What Do Vermonters Think About Green Mountain Care?
Vermont’s unexpected election results have led to a lot of speculation among Vermonters and in the media. Many have asked whether this election should be interpreted as a reflection on Green Mountain Care, Vermont’s proposed universal, publicly financed, single payer health care system. My response to this is: Yes. The election results suggest we should move forward.
It’s no secret that the implementation of Vermont Health Connect, our execution of the federal Affordable Care Act (ACA) – sometimes called Obamacare, has been problematic and troubling to many people. The election is very likely, at least in part, a reflection of people’s dissatisfaction with the rollout of Vermont Health Connect. But that dissatisfaction does not include Act 48, the legislation that established our intent to enact Green Mountain Care, the first universal, publicly financed healthcare system in the country. On the contrary - the legislature, the administration, and the advocacy community should feel encouraged, if not compelled to redouble efforts to move forward with Act 48 and Green Mountain Care.
Moving forward with Green Mountain Care is our way and the best way to move beyond Vermont Health Connect and the ACA and actually improve healthcare. Specifically, implementing Green Mountain Care: a true universal, publicly financed healthcare system, promises to decouple healthcare from employment, decrease administrative overhead, lower cost to consumers, improve access to healthcare, and improve health outcomes.
Main Street Alliance has spent the past four months traveling around the state and speaking one-on-one with hundreds of small, main street business owners about some of the issues facing Vermont, including healthcare. In these conversations, we’ve learned that there is a lot of confusion and uncertainty about Vermont’s efforts to reform healthcare in the context of the existing and federally mandated Affordable Care Act.
There’s been a lot of healthcare reform lately – so much that keeping it all straight is a legitimate challenge. But one thing is clear to us based on hundreds of conversations: proponents of universal, publicly financed healthcare need to effectively communicate with Vermonters about the difference between the ACA and Green Mountain Care. Most importantly, we need to make it clear that Green Mountain Care will move us out of Vermont Health Connect and the ACA and into a system that will be much more akin to providing Catamount or Dr. Dynasaur for all Vermonters, that it will take private insurers out of the equation, decouple healthcare from employment, and be paid for through a progressive tax that will replace premiums. Green Mountain Care is a Vermont healthcare system that will include and cover all Vermonters just because they’re Vermonters.
In our conversations, we’ve found that the majority of small business owners (most of whom are not currently providing healthcare to their employees), are supportive of the idea of a universal, publicly financed healthcare system. Of course, they’re eager to see the financing plan and the benefits package, as we all are, to be able to assess the administration’s specific proposal. But the support for the concept – the support to apply for a waiver to the ACA and to move forward with a universal, VERMONT plan that takes private insurers out of the system - is resounding. As one small business owner from Windham county said: “I’d love to see healthcare come from the state; small businesses can’t afford to offer it.”
Please visit our website to see the list of businesses that have formed a working coalition to support moving forward with universal, publicly financed healthcare in a responsible way. A full report on Main Street Alliance of Vermont’s 2014 Small Business Policy Project will be released in December.
This article was written by Lindsay DesLauriers, State Director at Main Street Alliance of Vermont and resident of Huntington. It was originally published in VT Digger and subsequently in the Barre Montpelier Times Argus.
Main Street Alliance of Vermont is happy to announce that we have joined with five other organizations to form the new Green Mountain Care Coalition. Each organization in the coalition independently supports Vermont in moving forward with Act 48, the legislation that established Vermont’s intent to enact Green Mountain Care, the first universal, publicly financed healthcare system in the country. Together, we support a healthcare system that is decoupled from employment, that will lower cost to consumers, improve access to healthcare and improve health outcomes for Vermonters.
Is Vermont delivering on the promise of quality, affordable health care for women?
Families depend on both men and women to make ends meet. Women across Vermont are leading households and supporting families. It’s critical to make sure that all women are getting the health care they need to lead healthy, prosperous lives. As the World Bank says: Gender equality is smart economics.
