I live and work in Starksboro, VT. I am a co-owner of a small worker cooperative business, AORTA, with 12 worker-owners working in 8 different states & generating about $1 million in revenue per year (well, at least we generated that much before Covid!). I’m writing to share a testimonial about our experience navigating health benefits for our workers as a plea for universal healthcare / medicare for all.

When our business reached a stage where we were able to budget for health benefits, we weren’t able to find a decent group health insurance plan that we could afford, so we decided to offer a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) plan and allow workers to manage their own health insurance & needs. We currently budget about $90,000 for this plan. But we recently found that workers who had previously accessed subsidized health plans through the ACA marketplace had, through being offered a QSEHRA, become ineligible for the subsidized plans, and are now paying more out of pocket for health insurance premiums even when they apply their QSEHRA funds to the cost.

So now we are of course back to the drawing board and trying to figure out whether we are now in a position to offer group health insurance. It’s impossible to find a plan that is both a good fit for everyone and fits within our budget. We are looking at spending $200,000 or more (20% of our budget) if we were to cover everyone fully with a decent plan. Some of our workers really depend on seeing providers that aren’t covered by health insurance, so would prefer more flexible funds. Others really like their ACA plans and would be disappointed if they lost access to them. Some workers desperately want us to provide comprehensive group health coverage. Others have the privilege of being covered by their partner’s plan, but worry about job security for their partner. We also worry that if we offer health insurance, workers who may want to move on at some point will feel stuck because of fear of losing their benefits.

I personally pay $350/month out of pocket to gain access to my partner’s health insurance plan offered by his employer, but because our kids aren’t covered, I have opted for a catastrophic plan with a $16,000 deductible that costs $534/month. I’m grateful that I can access my partner’s insurance and that my QSEHRA plan covers a fair amount of our health insurance costs, but I expect to pay over $10,000 in out-of-pocket health-related costs this year -- and it could be much more if my kids end up in the ER or need to see a specialist (knock on wood).

We have invested countless hours of staff time in researching and navigating all of the possible solutions, not to mention the time that each individual spends navigating their own state’s health insurance marketplace. What a dream come true it would be to be offered universal coverage by our government.

I’m also concerned about the devastating disparities between access to quality care for poor folks and people of color compared with people with access to wealth and/or white people. For example, according to an episode of The Daily podcast (listed below), at the height of the pandemic in NYC, there were high death rates from COVID-19 in public hospitals (where most Medicaid recipients and people without insurance are admitted) and much lower death rates in private hospitals (where people who are able to access private health insurance or fund their own care are admitted). And unnecessary bureaucracy got in the way of treating patients at overflow hospitals. It's clear that multitudes of lives could have been saved if we had a central system for managing health, and hospitals weren't competing for resources.

And Vermont is not immune to these issues - I deeply admire clinics like the Open Door Clinic that provide care to uninsured folks who might otherwise have no access to care, but I think it would be a more efficient use of resources if everyone were able to receive the same care by the same providers at the same clinics & hospitals.

My co-business-owners and I would gladly pay much more in payroll & income taxes if it meant universal coverage.

Better yet, increase taxes for the wealthiest (and place a cap on their income) while also divesting funds from police, ICE, the military industrial complex, prisons, immigrant detention centers, and other forms of racialized state violence and reinvest funds in universal healthcare, mental health & addiction treatment, schools, worker-owned cooperatives, land trusts, affordable housing, public transportation, alternative energy, reproductive healthcare, environmental restoration...we could go on, and we are connected through our work to thousands of organizers with brilliant plans for how to advance these complex yet absolutely possible solutions.

https://www.nytimes.com/2020/07/27/podcasts/the-daily/new-york-hospitals-covid.html?

https://opendoormidd.org/healthcare/