Health insurance mandate endorsed

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MONTPELIER — After months of deliberations, state lawmakers on Saturday decided that all Vermonters should have to buy health insurance as of Jan. 1, 2020.

The House and Senate each agreed to a compromise version of H.696, which establishes a state "individual mandate" for health insurance in response to pending changes at the federal level.

It's not yet clear how the state's mandate will be enforced: Figuring that out will be the job of a working group that will make recommendations for legislative consideration in 2019.

But supporters say it's important to keep the number of insured residents as high as possible in order to avoid big premium increases.

"There's a lot at stake here," said Rep. Tim Briglin, D-Thetford and ranking member of the House Health Care Committee.

State officials are taking action on the issue because Congress, in a tax overhaul approved last year, eliminated the financial penalty for the federal individual mandate as of 2019.

Some say that federal change could cause many people to drop their insurance, leading to increased premiums for those who maintain coverage. Briglin said new filings for Vermont insurers' proposed rate increases already reflect a premium increase due to expected drops in enrollment.

The Vermont House voted earlier this year to enact a state individual mandate as of Jan. 1, 2019, without a penalty for those who don't buy insurance. At the time, officials argued that it was important to keep some sort of mandate in effect even as the Legislature worked to figure out enforcement measures.

Gov. Phil Scott's administration endorsed that plan.

But the Senate rejected it, preferring to wait to enact a mandate once administration and enforcement had been figured out. "The Senate position was, you can't require someone to have health care coverage if you also don't have some form of enforcement or penalty," said Sen. Ginny Lyons, D-Chittenden.

A conference committee made up of three members from each body struck a last-minute deal on Saturday morning. The House and Senate endorsed the committee's report later in the day.

The compromise says Vermont residents must maintain "minimum essential coverage" starting Jan. 1, 2020. The definition of minimum essential coverage would be the same as in federal law.

Lyons said enacting a mandate for 2020 "sends a huge message for people it puts people on notice."

In the meantime, "we're hoping that the people who are signed up currently will not drop out," Lyons said. "That's the key."

It would fall to the Legislature in the 2019 session to decide on an enforcement mechanism for the mandate "in order to provide notice of the penalty to all Vermont residents prior to the open enrollment period for coverage for the 2020 plan year," the conference committee's report says.

The bill calls for a working group to meet this year and develop recommendations on administration, enforcement mechanisms and possible exemptions for a state health insurance mandate.

The group would include representatives of the state Agency of Human Services, Department of Financial Regulation and Department of Taxes; the Green Mountain Care Board; the Health Care Advocate's office; and insurance companies.

The group's report would be due by Nov. 1, giving legislators time to draft proposals for the 2019 session.

"There's obviously work for the General Assembly to do next year," Briglin said.

The bill also says the Department of Vermont Health Access and the Department of Taxes, with assistance from the state Health Care Advocate and others, should "engage in coordinated outreach efforts to educate Vermont residents about their responsibilities" regarding the individual mandate during the open enrollment period for 2020 health plans.

The compromise version of H.696 sailed quickly through the Senate with no debate, but it required a late night roll call vote in the House. The results of that vote were 118 in favor and 16 against.

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