Vermont is giving up on single payer

VTDigger
October 26, 2014
Correction: State No Longer Looking to Administer Medicare
By Anne Galloway

Two recent stories about the relationship between Medicare and Green
Mountain Care, the state's planned universal publicly financed health
care program – often called single-payer – were inaccurate. The stories
were based on statutes on the Legislature's website that had not been
updated.

Section (e) of chapter 18, Public Private Universal Health Care System,
in Title 33, Human Services, still states online that, "The Agency shall
seek permission from the Centers for Medicare and Medicaid Services to
be the administrator for the Medicare program in Vermont. If the Agency
is unsuccessful in obtaining such permission, Green Mountain Care shall
be the secondary payer with respect to any health service that may be
covered in whole or in part by Title XVIII of the Social Security Act
(Medicare)."

Act 144, which was enacted in 2014, repeals that section, though the
statutes have not been updated online.

Section (f) of the same chapter now reads, "Green Mountain Care shall be
the payer of last resort with respect to any health service that may be
covered in whole or in part by any other health benefit plan, including
Medicare, private health insurance, retiree health benefits, or federal
health benefit plans offered by the military, or to federal employees."

State officials have said they are no longer seeking to administer
Medicare as part of Green Mountain Care, and the law reflects that change.

It is currently unknown what Green Mountain Care will cover or what
private supplemental health insurance policies will be offered once the
program is in place.

Gov. Peter Shumlin has said there is no reason to expect that currently
available supplemental coverage options for Medicare would change if the
state moves forward with a single-payer health care system.

http://vtdigger.org/2014/10/26/correction-state-longer-looking-administer-medicare/

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Vermont Act 144
An act relating to miscellaneous amendments to health care laws.

Sec. 1 Principles for Health Care Financing

(3) As provided in 33 V.S.A. § 1827, Green Mountain Care shall be
the payer of last resort for Vermont residents who continue to receive
health care through plans provided by an employer, by another state, by
a foreign government, or as a retirement benefit.

Sec. 2 Vermont Health Benefit Exchange

(4) To the extent permitted by the U.S. Department of Health and
Human Services, the Vermont Health Benefit Exchange shall permit
qualified employers to purchase qualified health benefit plans through
the Exchange website, through navigators, by telephone, or directly from
a health insurer under contract with the Vermont Health Benefit Exchange.

Sec. 6 Administration; Enrollment

(e) [Repealed.]

(f) Green Mountain Care shall be the payer of last resort with
respect to any health service that may be covered in whole or in part by
any other health benefit plan, including Medicare, private health
insurance, retiree health benefits, or federal health benefit plans
offered by the military, or to federal employees.

Governor signed bill: May 27, 2014

http://www.leg.state.vt.us/docs/2014/Bills/H-0596/ACT0144%20As%20Enacted.pdf

Green Mountain Care
http://www.greenmountaincare.org/vermont-health-insurance-plans

Vermont Health Connect
http://info.healthconnect.vermont.gov/healthplans

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VPR
September 12, 2014
Shumlin Won't Pursue Single Payer If It Doesn't Help Economy
By Bob Kinzel

Act 48, the law that put Vermont on the path to a single-payer health
care system, was passed in 2011. It called on the governor to unveil a
single-payer financing plan in January of 2013.

That didn't happen because Shumlin said he needed more time to develop a
plan. Shumlin said he would be ready to release his proposal in January
of this year.

But Shumlin missed this deadline as well. He now says he'll unveil his
plan at the start of the Legislative session in January.

Shumlin says there's no point pursing a single-payer option if the
effort will hurt the state's business community.

"If we come up with a financing plan that doesn't grow jobs, economic
opportunity, and make Vermont more prosperous, trust me, we're not going
to do it," said Shumlin.

http://digital.vpr.net/post/shumlin-wont-pursue-single-payer-if-it-doesnt-help-economy

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Comment by Don McCanne

Many consider Vermont to be the trailblazer for a state single payer
program, serving as a model for other states to enact single payer
reform. Vermont does have lessons for the rest of us. Let's see what
they are so far.

Green Mountain Care is Vermont's program for Medicaid and for Dr.
Dynasaur (Vermont's Medicaid program for children and pregnant women).
Most participants are now required to enroll in PC Plus - a Medicaid
primary care managed care program. Vermont Health Connect is Vermont's
health insurance exchange (marketplace) under the Affordable Care Act
through which individuals and small businesses can purchase insurance.
Many Vermonters still have access to other programs such as Medicare,
employer-sponsored health plans, retiree plans, and federal employee
programs such as FEHBP and Tricare. So far this is not really much
different than programs in other states - certainly far from single payer.

What about Medicare? Vermont has given up on attempting to become the
administrator of Medicare, much less rolling Medicare funds into a
universal single payer program. Gov. Peter Shumlin has even stated that
"there is no reason to expect that currently available supplemental
coverage options for Medicare would change." Thus apparently they are
continuing even the private Medigap supplements and private Medicare
Advantage plans.

What about Green Mountain Care - the Medicaid program that was to be the
single payer for Vermont? A few months ago legislation was signed by
Gov. Shumlin that stated, "Green Mountain Care shall be the payer of
last resort with respect to any health service that may be covered in
whole or in part by any other health benefit plan, including Medicare,
private health insurance, retiree health benefits, or federal health
benefit plans offered by the military, or to federal employees."
Further, "Green Mountain Care shall be the payer of last resort for
Vermont residents who continue to receive health care through plans
provided by an employer, by another state, by a foreign government, or
as a retirement benefit." At this point in time, that does not look like
a program that is being remodeled to fulfill the role of a single payer.

The original Vermont legislation called on Gov. Shumlin to unveil a
single payer financing plan in January, 2013. He missed that deadline
and again missed the next one in January, 2014. He now says that he
intends to release a plan in three months. We will have to wait to see
what that proposal is, but at this late stage he is saying, "trust me,
we're not going to do it," if the effort will hurt the business
community. That seems quite tenuous for having worked on it a couple of
years.

Many still talk about the enabling ACA waiver that Vermont will obtain
in 2017, but the ACA section 1332 waiver applies only to the subsidies
and some specific requirements of ACA. Even combined with Sec. 1115
Medicaid waivers and waivers for Medicare demonstration programs,
especially considering the ERISA barriers, we simply do not have enough
leeway for states to independently establish their own bona fide single
payer systems.

The point is that we must have comprehensive federal legislation if we
wish to establish state-level single payer systems. We need need the
federal funds currently used in other federal health programs such as
Medicare and Medicaid, and we need relief from federal statues and
regulations such as ERISA. It would be far better to simply enact a
national single payer program, but those who wish to pursue a state
model must still advocate for comprehensive federal legislation.

Regardless, we can have single payer if we all work together to create
the momentum for federal legislation, state and/or national, but none of
us will see single payer if we each confine our activities to our
respective states. Many have called for a cooperative effort. This is it!