In briefings to the Senate and House, as well as Gov. Phil Scott, Welch highlighted two major concerns: First, if the Affordable Care Act is repealed without a sufficient replacement, he said, thousands of Vermonters would lose their health insurance. Some key benefits of the ACA — including requirements that insurance be offered to those with pre-existing conditions, elimination of lifetime caps on insurance claims, and clearance for children to stay on their parents’ policy until age 26 — would also go away, he said.
The second issue he warned about was the push by the Republican-controlled Congress, and supported by President-elect Donald Trump, to change Medicaid payments to the states from reimbursements for each procedure to set amounts in the form of block grants. Lawmakers, including Sen. Jane Kitchel, D-Caledonia, the chair of the Senate Appropriations Committee, warned Tuesday that block grants would result in the slow death of many programs.
“My message to you is they’re deadly serious,” Welch said of congressional repeal plans. Later he added: “It’s real, that’s what I’m saying, and there is not a replacement plan, which is astonishing.”
Welch said community hospitals in Vermont could be devastated because they depend on Medicaid funds. He spoke with many leaders of those hospitals Tuesday.
Congressional Republicans and Trump have said they will have a replacement plan and may push the effective date of ending the ACA into the future. A report by the Congressional Budget Office on Tuesday said 18 million Americans would lose coverage in the first year if a repeal occurred.
Welch promised to fight for federal funds for Vermont. On the expected repeal of the ACA, Welch said his strategy was to appeal to Republicans whose constituents would lose coverage and pressure those members of Congress to find a suitable replacement.
Welch, a Democrat who is a former Vermont senator, encouraged lawmakers to forge ahead with health care reform efforts in Vermont despite the uncertainty and “darkness” he said has pervaded the nation’s capital. He said an “all-payer” waiver the administration of former Gov. Peter Shumlin signed with the federal government was unlikely to be overturned because two dozen other states have also received waivers of some kind. Congress and the administration, Welch said, would be unlikely to “pick and choose” and remove only some.
One positive Welch saw on the medical cost front was Trump’s support for negotiating with pharmaceutical companies over the government’s bulk purchase of drugs. Welch recently introduced a bill calling for negotiation. He noted the uncertainty of knowing Trump’s positions.
“We’ve got Trump with us on this one, we think,” Welch said.
On funding for the cleanup of Lake Champlain, Welch said he was unsure what would happen and pointed to Sen. Patrick Leahy as the member of the congressional delegation more involved in fighting for water pollution-related programs.
Scott said in an interview that he was concerned about any changes to Medicaid funding because it makes up about a third of the state budget.
“Any small changes to Medicaid would have a dire effect on our budget. We’ll have to wait and see. We’re in a bit of a holding pattern as we contemplate what’s going to happen in Washington, D.C.,” Scott said.
Scott said he hoped the Legislature could avoid a special session, a prospect raised by Senate President Pro Tem Tim Ashe, D/P-Chittenden, who said Tuesday there was a 1 in 4 chance lawmakers would have to return if severe federal cuts were made after adjournment in Montpelier in the spring.
Sen. Kitchel told fellow Democrats she was concerned about moving to block grants for Medicaid funding.
“I think any of us who have worked with block grants knows that there is a dismal history,” Kitchel said, of freezing the amount over a period of years and states not being able to keep up as expenses and caseloads increase. Kitchel cited the Temporary Assistance for Needy Families program as an example of one that was moved to block grants that she said was overburdened. The program provides financial assistance for pregnant women and families with children.
The stakes are high, Kitchel said. The Agency of Human Services, she said, receives almost $1.4 billion from the federal government, a large part of which is Medicaid money.
In total, the federal government provides more than $2 billion a year to the state, for purposes including health care, transportation, labor, education and natural resources, according to a report Kitchel compiled.
Welch told lawmakers he was hopeful about passage of a nationwide infrastructure improvement program that he said had support from both sides of the aisle.
The real shame, Welch said, was the unwillingness of Republicans and Democrats to work together to iron out problems with the ACA instead of scrapping it altogether.
