Vermont is preparing to comply with part of the federal law by launching a health care exchange — a centralized marketplace in which most people will shop for health insurance at a common web site — by January 2014. A key link between the federal and state laws is that up to $300 million a year in federal subsidies are expected to flow into the state in the form of tax credits to help people pay for the insurance they choose on the exchange.
Howard said 12 to 15 states are moving aggressively to implement the exchanges called for under the federal law, but Vermont is unique in seeking to push as far as it is beyond the federal law.
Washington also has pledged about $123 million to Vermont in planning and implementation grants to set up the exchange and get it through its first year, said Mark Larson, commissioner of the state Department of Health Access.
Just last week, the state issued requests for proposals for health insurance companies that want to offer their services for sale under the exchange, said Robin Lunge, director of health reform for the Shumlin administration.
Meanwhile, Lunge said state officials are drafting a series of options to present to lawmakers this winter on how to pay for Green Mountain Care when it is fully launched in 2017.
Lunge said she expected the state to try to give several different packages of options for discussion purposes and didn't expect the administration to push a particular option at this stage.
"It's very important to make sure we understand people's different perspectives when we pick an option," she said.
Critics, including this year's unsuccessful Republican gubernatorial candidate, Randy Brock, have charged that the uncertainty over the future of health care is hurting business development in the state. Shumlin has countered that what might be paid through taxes later is being paid through private health insurance premium now.