The 2014 Women’s Health Report Card for Vermont underscores that we have a lot to be proud of — Vermont continues to lead the nation in women’s health. In the report card, Vermont was ranked No. 3 and earned a final grade of A. This report ranked all 50 states on 30 measures of women’s health, including coverage, access to care and health outcomes.
I was pleased to see this glowing grade as more evidence that Vermont is on the right track and is a leader in health care. However, I also took this opportunity to educate myself on Green Mountain Care — the next step in Vermont’s health care leadership. I’ll admit that I knew very little about the universal, publicly funded health care system outlined in Act 48. This is something to which the state of Vermont has already committed, and now I can comfortably say that I support this path forward and urge others to get educated.
So what is Vermont doing right? The positive strides of the Affordable Care Act expanded health coverage to more women through the new health insurance marketplaces and through Medicaid, improved coverage of preventive care, created stronger oversight of insurance rates, and increased quality improvement initiatives.
But can Vermont be doing better? Yes. There is room for improvement to ensure that all women in Vermont have access to the health care they need to lead healthy and prosperous lives — especially women of color. Our great report card cannot erase the truth that women of color in Vermont are still less likely to have health coverage, access to health care, and have poorer health.
Looking at the measures of women’s health by race, 6.1 percent of white women in Vermont report being uninsured. That percentage rises to 8.4 percent for black women and then jumps to 17.3 percent of Latinas. Additionally, 11.7 percent of elderly women earning less than 138 percent of the federal poverty level are uninsured along with 9 percent of those between 138 percent and 400 percent of the poverty level. These upsetting disparities will be erased if Vermont moves to Green Mountain Care in 2017. All Vermonters will have health insurance, just by virtue of being a Vermonter.
Vermont has a special opportunity to achieve the equality that is missing here and throughout the nation. There are many leaders working to balance the financing of this system; to translate the dollars we are already spending on health care into an equitable, universal system. This is enormously complicated, and the devil will truly be in the details. While not increasing the burden on individual Vermonters and Vermont businesses, we need all of our state leaders to side with women and communities of color to make their health a priority — to give our mothers, sisters and daughters full and fair opportunities that begin with quality, affordable health care.
Please join me in supporting our legislators’ commitment to work with the administration to finance Green Mountain Care. And let’s make an example of our state with a true system that is fairly financed, does not harm economic growth and achieves the equality we all deserve.
Stephanie Hainley is Chief Operating Officer at White and Burke Real Estate Investment Advisors in Burlington. She a founding board member at Main Street Alliance of Vermont and is past president of Burlington Business & Professional Women. This op-ed was originally published at the Barre Montpelier Times Argus and subsequently in the Burlington Free Press.
Women and working family issues addressed in new State of Main Street report
Portland, OR - This morning, Main Street Alliance of Oregon leaders, Deborah Field, co-owner of Paperjam Press, and Sara Howe and Christy Cushing, co-owners of Howe Innovative Design, met with Congresswoman Suzanne Bonamici to release the new survey report, State of Main Street. This report challenges conventional perceptions of small business owners’ thoughts on key policy issues. It details responding business owners’ views on key issues facing Oregon and the nation.Sara Howe, Christy Cushing, Deborah Field, Congresswoman Suzanne Bonamici, Stephen Michael, and Sean Place. Photo credit: Kristin Rasmussen, Dist. Rep for Suzanne Bonamici (left to right)
Oregon small business owners are supportive of giving Oregon working families a fair shot—real opportunities to succeed and prosper with policies like basic standards for paid sick days as well as safe, secure, and effective retirement savings vehicles for small business owners and their employees. Women small business owners and business owners of color are particularly supportive of these policies. There is a clear call from the small business community that it’s time to rethink the “business as usual” agendas promoted by Big Business and special interest groups. We need to move towards understanding the whole picture of how our businesses interact with the communities we serve.
