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Tom Scull Explains Local Healthcare Reform

After 22 years as a student of health care in various roles its' never been more interesting to participate and contribute in needed changes as we venture into a very different looking framework under both Act 48, An Act Relating to a Universal and Unified Health System, in Vermont, and under The Patients Protection and Affordable Care Act (PPACA, or my least favorite description, "Obamacare").

For both individuals and employers, health insurance as we know it today will change dramatically and whether or not you are offering insurance now, you will need to make a decision on your level of participation in the very near future. In an attempt to equalize everyone's contribution into the system, 2014 will mandate everyone to carry health insurance. The PPACA mandate to have health insurance comes with eligible cost-sharing subsidies to help pay for insurance premium on what will be known as Health Care Exchanges. These subsidies will be similar to programs we have today in Vermont such as Catamount Health and Dr. Dynasaur. In face Household income eligibility for a family of four to receive subsidies under the PPACA Health Care Exchange can be as much as $88,200 and for an individual it caries in amounts up to $43,430. Small business (defined as those with less than 50 employees) and individuals will likely utilize the Exchange for health insurance while businesses with greater than 50 employees will be penalized if their employees use the Exchange, at least until 2017. In order to avoid penalties, large employers will be required to offer all their full-time employees equivalent coverage and cost similar to what is offered on the Exchange plans.

While 26 states pursue the unconstitutionality of the 2014 health insurance mandate and many of those same states and others balk at building their Exchange, Vermont has chosen a very different path. In Vermont, our Governor signed into law Act 48, a framework that will allow for our Exchange to be built in a  way as to transform itself into our country's first single payer universal health care plan called Green Mountain Care. You will read varying views on Green Mountain Care that will be politically charged. In fact get ready for a double header because we will witness first a debate surrounding how hospitals and providers should be paid followed shortly by how the entire Vermont health care system will be funded. In the end we will eventually come to grips with change of some sort and while there is no disputing the problem; health care cost inflation simple cannot continue at past levels, it will be a very interesting journey.

I would urge you to stay informed, learn, participate and help shape the outcome of what these two frameworks ultimately provide. My team and I are deeply engaged locally and have a very good understanding of both the Acts that have been signed into law. As a local business, this is a resource you are welcome to visit.

Tom Scull is a Vice President at The Richards Group and manages our Employee Benefits division. With 25+ years of experience in the Employee Benefits Industry, Tom is respected as a thought-leader when it comes to employee benefits in Northern New England.