takes action. Meanwhile, comments from Republican leaders suggest repeal of the Affordable Care Act is still on the table, despite the defeat of a bill last summer.
Rep. Bill Lippert, D-Hinesburg, chair of the House Health Care Committee, said Tuesday that lawmakers will consider steps at a state level to ameliorate federal changes — including exploring a state-level health insurance mandate — but they continue to grapple with many unknowns.
“The fact that Congress has kicked into January so many issues that were supposed to be resolved before we got back leaves a fair amount of uncertainty,” Lippert said.
Congress has not approved long-term funding for federally qualified community health centers and the children’s health insurance program, known as CHIP.
Both programs expired at the end of the federal fiscal year in September. Congress passed a short-term extension through March for both as part of a spending resolution in December.
Vermont’s 12 health centers stand to lose $14 million in federal funding if Congress doesn’t renew funding. About 25 percent of the state’s population uses the centers for primary care services.
CHIP funding, along with Medicaid, supports the state’s Dr. Dynasaur program. According to estimates from the legislative Joint Fiscal Office, the state would be left with a $1.9 million budget shortfall in the current fiscal year and a $21.6 million in the next year if the federal program ends. Currently, the federal government pays 90 percent of the cost of health care for children through the Medicaid program under CHIP. If the program is not reauthorized, children would be picked up by the general Medicaid program, which has a much higher state match.
Congress also did not renew a program that gives a 2.5 percent to 3 percent bump in Medicare payments to home health agencies to help manage costs related to operating in rural areas, such as additional mileage. The Medicare extension ended at the beginning of January. Jill Olson, the executive director of the VNAs of Vermont, estimated in December that home health agencies in the state would lose about $1.3 million in federal funding.
Sen. Claire Ayer, D-Addison, the chair of the Senate Health and Welfare Committee, does not expect Congress will allow CHIP or the federally qualified health centers program to lapse permanently. CHIP has been such a popular program across political lines that it is unlikely not to be continued, she said.
“We are sort of holding our breath and assuming of course they’ll renew it,” Ayer said.
Ayer said the renewed political rhetoric over repealing Obamacare will not affect the Legislature’s health care agenda this year.
“We need to look for the best policy solutions for Vermont,” Ayer said. “We can’t wait until they decide what to do.”
Now that the federal insurance mandate for individuals has been repealed, Vermont lawmakers will consider whether to create a state individual mandate, Lippert said. Ayer said her committee will also explore what the repeal of the individual mandate means for Vermont and will consider the state’s options, she said.
The legislative Joint Fiscal Office predicted in a report last month that the individual mandate will not have short-term impacts on state finances. However, repealing the mandate will likely have repercussions in many aspects of the state’s health care system, “but it is too early to estimate the specific impact that the repeal will have,” analysts wrote.
Lawmakers will also address the impact of an executive order from President Donald Trump that allows insurance plans to be sold across state lines.
“We’re going into this with a lot of questions, not a lot of firm answers,” he said.
The potential upheaval in the Capitol on a wide array of health care programs can be “terrifying” when trying to plan for the future, she said. However, she said, lawmakers are conscious of the potential changes in Congress.
“We’re mindful, but we’re not paralyzed,” she said.
Lippert said he expects to spend part of the session on state-based issues, like monitoring the roll-out of OneCare, a new $620 million a year, population-based health care system.
Vermont Human Services Secretary Al Gobeille said that any changes to how the Medicaid program or the Affordable Care Act functions would have major implications for Vermont.
“If that was to become a conversation again … that would be the biggest thing we’d face,” he said.