“Small businesses are a critical part of Oregon’s economy, especially in rural areas. Policies that support small businesses help create economic security and stability for working Oregonians. These policies include access to capital for those who want to start a new business, quality education, stable housing, and affordable health care,” Congresswoman Suzanne Bonamici said. “When families earn a living wage, can take paid leave, and do not struggle to pay for child care, they are more likely to succeed and thrive. The Main Street Alliance report recognizes that these policies are good for small businesses because they lead to healthier families, a stronger local work force, increased consumer spending, and ultimately a stronger local economy.”
“As we continue to recover from this recession, I am committed to helping small businesses remain competitive in today’s market,” said Congressman Earl Blumenauer. “This report, issued by The Main Street Alliance of Oregon, clearly outlines some of the challenges that remain. While I’m concerned the benefits of our economic recovery aren’t being broadly felt, it’s encouraging to know Oregon’s small businesses feel as strongly as I do about the importance of affordable, quality healthcare, reforming our broken immigration system, and ensuring fair and equitable access to credit.”Sara Howe addresses Congresswoman Bonamici on issues impacting her small web, social media and marketing firm.
The Main Street Alliance of Oregon hopes lawmakers, the media and other decision makers will look closely at the results of this survey in planning public policy. We encourage them to listen and respond to the true voices of Main Street.
Main Street Alliance, a national network of state and locally based small business coalitions, announced this week that they are affiliating a state project in Vermont under the leadership of Lindsay DesLauriers.
“We are thrilled to begin working with businesses in Vermont where so many exciting things are on the horizon,” said Main Street Alliance’s national Director, Amanda Ballantyne. “We worked with businesses in support of the Affordable Care Act and we are looking forward to helping elevate the strong support among small business owners in Vermont for Universal Health Care, among other issues.”
The group’s founding members include Liza Cain and Randy George, co-owners of Red Hen Bakery; Melinda Moulton, CEO of Main Street Landing; Trudy Trombley, owner of the Boutique at Stowe Mercantile; Stephanie Hainley, COO at White and Burke Real Estate Investment Advisors and former President of the Burlington Chapter of Business and Professional Women (BPW), and Wayne Nelson, partner at L.N. Consulting. They issued a joint statement saying, “We are excited to welcome Main Street Alliance to Vermont and to help elevate the voice of Vermont’s small businesses. We know that when we support our communities, we support our community businesses and we’re looking forward to making it easier for small businesses to join in these conversations in Montpelier.”
DesLauriers, comes to this role fresh from the 2014 Paid Sick Days Campaign, where she was the Campaign’s Director, employed by Voices for Vermont’s Children. “I’m so happy that I’ll be able to continue to work with the Earned Sick Days Coalition and local business owners to advocate for a standard of paid time in Vermont,” DesLauriers said. “As the Campaign Director for Paid Sick Days, it was my goal to address Vermonters’ real need for a standard of paid time in a way that makes sense for businesses and honors their leadership in policy development. We made a lot of progress last year and we’ll continue to work toward this goal in 2015.”
Main Street Alliance small business members have helped develop, support, and implement economy-boosting paid sick days laws in Seattle, Washington; Portland and Eugene, Oregon; Newark and Jersey City, New Jersey; and New York City.
Personally, DesLauriers grew up working and skiing at Bolton Valley Resort, which was owned and operated by her family until 1997. With both family and professional ties to the business community and the hospitality industry, DesLauriers describes herself as uniquely sympathetic to the challenges and responsibilities borne by small and mid-size businesses in Vermont. “Main Street Alliance is a great fit because both I and the organization as a whole are committed to the core values that will that will support and grow local businesses by supporting and building a robust economy for all Vermonters.”
Main Street Alliance creates opportunities for small business owners to speak for themselves to advance public policies that are good for small businesses, their employees, and the communities they serve. Vermont will be the 12th state affiliate.
