Rutland Herald

By Peter Hirschfeld
Vermont Press Bureau
MONTPELIER — Health care advocates and Democratic politicians on Thursday cheered a Supreme Court decision that preserves the foundation on which Gov. Peter Shumlin plans to build the nation’s first single-payer health care system.

While he vowed earlier this week to proceed with a publicly funded, universal system regardless of how the country’s highest court ruled on the Affordable Care Act (ACA), Shumlin said Thursday that the federal subsidies included in Obamacare will ease Vermont’s transition to single payer.

“Let’s hear it for the U.S. Supreme Court!” Shumlin said to large crowd of single-payer supporters gathered inside the Pavilion Building in Montpelier. “I can’t tell you how excited I am to see the energy in this room, to see people who waited so long and worked so hard to get us to point we’ve gotten. And all I can say is, we’re just warming up.”

As Shumlin took a victory lap around Montpelier, his Republican opponent in the 2012 gubernatorial race tried to use the court ruling to foment opposition to single payer.

Speaking outside an insurance-industry sponsored health forum, Randy Brock called Shumlin’s health care agenda a dangerous blunder.

“Federal dollars can now temporarily plug the huge holes the governor’s plan will generate in Vermont’s budget,” Brock said. “Let’s be frank about this: Titanicare is doomed to sink and take all of us with it. It’s just going to sink a teeny bit slower with this subsidy.”

Brock said in a phone interview that the Supreme Court ruling will only exacerbate voter unease over Titaniccare — his term for single payer. He said he’ll soon unveil an alternative plan that relies on free-market competition, not government intervention, to contain skyrocketing health care costs.

“For those who were not enthusiastic about the ACA and perhaps less enthusiastic about where Vermont is going, this Supreme Court decision probably energizes a lot of voters because their only recourse now is in November,” Brock said.

Shumlin said he’s happy to turn the November election into a referendum on single payer. The Democratic incumbent made health care reform the keystone of his 2010 campaign platform, and he told advocates Thursday that it remains at the top of his list in 2012.

Polls indicate that a plurality of Vermonters favor the single-payer concept.

“Single payer has been my top priority and I can assure you that nothing will make me waver from my commitment to deliver on single payer for Vermont as quickly as I know how,” he told advocates. “You’re picking the wrong horse if you think I’m going to be a leader that settles for half a loaf.”

Minutes later, Shumlin told a group of reporters that he’ll abandon his single-payer plan if he comes to believe it won’t contain costs.

“I will bail on reform if reform doesn’t work,” Shumlin said. “My promise is if we can’t design a delivery system that reduces costs … then there is obviously no sense in going forward.”

Robin Lunge, director of health care reform for the Shumlin administration, said she wasn’t as invested in the outcome of Thursday’s ruling as Vermonters might expect.

“I’ve been saying for awhile that we’re going to be doing pretty much the same thing no matter what happens,” she said.

Lunge said the loss of the federal subsidies — Vermont is expected to draw down up to $400 million annually beginning in 2014 to help low-income residents pay for insurance — would have required some adjusting.”

Lunge added, “It would have made our cost-containment efforts that much more vital, because we wouldn’t have the federal law to assist us in paying for care.”

Helpful as the federal money will be, she said the ACA also delays the implementation of single payer. That’s because the federal law bars Vermont from seeking the waivers it needs to proceed with single payer until 2017.

“Without it, we’d move toward single payer more quickly,” Lunge said.

John Franco, a Burlington lawyer who helped the administration craft its single-payer law in 2011, said the logic used by Supreme Court Justice John Roberts to uphold the individual mandate bodes well for Vermont.

“It is precisely because the individual mandate is equivalent to a tax that Justice Roberts ruled with the majority,” Franco said. “And that is the core concept of single payer — that it is a tax-financed system. What Roberts says means single payer is immune to all the constitutional attacks we’ve seen lobbed at the ACA, and that we likely would have seen lobbed at single payer in Vermont.”

Jeff Wennberg, executive director of Vermonters for Health Care Freedom, said now that federal funding is secure and single payer remains on course, Shumlin owes it to Vermonters to tell them how he’s going to finance the publicly funded system.

“We once again call upon Governor Shumlin to release his budget and financing plan for Green Mountain Care before the fall elections,” Wennberg said.

Vermont’s single-payer statute doesn’t require the Shumlin administration to propose a financing plan until January 2013. But on Thursday, Shumlin raised new doubts about whether he’d meet that deadline.

Asked whether his administration would present a financing plan before the end of the 2013 legislative session, Shumlin said, “I don’t know yet.”

“The first challenge is to define a system that makes sense,” the governor said. “The minute we think we’ve got that figured out, we can easily figure out how to pay for it.”