Just two small issues need to be resolved before the state gets to all systems go: First, it needs the federal government to grant waivers allowing Vermont to divert Medicaid and other health-care funding into the single-payer system. And second, Vermont needs to find some way to pay for it.
Although Act 48 required Vermont to create a single-payer system by 2017, the state hasn’t drafted a bill spelling out how to raise the additional $1.6 billion a year (based on the state’s estimate) the system needs. The state collected only $2.7 billion in tax revenue in fiscal year 2012, so that’s a vexingly large sum to scrape together…
Paying for this program would likely make Vermont the highest-taxed state in the nation, by quite a lot.
TRICARE, the health insurance program for active duty military and their families, has a well-deserved reputation for inadequate quality at an exorbitant public cost:
- A 2008 survey found that 96 percent of physicians accepted new commercially insured patients, 86 percent accepted new patients on Medicare, and 72 accepted new patients on Medicaid. By contrast, between 2008 and 2011, only 58 percent of civilian providers accepted new TRICARE patients.
- Premiums for enrollees have not risen in the 17 years since TRICARE’s inception in 1996. As a result, enrollment fees for TRICARE Prime recipients remain at $38 a month, about 12.5 percent of the average cost of comparable private insurance.
- From 2001 to 2011, general military health care spending grew twice as fast as the rise in the nation’s overall health care costs. The TRICARE program has largely contributed to this growth, tripling over the last decade. TRICARE spending now accounts for about 10 percent of the baseline defense budget.
A new Health Affairs study:
- Pre-ObamaCare, approximately half of low-income adults might have experienced a change of circumstances that caused churn between Medicaid and private coverage each year.
- Higher-income states and states that had more generous Medicaid eligibility criteria for nonelderly adults before the ACA experienced more churning.
- Under ObamaCare, more than 40 percent of adults likely to enroll in Medicaid or subsidized exchange coverage would experience a change in eligibility within twelve months.
Why is this important? Because people who are eligible for Medicaid are not allowed to get private, subsidized insurance in the exchange and vice versa.