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Electronic Letters to:

John E. McDonough, Michael Miller, and Christine Barber, A Progress Report On State Health Access Reform, Health Affairs Web Exclusive, January 29, 2008 [Abstract] [PDF] [Reprints & Permissions]

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Electronic letters published:

Vermont Does Not Have An Employer Mandate

Jeanne Keller   ( 31 January 2008 )

Vermont Does Not Have An Employer Mandate 31 January 2008
Jeanne Keller, President Keller & Fuller, Inc Send letter to journal: Re: Vermont Does Not Have An Employer Mandate jkeller{at}keller-fuller.com Jeanne Keller	Contrary to what is stated in the article, Vermont does not have an employer mandate. And that explains why Vermont has, thus far, escaped ERISA challenges. Vermont assesses employers $91.25 per quarter ($365 per year) per "uncovered FTE." "Covered" is not the same as "Insured by the employer," however. As long as the employer offered to cover the employee with a plan that insures hospital and medical benefits, and the employer would have contributed any amount at all toward that plan, the employee is considered "covered" even if the employee does not accept the plan, as long as the employee has other insurance, such as through a spouse. The assessment is levied regardless of whether the "uncovered" employees are even eligible for, or are covered by, the new insurance subsidy plan, which is called Catamount Health. So "uncovered" employees aren't necessarily covered by the state, either. So it's not a mandate, because the employer isn't actually insuring all employees. And it isn't a "play or pay," either, because of the way it is structured (you can avoid both insuring and the assessment on employees covered under spouse plans), and the small amount assessed. The lack of an ERISA challenge was not a sign that the business community supported this plan, something implied in the article. The lack of a challenge is because this is neither a mandate nor a play-or-pay model. It's a tax to fund Medicaid expansion and insurance subsidies. And for me, at least, that means it's not health care reform, either. I'd be very interested in an in-depth review of state initiatives that actually reform health care, and not just provide financing for insurance. Is anyone out there getting a handle on hospital costs, the shocking variations in care that Wennberg and Fisher keep pointing out, the maldistribution of physicians, shortage of primary care providers including nurses, and oversupply of expensive high-tech care? Now THAT would be health care reform.