This commentary is by Sen. Ruth Hardy and Rep. Lori Houghton. They are the authors of the Medicaid Expansion Act of 2024. Sen. Hardy (Addison District) chairs the Senate Government Operations Committee and is a member of the Senate Health and Welfare Committee. Rep. Houghton (Essex Junction) chairs the House Health Care Committee.
The cost of health care impacts everyone these days, stressing family wallets, increasing personal debt, and driving up public and private budgets. And while most Vermonters (nearly 97%) have health insurance, about 40% of Vermonters are under-insured, meaning their insurance doesn’t cover basic medical expenses like going to the doctor for routine care.
Over the past decade, policymakers have spent a lot of time debating “health care reform,” with well-intentioned efforts to create accountable care organizations, payment reform, and studies to combat patient wait-time and ballooning hospital budgets. While these steps have resulted in some incremental progress and will continue, most people’s access to dental care, mental health services, specialty care, prescription drugs, long-term care and substance use treatment has gotten worse, especially as we recover from the effects of a global pandemic.
During all of this, one health insurance program has been working well, and even getting better: the Vermont Medicaid Program and its children’s health program, Dr. Dynasaur. Nearly one-third of Vermonters are covered by this comprehensive health insurance program, run and funded through a partnership between the state and federal governments. During the pandemic, thousands more Vermonters received health insurance coverage through Medicaid, thanks to additional federal funding. Now, many of those folks are being kicked off the program due to procedural issues and waning federal pandemic funding.
What if we didn’t kick Vermonters off Vermont’s comprehensive, nationally recognized Medicaid program? What if we embraced Medicaid coverage for more Vermonters, including youth in their 20s, pregnant individuals, hard-working adults and seniors living in poverty? What if we do for health care what we did last year for child care — build on a successful state-federal program to reduce costs and expand access to health care for Vermonters, while at the same time increasing key support for healthcare providers?
This is precisely what our bill to establish The Medicaid Expansion Act of 2024 (H.721/S.240) would do. People shouldn’t have to choose between their health and their wallets, so this bill puts affordable health care back where it belongs—in the hands of every Vermonter. This legislation would take a significant stride toward addressing health care affordability and access.
Over the next six years, this legislation would expand access to comprehensive Medicaid health insurance to adult Vermonters earning up to 317% of the federal poverty level, which currently is an annual income of $95,100 for a family of four. This level of coverage is already provided to children, so the bill would start by expanding this access to young adults up to age 26 and pregnant individuals, and then gradually increase the income eligibility level for all adults.
Importantly, the bill would also create savings accounts for older adults to prevent the sticker shock of transitioning from comprehensive Medicaid coverage to more expensive Medicare coverage. Simultaneously, the bill would increase reimbursements to providers of primary, mental health, dental, and long-term care, as well as make it easier for children and youth to access mental health care without a complicated or stigmatizing diagnosis.
Many of the people who would benefit most from this legislation are the 40% of Vermonters who are currently under-insured and unable to afford medication and urgent, specialty, or even basic health care services. By opening up our state’s nationally recognized Medicaid program to more Vermonters, we would reduce staggering health care costs facing families, small businesses, and self-employed individuals, freeing up more of their income for other needs and investments.
For too many years, our health care reform efforts have focused on systems, not people. This legislation would bring the focus back to Vermonters by expanding access to comprehensive health care for thousands of people who are struggling to afford a visit to their doctor. We are ready to do this work for the good health of all Vermonters.
