Lowering health care costs for Vermonters without breaking the bank

By DON TURNER
By Don Turner

While presidential candidates discuss Medicare-for-All and other proposed massive health care changes with multi-trillion-dollar price tags, Vermont has taken steps to reform its health care system without breaking the bank.

Over the last three years, we’ve passed a prescription drug importation bill, designed to provide Vermonters with access to more affordable drug options; expanded state telemedicine and telehealth protections; and moved forward with transitioning from fee-for-service to quality-based compensation for health care.

Yet, premiums continue to skyrocket for everyday Vermonters. We need to continue the discussion on common-sense reforms that will make health care more affordable, without imposing a huge price tag on taxpayers or creating another failed bureaucratic experiment like Vermont Health Connect.

In 2012, the Vermont Medical Malpractice Study Committee recommended four tort reforms, only two of which were implemented. The Legislature did not take action on assuring expert witnesses are qualified or revitalizing early full disclosure and resolution options, which the committee proposed. Considering that previous reports found that medical malpractice reforms could reduce insurance premiums by around 5.7% for Vermonters, these ideas should be reengaged by the Legislature.

Another opportunity to lower health insurance costs is by expanding so-called “Copper Plans,” otherwise known as catastrophic coverage. These plans have been proven to reduce premiums by double-digits, but are only available to certain Vermonters (those under 30 or those who can prove a qualifying hardship exemption). Vermont should work with federal regulators to get the necessary waiver and give all residents access to Copper Plans, which would provide Vermonters with a more affordable option for insurance.

Direct Primary Care (DPC) is another option that allows consumers to coordinate directly with providers for care, rather than going through insurance companies. This can lower costs by reducing the administrative burden that insurance companies inherently impose. It’s no surprise that more than half of all states have chosen to expand DPC, empowering consumers. We should follow their lead.

Vermont is one of just two states in the nation (the other being New York) that prohibits age-rating for health insurance. Currently, young Vermonters (namely, those under 40) heavily subsidize older Vermonters. This is partially how the concept of insurance works; healthy participants lower costs for less-healthy patients. But in Vermont, it’s way out of control. Unsubsidized premiums for Vermonters under 40 are higher in Vermont than all but five other states, and part of that is likely attributable to our unique ban on age-rating. At a time when young families are struggling to get their roots in Vermont, we should consider allowing limited age-rating (as the Scott Administration proposed last year) to give these families a break.

At the same time, we can still protect those with high medical expenses. Last year, Vermont partially restored the state income tax medical deduction in response to a tax change in 2018 that effectively eliminated these deductions. But we should take it a step further: all medical expenses should be deductible (rather than just those in excess of the standard deduction), providing those with high medical costs and seniors (who spend a great deal of their fixed incomes on health care) with much-needed relief.

Last year, the state took a huge step backwards by limiting the availability of Association Health Plans (AHPs). Currently, large corporations can take advantage of exemptions in federal law to more easily provide insurance to employees. AHPs allow small businesses to achieve the same outcomes by banding together across industries and regions to provide more-affordable health insurance to their employees. At a time when fewer and fewer small businesses can afford to offer their employees insurance, AHPs could empower these same businesses to provide up to four million Americans with access to health care by leveling the playing field between small and large businesses. Vermont should reverse course and allow small businesses to utilize AHPs.

There are a few pieces of pending legislation that could also be passed to make health care more affordable. We should implement the Governor’s proposal to provide tax credits to Vermont nursing graduates to get them to stay in Vermont, especially considering our medical-provider and nursing shortage. We should enact S. 309 , protecting Vermont consumers from bearing the full cost of surprise medical bills. We should pass H. 795, which would provide more health care pricing and charging transparency to patients. And while we’re at it, let’s give consumers the right incentives to shop for the best care by enacting so-called “right to shop” provisions.

Together, these reforms could lower costs, expand options, improve transparency, protect consumers, empower small businesses, and reduce the number of uninsured (and underinsured) Vermonters. Let’s jump on them and take action to provide real health care cost relief to Vermonters.

Don Turner is a former Republican state representative from Milton, former House minority leader, current Milton town manager and longtime member of the Milton Fire and Rescue departments. He was a candidate for lieutenant governor in 2018.