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Sen. Vychovsky presents S.1 to phase in Medicaid-style, state-run health coverage
Summary
At a Senate Health and Welfare committee meeting, Sen. Vychovsky described S.1, a bill that would phase in a Medicaid-equivalent, state-run health program over time beginning with people under 25 and those approaching Medicare age, and asked the committee to consider funding options and federal waivers.
Sen. Vychovsky, sponsor of S.1, told the Senate Health and Welfare committee that her bill proposes a phased path to realizing “health care as a public good,” beginning with people under age 25 and people aged 55 up to Medicare age and gradually expanding coverage until everyone is included.
The bill, Vychovsky said, would use the state’s existing comprehensive health programs as the template and seeks federal waivers and studies to implement the changes. “Back in 2011, [the Legislature] passed Act 48, standing up health care as a public good. But we have not yet realized that,” she said. “S.1 is a proposal for a path forward to realizing healthcare as a public good.”
Vychovsky described S.1 as creating “a Medicaid-equivalent program” administered at the state level. In its initial phase the bill would “bridal in” — that is, bring into the program — everyone under 25 and everyone from age 55 up to Medicare eligibility, then “come to meet in the middle until everyone was covered,” she said. The bill includes provisions to seek federal waivers and requires multiple studies; Vychovsky acknowledged the waivers could be difficult to obtain.
If federal waivers are unavailable, the bill includes language to allow state-only alternatives modeled on prior programs for migrant workers that provided comparable benefits without relying on federal funding. On funding, Vychovsky said the bill lists options to consider, including attempting to secure federal matching funds through waivers and exploring a payroll tax. She argued doing nothing has costs for Vermonters: “given that many Vermonters are paying 10, 15, sometimes 20% of their incomes towards health care, we could also look at what a potential payroll tax might be, and see if that would be less than largely what people are paying now.”
Committee members said the concept has been on the table before. A committee member noted the Equity Working Group also has considered similar ideas. Vychovsky said the Senate has two years of the biennium to continue work on the issue and that the committee may return with a separate committee bill aimed at lowering health-care costs.
No formal action or vote on S.1 occurred during this meeting; committee members agreed to hear the bill and ask questions before making a decision about how to proceed.
Next steps: committee review and more detailed consideration of the bill’s funding mechanisms, required federal waivers, and any studies specified by the bill. The committee may draft a committee bill addressing health-care costs during the current biennium.
