MONTPELIER, Vt. (AP) -- Business lobbyists are turning up the heat on the administration of Vermont Gov. Peter Shumlin to detail the costs of the governor's ambitious health insurance plan, now that three possible benefit packages have been made public.
"You should be as transparent as you can so that we can understand the changes that may be coming," said Jim Harrison, president of the 600-member Vermont Grocers' Association. "Give people some estimates now."
Meanwhile, a House committee voted Thursday to support a bill to begin implementing the health care agenda passed in broad outline last year. It still must be voted on by the full House and then the Senate.
Much of the measure advanced Thursday seeks to implement the federal health law passed in 2010. The state plan passed last year calls for Vermont to go well beyond where the federal law stopped. The federal law calls for states to set up new health insurance marketplaces or "exchanges," designed to give consumers more information about coverage levels and costs as companies and individuals shop for insurance.
The bill approved by the House Health Care Committee would require that all Vermont individual health insurance subscribers and all employers with 50 or fewer employees get insurance through the exchange. Those smaller employers would not be required to offer insurance to their workers. The requirement would take effect in January 2014.
Rep. Mike Fisher, chairman of the House Health Care Committee, said the federal law requires companies with more than 50 workers to offer health insurance; those that don't face penalties.
For companies with 50 or fewer workers, he said, some might conclude it makes more sense to let them buy insurance as individuals because the federal law will allow many to take advantage of generous tax credits or subsidies.
Vermont is first planning to set up the exchange under federal law and then use that as the backbone for a unified health financing system, to be in place by 2017. It would include as many Vermonters as possible under a single insurance umbrella. Certain people, such as federal employees, would be exempt.
As envisioned in last year's legislation, the new system, called Green Mountain Care, would:
— Streamline health insurance claims, funneling them through a "single-payer" system.
— Move away from traditional "fee-for-service" payments for doctors and other providers, in which the more times they do a procedure, the more they get paid. That would be replaced with a system in which providers would get a set budget for providing a certain range of health services to a certain population of patients.
— Get the health care system to focus more on preventive care and management of chronic diseases to reduce the number of crises that result in expensive trips to the hospital.
The Shumlin administration has been resisting pressure for months from critics of its proposals to say before the elections this November what it expects the Green Mountain Care system will cost and what taxes will be raised or premiums charged to pay for it. Aides to the governor say they won't be able to flesh out a financing mechanism before next winter, after the election.
Earlier this week, Robin Lunge, Shumlin's director of the health care overhaul, identified three finalists for benefit packages. A selection will be made next month.
But she was quick to caution that the benefits being chosen now will be in effect only while the state is operating under the federally mandated exchange from 2014 through 2016. Design of the Green Mountain Care benefit package — the one slated to take effect in 2017 — is still to come, she said.
Craig Fuller, managing director of the Vermont Employers' Health Alliance, recently released data he said he had received from the private insurance industry showing what plans like those described by Lunge cost today. Individual coverage from the three top insurers in the state ranged from $4,839 to $7,068 a year; family plans ranged from $12,581 to $19,738.
"I think there's enough information out there where you could do some very interesting modeling, where you could cost things out" and estimate what the cost of Green Mountain Care will be, Fuller said. He said the reluctance to do so by the administration until after the election is based on a political calculation.
"We've been very careful about when we want to talk about what it is and how much it will cost," he said.
But Lunge and Stephen Kimbell, commissioner of the state department that regulates insurance and helps regulate health care, said there were too many unknowns to produce any reliable estimates right now. Among them are what the full effect of federal subsidies will be and what savings might be achieved from streamlining payments and changing the way providers are paid.
"You know what the biggest problem is?" Kimbell asked. "This is about a 10-year process, and we've got a two-year political cycle. It just doesn't fit the cycle."
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