As part of our founding work, the Vermont Main Street Alliance Outreach Team has been traveling across the state this summer speaking to hundreds of small business owners about a variety of statewide policies. The small business owners we’ve met have helped us to understand their concerns, they’ve shared their ideas, and they've shown tremendous support for a number of issues that we know will be addressed in the upcoming legislative session – including overwhelming support for the implementation of a universal, publicly-financed healthcare system in Vermont.
The owners we spoke to have shared that a universal healthcare system would remove a cost-burden from employers that many of them simply cannot afford. Even those who are providing insurance still struggle with the knowledge that, under the current system, many of their employees often can’t afford the co-pays and high premiums.
Additionally, many of the small business owners we’ve met have shared that the lack of affordable, high-quality childcare in Vermont has made it difficult to retain employees. They are keenly aware of how hard it is for Vermonters - owners and employees alike – to manage the demands of work with small children to care for. In some areas of our state, it is just plain hard to find reliable, high-quality childcare; where it is available, it’s hard to afford. We are learning that this is much more than an issue impacting low-income working families: the challenges posed by accessing childcare and the need to improve quality impact all of our families – owners and employees alike. Many of the businesses have even signed a statement of support for the efforts of Let’s Grow Kids, a public education campaign focused on the importance of early childhood.
But one of the most interesting and validating themes that has come up unsolicited again and again is that our main street business owners aren’t feeling represented by the larger business chambers – often both at the regional and state level. There is a feeling shared by many that the traditional chambers prioritize the interests of larger businesses, not always understanding the implications of how truly tied to the community locally owned small businesses are. The Vermont Main Street Alliance outreach team has been working hard to make these connections with real Vermont small business owners to help ensure that the voices and interests of small businesses are heard and represented.
Burying the Lead: What the NFIB Obamacare study really tells us about the Affordable Care Act and small business
Small businesses plan to increase health care offering next year, breaking a decade-old trend
The NFIB has made no secret of their distaste for the Affordable Care Act. After all, the right-wing small business lobbying group was a lead plaintiff in the failed lawsuit overturn the health care law.
So, when the NFIB last month released the first report in a planned series of three annual reports based on a longitudinal survey of small employers designed to measure “actual changes associated with the introduction of the Affordable Care Act,” it was not surprising that they did so with a decidedly negative media spin: “Small-Business Healthcare Survey Reveals Reality of Painful Premium Increases.”
However, buried in the 56-page report are findings that tell a remarkably different story about how the Affordable Care Act is helping small businesses and their employees access quality, affordable health care.
“Breaking a decade-old trend:” Small businesses plan to increase insurance offerings next year.
Buried on page 26 of the NFIB’s report, is perhaps its most important finding: an increasing share of small business owners plan to offer insurance coverage next year.
According to the NFIB’s report, “The number of small businesses offering employee health insurance fell from last year to this, another in a long series of declines. The size of the decline is modest. However, small employers expect that trend to change this year. More plan to introduce the benefit than drop it. … If small employers follow those plans, the net proportion of them offering would rise, breaking a decade-old trend.”
The NFIB is correct to point to the trend of declining small business health insurance offerings. Kaiser Family Foundation’s 2013 Annual Employer Health Benefits Survey reports that 57 percent of small firms (3-199 workers) offered health insurance in 2013 compared to 65 percent in 2003, an 8 percent decline. Using somewhat different methodology, a 2013 Robert Wood Johnson Foundation report found a 9.7 percent decline in insurance offerings from small employers (under 50 employees) from 1999/2000 (47.2 percent) to 2010/2011 (37.5 percent).
Forty-six (46) percent of the small employer respondents (2-99 employees) to NFIB’s survey reported offering insurance in 2013, down from 48 percent the previous year, following the historical trend. However, when asked about their plans for next year, 48 percent planned to offer, reversing the trend with a two percent increase.
The fact that small business owners have increased optimism about offering health insurance next year is a big deal. If small employers follow through on those plans, it would be cause for celebration.
