ADDISON COUNTY — Addison County lawmakers spearheading Vermont’s health care reform effort hailed the U.S. Supreme Court’s decision on Thursday to substantially uphold the federal Affordable Care Act (ACA), a decision they said gives them further confidence in pushing the state toward a single-payer system.
“I’m obviously satisfied and pleasantly surprised, I have to admit, by the ruling,” said Rep. Michael Fisher, D-Lincoln, and chairman of the House Health Care Committee.
Like many other state and federal lawmakers who have supported the ACA, Fisher was bracing for the worst — namely, a U.S. Supreme Court ruling that might have invalidated all or large portions of the new law that, among other things, will require Americans to obtain health insurance by 2014 or pay a financial penalty.
In a 5-4 decision that saw Chief Justice John Roberts side with his more liberal colleagues, the nation’s highest court ruled that the requiring people to obtain health care or face a financial penalty was constitutional, essentially that it represented a tax.
Opponents had challenged the ACA on several grounds, including whether the individual health care mandate was a permissible exercise of Congress’s powers under the commerce clause in the U.S. Constitution.
Republican Congressional leaders have vowed to push for a repeal of the ACA when federal lawmakers return to Washington on July 11, but that effort is not expected to garner enough votes in the U.S. Senate. Vermont legislators will now be moving forward as planned with a single-payer health care system that supporters want to see fully phased in by 2017.
In the meantime, Fisher said many young or ailing Vermonters should be celebrating the U.S. Supreme Court’s ruling for the protections the ACA has guaranteed to those groups. Those protections, he noted, include allowing children to stay on their parents’ health insurance plans up to age 26 and a rule prohibiting insurance companies from denying coverage based on pre-existing health conditions.
“There is a whole population of people who are finding real relief with this ruling,” Fisher said.
He added 2014 will usher in new federal subsidies to help Vermonters, and all Americans, better afford health care coverage.
“That will represent a real access to real care, not under-insurance, for many Vermonters who don’t currently have good insurance,” Fisher said. “I am just really happy for Vermont that we get to continue to move in that direction. The combination of that state law and the federal law is lining up a scenario that will represent much better access to care.”
Sen. Claire Ayer, D-Addison, is chairwoman of the Senate Health and Welfare Committee. Her panel has been coordinating health reform efforts in the state’s highest chamber.
“I’m very happy with the court’s decision,” Ayer said.
Still, Ayer stressed it would be important for supporters of the ACA and Vermont’s own reform effort to explain clearly how those measures will benefit citizens. That message, she said, has become muted amid well-financed lobbying efforts mounted by opponents of the law.
“There is so much misunderstanding about what’s required with an insurance mandate and the effects it would have on business, who is going to pay and who’s not going to pay, that I am seriously worried about money in politics,” Ayer said. “When I hear people who I know should be educated and knowledgeable make statements like, ‘They shouldn’t force poor people to buy insurance; they can’t afford it,’ they don’t understand the main thrust of this is that if you can’t afford to buy health insurance at your income level, we are going to limit you to a certain percent and we’ll pick up the rest.”
Ayer, Fisher and their respective committees will continue to move forward with the provisions of ACA and Vermont’s own health care model, called Green Mountain Health. Those efforts will include setting up a health care exchange from which people will purchase insurance from private carriers, overseeing the computerization of consumers’ medical records, and completing a health care financing plan by next year.
By Jan. 1, 2014, individual Vermonters and businesses of fewer than 50 employees will sign up for health coverage under state’s health care exchange, according to Fisher. Businesses of 50 to 100 will be brought into the exchange by January of 2016.
Plans call for all individuals and businesses to be brought into the fold by January 2017, excluding those that are self-insured, Fisher said. He noted 2017 is the same year during which Vermont will be able to apply to the feds for a waiver to pursue Green Mountain Health.
Porter Medical Center President Jim Daily said Addison County’s hospital is already working to meet state and federal requirements in health care.
“Regardless of what you think of the Affordable Care Act or Thursday’s ruling, the need and process for reforming our health care system is necessary, inevitable and already under way here in Vermont and elsewhere,” Daily said. “Here in Vermont, Porter and the other community hospitals in our state will continue to work with the Green Mountain Care Board on a variety of initiatives necessary to fulfill our mission and deliver quality health care services in new and better ways. Our work with the Blueprint for Health and our new Community Health Team are two concrete examples of the work that is already under way here in Addison County.”
Daily said work must continue to contain rising health care costs.
“As we review today’s ruling along with everyone else, Porter will continue to focus primarily on our mission and our patients — as well as our ongoing efforts to support necessary reform efforts,” Daily said.
All three members of Vermont’s Congressional delegation hailed the high court’s ruling.
“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,” said U.S. Sen. Patrick Leahy, D-Vt.
“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.”
Rep. Peter Welch, D-Vt., said the ruling allows the nation to make progress on what has been a perennial problem.
“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,” Welch said. “The Affordable Care Act will remain the law of the land.”
Sen. Bernie Sanders, I-Vt., said the court’s decision should encourage the nation to extend health care coverage beyond the level envisioned in the ACA.
“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,” Sanders said. “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.”
Gov. Peter Shumlin also applauded the court’s decision.
“What do we do in Vermont? We will press on to get health care spending under control so that we can grow jobs and economic opportunities,” he said.
Reporter John Flowers is at email@example.com.