By Michael Bielawski
A bill that would initiate a potentially massive expansion of Medicaid for the Green Mountain State has been brought forth by four majority party senators. According to its text, its proponents want it with or without federal money and they want a full expansion to cover all Vermonters.
“This bill proposes to provide Medicaid-equivalent coverage to all Vermonters by age bands over time, regardless of household income,” the text of S.1 states.The bill is sponsored by Sens. Rebecca White, D-Windsor, Martine Gulick, D-Chittenden Central, Sen. Anne Watson, D/P-Montpelier, and Sen. Tanya Vyhovsky, P/D-Chittenden-Central. It’s been referred to the Committee on Health and Welfare.
Under S 1, if the federal government won’t pay for Medicaid, Vermonters will foot the bill.
“It would direct the Agency of Human Services to seek approval for federal financial participation in the expanded coverage, with the State paying the full amount if the federal government does not approve the request,” it states.
For now, no formal estimate is given for what such an expansion in public medical services would entail.
“The bill would direct the Agency of Human Services and others to develop cost estimates for the Medicaid-equivalent coverage and a detailed implementation plan,” it states.
A payroll tax?
The bill notes they seek an estimate costs with and without a payroll tax. The payroll tax was created last session to subsidize child care. Opponents expressed concern it could be expanded to fund other needs and wants.
It states, “The bill would also require the Department of Taxes to report on potential payroll tax design options to support the State’s financial obligation in providing the Medicaid-equivalent coverage, both with and without the federal funding.”
“All Vermont residents shall be eligible”
The bill would incrementally phase in different age groups under Medicaid coverage. It would cover individuals up to age 26 beginning in 2029. Next, 2030 would include “individuals who are not less than 55 years of age and not more than the age of eligibility for the federal Medicare program.”
By 2031 those “not less than 45 years of age and not more than 54” would be included, and by 2032 those between 35 and 44. By 2033, “all Vermont residents shall be eligible for coverage.”
Global Commitment to Health waiver?
Another part of the bill suggests that existing Vermont law concerning eligibility for public healthcare needs to be modified.
It states, “On or before September 1, 2025, the Secretary of Human Services shall request approval from the Centers for Medicare and Medicaid Services to amend Vermont’s Global Commitment to Health Section 1115 Demonstration Waiver to make all Vermont residents eligible for hospital, medical, dental, and prescription drug coverage equivalent to coverage in the Vermont Medicaid state plan, regardless of income, as set forth in 33 V.S.A. § 1851.”
Again it is clarified that the public will pick up the bill if the federal government cannot.
“In the event that the Centers for Medicare and Medicaid Services does not approve Vermont’s request for federal financial participation in providing Medicaid-equivalent coverage to all Vermonters, regardless of income, the coverage shall be funded with State-only dollars,” it states.
Healthcare costs already strained?
Vermont’s healthcare costs are already under pressure as it faces the highest health insurance premiums in the nation and potentially daunting hospital infrastructure projects, with the potential closures of hospitals looming.
A report by KFF, a healthcare think tank, states, “Four consecutive years of rate increases led to a 15% increase in health insurance premiums since 2022. Residents of 42 states will see higher premiums in 2025 – driven by the rising cost of medical care around the country.”
Last session’s Medicaid expansion bill saw Planned Parenthood seek inclusion of abortion and transgender services. It is unclear whether the same request will be made this year.
The author is a writer for the Vermont Daily Chronicle