Most estimates conclude that Vermont would be one of the hardest hit states on a per capita basis by the proposed Graham-Cassidy health care bill.
For the past few weeks, Human Services Secretary Al Gobeille has been anxiously reviewing projections about how the GOP health care plan would affect the state of Vermont.
That's because the new bill converts the current Medicaid program into individual state block grants and rolls back funding for states, like Vermont, that expanded its Medicaid program under the Affordable Care Act.
Gobeille says the loss of federal money would be staggering for Vermont and represents roughly 30 percent of the state's entire Medicaid budget.
"We have the numbers in the $200 million range, some estimates are over and some estimates are just a little bit under, but that's a big number to a tiny state like Vermont," said Gobeille.
Gobeille says passage of the bill would set off an extremely painful debate at the Statehouse over the future of the state's Medicaid program.
"I'm not a Chicken-Little-kind of person and I don't like to overact to things, but these numbers that we're putting out there are big and so everything would have to be on the table," said Gobeille.
And Gobeille says the bill doesn't leave any good options on the table for Vermont lawmakers to consider.
"There's no way that we could maintain our current level of service and or our current level of taxation or other things with something of this magnitude,” said Gobeille. “I think it would cause everyone to pause when we started to run scenarios on what we would do."
Gobeille says the legislation essentially ends the federal-state Medicaid partnership that's been in place for more than 50 years.
"We all went in on this together and we were going to cover basically those least fortunate among us,” said Gobeille. “This breaks that partnership and it says, 'we're only going to pay you sort of what we think we should and if you want to do anything over that it's on you states.'"
Eileen Burgin, a political science professor at the University of Vermont says shifting the federal Medicaid program to a state block grant represents an enormous change in federal health care policy.
"It's probably the most massive devolution of federal money and responsibility to states in anything ever,” said Burgin. “It's sort of mind-boggling."
Burgin says the bill also sets up an unrealistic timeframe for states to chart their own health care future.
"It's asking states to put something together in a couple of years — that's just incredibly complex and complicated for states to do,” said Burgin. “When Massachusetts put together its program ... what people call 'Romneycare' — it took the state four years to figure out how to do it."
Burgin notes that the passage of the Affordable Care Act came after months of public hearings. In contrast, the new GOP bill has had virtually no legislative review.
"There isn't any legislative history,” said Burgin. “It hasn't gone through that sort of process in the Senate and that is not a good way to make legislation."
Gov. Scott is working with a bipartisan group of governors to urge Congress to take steps to strengthen the Affordable Care Act in the coming weeks. They hope work on their plan will proceed if the current GOP legislation is rejected by the Senate.