Vermont health care reform

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In 2011, the Vermont state government enacted a law functionally establishing the first state-level single-payer health care system in the United States. Green Mountain Care, established by the passage of H.202, creates a system in the state where Vermonters receive universal health care coverage as well as technological improvements to the existing system.

Contents

On December 17, 2014, Vermont abandoned its plan for universal health care, citing the taxes required of smaller businesses within the state. [1]

Planning

In 2010, the State Legislature passed S 88 (which included provisions from Act 128), which enabled the state of Vermont to establish a commission to study different forms of health care delivery in the state. [2] Dr. William Hsiao, a Harvard University professor of economics who was an advisor during Taiwan's transition to single-payer health care, [3] was enlisted to design three possible options to reform Vermont's health care. [4] Hsaio, along with Steven Kappel and Jonathan Gruber, presented the proposal to the legislature of Vermont on June 21, 2010. [5]

The three options were laid out as follows:

The commission's proposal ultimately considered the third option to be "the most politically and practically viable single payer system for Vermont," noting that Vermont, "a small state with communitarian values," with its existing network of non-profit hospitals and a medical community that had previously shown support for state intervention, would be "uniquely poised to pass universal health reform." [5]

Legislation

Following the proposal, Democratic state representative Mark Larson introduced H 202 on February 8, 2011, titled Single-Payer and Unified Health System. [6] The bill passed the House on March 24, 2011, with 94 votes in favor and 49 against. [6] [7] The bill then passed the Senate on April 26, 2011, with 21 votes in favor and 9 against. [6] [8] The conference report legislation passed the Senate on May 3, 2011 with 21 votes in favor and 9 opposed, and the House on May 4, 2011 with 94 votes in favor and 49 against. [6] [9] Governor Peter Shumlin signed the bill on May 26, 2011. [6]

Green Mountain Care

The signing of H. 202 led to the creation of Green Mountain Care, described by Kaiser Health News as "a state-funded-and-managed insurance pool that would provide near-universal coverage to residents with the expectation that it would reduce health care spending." [10] Governor Shumlin, in a blog post at Huffington Post , described the plan as "a single payer system" that he believed "will control health care costs, not just by cutting fees to doctors and hospitals, but by fundamentally changing the state's health care system." [11] As of January 2013, Vermont was still working out the role of Green Mountain Care and the responsibilities of the bill, as well as how to fund the program. Dr. Hsiao, for example, had proposed an 11% payroll tax on employers, and the administration was required under Act 48 to provide a financing system in 2013. [12] The state also had to align Green Mountain Care with provisions in the Patient Protection and Affordable Care Act, passed by the United States federal government in 2010, which required the creation of a health care exchange in individual states. To launch fully, Green Mountain Care would have had to gain approval from the federal government to use federal health finances to fund the state program.

As of April 2014, Vermont had yet to craft a bill that would address the $2 billion in extra spending necessary to fund the single-payer system, [13] [14] and by the end of the year, the state abandoned its plan for universal health care, citing the taxes required of smaller businesses within the state. [1]

Dr. Hsiao, in his proposal, noted that "a two-thirds majority of Vermonters said that all Vermonters should be able to get the health care they need when they need it, regardless of their ability to pay even if this means that they would have to pay higher taxes and higher insurance premiums themselves." [5] The bill was passed in the Vermont legislature on party line votes, with Democrats and Progressives in favor and Republicans against. The bill is considered the first single-payer bill to be passed on the state level, but private insurers can continue to operate in the state. Representative Larson has described Green Mountain Care's provisions as "as close as we can get [to single-payer] at the state level." [13]

According to Leigh Tofferi, the director of government, public and community relations for Blue Cross Blue Shield of Vermont, the lack of initial specifics was causing "anxiety" to many providers. The Vermont Medical Society had no position on the bill or on single-payer in general. David Himmelstein, the founder of Physicians for a National Health Program, a single-payer advocacy group, was critical of the plan due to the ability of private insurers to operate in the state, arguing that the plan "give[s] up a significant part of the administrative savings by doing that," but agreeing that Green Mountain Care "lays the foundation" for single-payer. [13]

