The decision by Gov. Peter Shumlin to abandon a single payer health care system is having an unexpected impact on Vermont's larger businesses. And lawmakers will now have to make decisions that Vermont's health care law never anticipated.
When lawmakers passed Act 48 back in 2011, the legislation laid out a timeline for businesses with fewer than 100 employees to purchase their policies on Vermont Health Connect.
But one group was never subject to the mandate: companies that have more than 100 employees, the so-called “Large Group Market.”
These larger businesses were allowed to purchase their coverage outside of the exchange until 2017 – that's when Act 48 assumed that Vermont would transition to a single-payer system.
Now the question is, what should happen to these companies? Should they be subject to the same rules and regulations that smaller businesses have to comply with?
Al Gobeille, the chairman of the Green Mountain Care Board – a group that oversees virtually all aspects of health care in Vermont – says he’s going to ask lawmakers to ensure these companies can conduct business as usual until 2018 at the earliest.
"I think it's important to take a look at this population and say, ‘What are the ups and what are the downs and do we want to do this?’ Because the analysis is not done, and I think it has to be done before we just do something,” Gobeille says.
Gobeille says requiring these larger businesses to enter the exchange could subject them to new insurance mandates. And he says those new mandates could put upward pressure on insurance costs.
"If they move into the exchange, so to speak, then they have to have the Affordable Care Act's Essential health benefit, they have to be community rated,” he says. “So these are real people and this will have a real impact and we should know exactly, to the best of our ability, what's going to happen."
Gobeille is urging lawmakers to deal with this issue before they adjourn for the year.