Ver­mont turns to­ward a sin­gle-payer sys­tem while Florida em­braces Med­i­caid priv­i­ti­za­tion

Modern Healthcare - - Front Page -

States are tak­ing in­creas­ingly di­ver­gent paths as they seek to re­vamp their roles in health­care and rein in costs.

Per­haps no two states ex­em­plify the ex­tremes in ap­proaches like Ver­mont and Florida. In both states, lawmakers in re­cent weeks have passed sweep­ing bills that are on op­po­site ends of the care-de­liv­ery spec­trum.

The Ver­mont bill puts the state on the path to­ward sin­gle-payer cov­er­age, where pub­lic and pri­vate health­care dol­lars would be put in one pot and ad­min­is­tered by the state. Demo­cratic Gov. Peter Shum­lin is slated to sign the bill May 26.

Florida, by con­trast, plans to move nearly all 2.9 mil­lion Med­i­caid re­cip­i­ents into man­aged care start­ing in 2012. The ap­proved leg­is­la­tion would cre­ate 11 re­gions to be ad­min­is­tered by pri­vate in­sur­ers and elim­i­nate the fee-for-ser­vice sys­tem, at an ex­pected sav­ings of about $1.1 bil­lion in the first year. Repub­li­can Gov. Rick Scott is ex­pected to sign the bill pack­age soon.

“Some states are look­ing for ways to be more in­no­va­tive in terms of man­ag­ing care and de­liv­er­ing care in ways that will be more efficient and bet­ter, and oth­ers are cut­ting back,” said Dee Ma­han, di­rec­tor of long-term ser­vices ad­vo­cacy at Fam­i­lies USA. “Some of these changes are dra­co­nian, but some states want to be smarter in the way they de­liver care.”

In Ver­mont, the fo­cus is on ex­pand­ing cov­er­age to ev­ery­one. The first step is House bill 202, which would set up a new five-mem­ber panel to draft a pro­posal to move the state to a uni­ver­sal health­care sys­tem. The bill does not in­clude de­tails on how the pro­gram would be fi­nanced, and the state would have to ob­tain waivers from the CMS to gain flex­i­bil­ity to ad­min­is­ter its Med­i­caid and Medi­care pro­grams in a new way.

Ul­ti­mately, the idea is to set up a sin­gle-payer sys­tem called Green Moun­tain Care that would be avail­able to all Ver­mon­ters, per­haps in 2017, re­gard­less of whether res­i­dents cur­rently have cov­er­age through Med­i­caid, Medi­care or a pri­vate in­surer or are unin­sured. Med­i­caid and Medi­care re­im­burse­ments to providers would be paid out through Green Moun­tain Care, if fed­eral waivers are ap­proved.

Ini­tially, the bill re­quires that Ver­mont set up a health in­surance ex­change, as man­dated in the fed­eral health­care re­form law, and be­gin en­rolling in­di­vid­u­als and em­ploy­ees of small firms by Jan­uary 2014.


Votes are tab­u­lated May 5 dur­ing a roll-call vote on the health re­form bill in Ver­mont’s House of Rep­re­sen­ta­tives. In the Green Moun­tain State, the fo­cus is on ex­pand­ing cov­er­age to ev­ery­one un­der a state plan.

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