In the 2014 gubernatorial election, Governor Shumlin was heavily favored for re-election but only received a plurality of the vote, 46.4%, to Republican Scott Milne's 45.1%. The election was decided by the Vermont General Assembly on January 8, 2015; Shumlin defeated Milne by a vote of 110 to 69. [15] The Burlington Free Press ascribed the result, in part, to voters' dissatisfaction with the progress the state had made in instituting single-payer health care. [16]

Aftermath

One of the problems found since the abandonment of the Vermont Health Care initiatives is questionable billing from Jonathan Gruber, who according to CNBC, has come under more scrutiny because of the contract. [17] According to a Vermont State report filed by Doug Hoffer, [18] an invoice sent by Gruber to Vermont on December 30, 2014 for $40,000 increased the amount of scrutiny on the billing. [19]

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References

  1. 1 2 Brinker, Luke (December 18, 2014). "Vermont abandons plan for single payer health care". Salon . Retrieved April 4, 2024.
  2. 1 2 S 88 Archived October 19, 2013, at the Wayback Machine : An act relating to health care financing and universal access to health care in Vermont. As passed by House and Senate, 2010.
  3. ↑ Underwood, Anne (November 3, 2009). "Health Care Abroad: Taiwan". Prescriptions Blog. The New York Times Company . Retrieved April 4, 2024.
  4. ↑ Lindholm, Jane (January 20, 2011). "Dr. William Hsiao On Health Care System Reform". Vermont Public Radio . Retrieved April 4, 2024.
  5. 1 2 3 4 5 6 7 8 The Vermont Option: Achieving Affordable Universal Health Care. Dr. William Hsaio, Steven Kappel, Jonathan Gruber, and a team of health policy analysts, June 21, 2010.
  6. 1 2 3 4 5 Project VoteSmart: H 202 - SINGLE-PAYER AND UNIFIED HEALTH SYSTEM - KEY VOTE.
  7. ↑ H. 202
  8. ↑ Davenport, Melinda (April 26, 2011). "Vt. Senate approves single-payer plan". Wcax.com. Archived from the original on March 9, 2012. Retrieved December 29, 2014.
  9. ↑ H. 202 conference report.
  10. ↑ Marcy, Jessica (October 2, 2011). "Vermont Edges Toward Single Payer Health Care". KFF Health News . Retrieved April 4, 2024.
  11. ↑ Shumlin, Peter (August 5, 2011). "The Economic Urgency of Health Care Reform". HuffPost . Retrieved April 4, 2024.
  12. ↑ Stein, Andrew (January 13, 2013). "Legislative preview: Health care committee to look at insurance subsidies, financing for single payer, role of Green Mountain Care Board". VTDigger . Retrieved April 4, 2024.
  13. 1 2 3 McArdle, Megan (April 11, 2014). "Vermont's Single-Payer Dream Is Taxpayer Nightmare" . Bloomberg News . Archived from the original on October 26, 2014. Retrieved April 4, 2024.
  14. ↑ Kliff, Sarah (April 9, 2014). "Can Vermont replace Obamacare with single payer?". Vox . Retrieved April 4, 2024.
  15. ↑ "Shumlin defeats Milne in Legislature governor vote". The Burlington Free Press . Gannett. January 7, 2015. Retrieved May 31, 2015.
  16. ↑ Hallenbeck, Terri (November 5, 2014). "How a two-term incumbent governor nearly lost". The Burlington Free Press . Gannett . Retrieved November 11, 2014.
  17. ↑ Mangan, Dan (February 24, 2015). "Obamacare guru Gruber had 'questionable' billing: Audit". CNBC . Retrieved October 22, 2018.
  18. ↑ "Gruber contract memo final" (PDF). STATE OF VERMONT OFFICE OF THE STATE AUDITOR. February 23, 2015.
  19. ↑ Gullo, Joe (February 23, 2015). "Report: Gruber May Have Overbilled VT". MyChamplainValley.com. Nexstar Media Group. Archived from the original on February 27, 2015. Retrieved February 27, 2015.
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