Perhaps because the headline “small businesses plan to increase insurance offerings next year” does not align with the NFIB’s political agenda, this significant finding is buried on page 26 of the report and receives no mention in the organization’s press release. [i]
Change in Insurance Costs: NFIB ignores evidence of premium moderation, hypes premium hikes
The NFIB’s report offers a misleading analysis of changes in insurance costs due to flawed survey methodology, while ignoring evidence of premium moderation.
The NFIB survey asked small employers who offer insurance whether the per-employee cost of their current health plan was more (64 percent), less (6 percent), or about the same (29 percent) as in previous years (Q#41). Respondents were then asked to estimate the per employee percentage change in the cost of this year’s plan to the previous year’s plan, however this follow-up question appears to only have been asked for employers who witnessed price increases (Q#51).
In analyzing survey results, NFIB writes “The median price increase, incorporating in the calculation those with increased, stable, and lower prices, was about 6 percent, though the average increase was closer to 12 percent.” It is impossible for NFIB to have made a calculation for the average change in price because they did not ask respondents experiencing price decreases to estimate the amount of those declines.
Kaiser Family Foundation’s Annual Employer Health Benefits Survey offers a more reliable indicator of changes in small employers’ health insurance premium costs. Reporting on the 2013 Kaiser survey, a Bloomberg headline read “employer health premiums slow for the second straight year.” Drew Altman, the foundation’s president, said “we are in a prolonged period of moderation in premiums, which should create some breathing room for the private sector to try to reduce costs without cutting back benefits.”Source: Main Street Alliance analysis of Kaiser Family Foundation's Annual Employer Health Benefits Survey, 2013.
Main Street Alliance analysis of the Kaiser survey data reveals that in 2013, small employers (3-199 employees) experienced the lowest price increase for family coverage ever recorded in the 15 years Kaiser has conducted the survey. In 2013, annual premiums for covered workers with family coverage in small firms increased only 2.2 percent, compared to an average annual increase of 7.5 percent over the last 15 years.
A lead investigator for the Kaiser study told Bloomberg that, while the health law had contributed to the 2013 slowdown in premium increases, the economy likely played a key role. By contrast, the NFIB used the release of their study to pin the blame for premium increases, a decades-old trend, squarely on the Affordable Care Act, telling Bloomberg Businessweek that the health law was “raising costs for smaller firms.” When pressed, NFIB researcher William Dennis conceded “how much is due just to rising costs normally and how much is due to the ACA, I couldn’t untangle that.”
Furthermore, the NFIB study design minimizes or ignores investigation into how the law’s provisions are improving affordability for small businesses beyond premiums. The NFIB survey did not ask all respondents who offer insurance whether they took advantage of the Affordable Care Act’s small business tax credit, which next year is worth up to 50 percent of small employers’ costs for insuring their employees. Instead, they only asked business owners who had experienced price increases whether they had taken the tax credit “in order to pay for the increase” (Q#50). Seventeen (17) percent of those experiencing price increases reported taking the tax credit, however the NFIB did not ask them to quantify how much the tax credit had saved their firms.
Similarly, the NFIB did not ask whether responding small employers had received rebate checks from their insurance companies which are required when insurers fail to spend at least 80 percent of premium dollars on health care. Insurers who violate the health law’s 80/20 rule designed to penalize insurers for wasteful spending have already been required to issue rebates worth more than $1 billion to consumers and small businesses.
In releasing its report, NFIB hyped a narrative about rising premiums, while ignoring evidence of premium moderation and Affordable Care Act provisions that lower costs for small businesses.
Employer Responsibility: Small businesses are not limiting growth or cutting employee hours due to the Affordable Care Act
Critics of the Affordable Care Act, including the NFIB, have frequently predicted that the law’s employer responsibility provision would lead businesses to limit the size of their firms to under 50 FTEs or to reduce employees’ hours in order to avoid employer responsibility assessments. However, the NFIB survey struggles to find evidence that validates these claims.
