STATES OF CONFUSION
Vermont turns toward a single-payer system while Florida embraces Medicaid privitization
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.