Vermont’s single-payer experiment starts to take shape
Reports, bill reveal path to first-of-its-kind system
Aclearer picture of the pathway to the nation’s first publicly funded single-payer system has emerged as Vermont officials released a set of reports and introduced a bill aimed at laying the groundwork for Green Mountain Care.
The bill would merge the individual and small group insurance markets; award the Green Mountain Care Board authority over health insurer rate reviews, hospital budget reviews and certificate-ofneed processes; and authorize a state agency to seek waivers from the CMS. It would also require the state’s 16 hospitals to cover 15% of expenses incurred by the board to collect data and information relating to budget reviews, a requirement that the Vermont Association of Hospitals and Health Systems does not support.
The issue for hospitals, said VAHHS President and CEO Bea Grause, is that the Green Mountain Care Board is intended to be independent of state government. The Banking, Insurance, Securities and Health Care commissioner previously had oversight over hospital budget reviews and certificate-of-need processes.
“Our main concern is to make sure that hospitals have due process,” Grause said, “and that it’s a fair and predictable process.”
The bill proposes giving the board emergency rulemaking authority for hospital budget reviews, which have to be finalized by Sept. 15, also raised concerns with VAHHS.
While Grause said she understands that the normal six- to seven-month rulemaking process could place the board in the position of having jurisdiction without rules in place, the association plans to stay engaged on the issue during ongoing discussions over budget reviews and payment reform pilot projects.
Most healthcare industry organizations have remained neutral about the state’s healthcare law, which Gov. Peter Shumlin signed into law in May.
The developments of the last week, including this initial round of reports and the introduction of the bill laying the groundwork, are causing some groups to begin to voice concerns about the shape the law is beginning to take. The reports touch on a number of issues, including the state health benefits exchange required by the Patient Protection and Affordable Care Act, the exchange’s transition to Green Mountain Care, the board’s annual report and a public engagement plan. “These studies provide light on the next steps of health reform, but they do not provide long-term answers,” Grause said.
The National Federation of Independent Business and Blue Cross and Blue Shield of Vermont have questioned the bill’s proposed definition of small groups as 100 employees or less for three years starting in 2014, and the proposal that individuals and small groups are required to buy insurance off the exchange. The state now defines small groups as employers with 50 or fewer employees.
Kevin Goddard, a spokesman for Blue Cross and Blue Shield of Vermont, which represents nearly 45% of those enrolled in private health insurance plans in Vermont, said the average small group size of employers that use the insurer’s plan is eight employees. “It would be prudent to wait and start with businesses with fewer than 50 employees,” he said.
The Green Mountain Care Board also faced criticism from the Shumlin administration for plans to spend $50,000 on a communications consultant to support the public engagement plan. The board later voted to rescind the request for proposals, though Anya Rader Wallack, the board’s chair, said there is a possibility the board will issue a similar RFP in the future.
A bill was introduced this year by state Sen. Randy Brock, a Republican planning to run for governor, to move up the deadline for the financing plans. By releasing the plans Sept. 15, rather than Jan. 15, 2013, voters can better understand the cost implications of Green Mountain Care before the election, Brock said.
Other states with pending single-payer healthcare legislation are keeping watch over the Green Mountain Care Board’s activities. Last week in California, the state Senate Appropriations Committee voted 6-2 for a bill that would create a universal healthcare system.
According to Physicians for a National Health Program, an advocacy group that supports a national single-payer system, 12 states have active single-payer bills. That Vermont “is taking concrete steps in a tough environment is very inspiring,” said Dr. Ida Hellander, director of policy and programs for PNHP.