The NFIB survey specifically asked employers whether they were considering either reducing employment or reducing employee hours in response to the health care law. Thirteen percent respondents answered affirmatively on each question. However, in a surprisingly candid analysis, the NFIB reports that “both contraction and planned reduction in employee hours appear highly related to business profitability” rather than whether the employer would face requirements under the Affordable Care Act.
Last month, the Wall Street Journal analyzed Department of Labor data and found “little evidence for the notion that the health law is driving a shift to part-time work.”
In struggling to find evidence of businesses contracting or reducing employment due the Affordable Care, the NFIB’s study throws cold water on their own claims.
Buried in the NFIB’s study on the Affordable Care Act is evidence that the law is working and opponents’ doomsday predictions are unfounded. Small employers plan to increase health insurance offering next year, breaking a decade old trend. There is mounting evidence of premium moderation for small businesses, and the Affordable Care Act is helping lower small business health care costs through tax credits and insurance rebates. Despite the predictions of opponents, there is little evidence that the health law is causing firms to downsize or driving a shift towards part-time work.
The rollout of the health care law has been rocky. Full online functionality of the health insurance marketplace has been delayed for small businesses, and the website has been mired in technical glitches. These problems need to be fixed. Nevertheless, the Affordable Care Act still holds enormous promise that a reformed marketplace with help small business owners access quality, affordable health care.
[i]Sean Vitka at Slate noted NFIB’s omission of positive news in their press materials, while giving NFIB appropriate credit for publishing the results, writing “in today’s climate, we should all be happy that NFIB has the integrity to release surveys that don’t back up their own case, and honestly answer questions that undermine their political leanings—even if their PR department hasn’t gotten the memo.” Bloomberg View columnist, Megan McArdle, meanwhile questioned whether the NFIB’s survey actually showed the results they reported, apparently not realizing that the survey results were weighted based on a stratified random sample (see methodology on page 31).
As part of National Small Business Week (June 17-21), small business owners from across the Main Street Alliance network are speaking out on the top issues facing the nation.
Each day during Small Business Week, we're releasing a new "Straight Talk on Main Street" issue fact sheet providing unique small business perspective and analysis, on the following schedule:
- Monday - IMMIGRATION REFORM: Immigration reform with a roadmap to citizenship strengthens consumer demand, boosts economy
- Tuesday - TAX FAIRNESS: Ending offshore tax dodging will level playing field for small business
- Wednesday - HEALTH CARE: Small business owners preparing for full implementation of health care reform
- Thursday - ECONOMY-BOOSTING JOBS: Small business engagement critical to growing momentum on Paid Sick Days
- Friday - MONEY IN POLITICS: Small businesses seek greater disclosure of secret political spending by corporations and trade associations
While corporate CEOs are pressuring Congress to cut Social Security and Medicare as part of a so-called "Grand Bargain" to reduce the debt, small business owners say that cuts to Social Security and Medicare would be devastating to small businesses across the country.
A new series of reports from the Main Street Alliance and Social Security Works, Business is (Baby) Booming, analyze the important role Social Security and Medicare play in both strengthening the retirement security of small business owners themselves, and fueling consumer demand on Main Street in all 50 states and the District of Columbia.
Instead of cutting Social Security and Medicare, small business owners say Congress should crack down on offshore tax abuse that allows the wealthy and corporations to avoid more than $100 billion in U.S. taxes per year by sheltering their income offshore.
State "Business is (Baby) Booming" Reports
- Washington, D.C.
- North Carolina
- North Dakota
- New Hampshire
- New Jersey
- New Mexico
- New York
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
As states across the country take steps to move forward with health reform, the Main Street Alliance released an updated set of small business recommendations for the design and governance of new competitive marketplaces for health insurance, called health insurance exchanges. The recommendations aim to ensure that the exchanges maximize benefits for participating small businesses and avoid conflicts of interest.