Vermont moves toward single-payor system

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Vermont Gov. Peter Shumlin May 26 signed into law a bill that will begin a plan for a single-payor universal healthcare system in the state, the first of its kind in the U.S.

The bill implements a five-member board—appointed by Shumlin ­with consent of the Senate–to develop a strategy for a single universal healthcare system for Vermont.

Advocates claim the multi-faceted plan is an answer to rising healthcare costs and large numbers of uninsured residents. “This law recognizes an economic and fiscal imperative–that we must control the growth in healthcare costs that are putting families at economic risk and making it harder for small employers to do business,” Shumlin said in a May 26 statement. “We have the moral imperative to fix this problem, with 47,000 Vermonters uninsured and another 150,000 underinsured and worried about how to afford keeping their families healthy.”

The bill, titled “Road Map to a Universal and Unified Health System,” lays out three tasks: immediate efforts to control healthcare costs, the creation of a health insurance exchange and detailed planning to implement the single-payor plan, according to a statehouse release. A five-member board will develop the system, plan how to pay for it and submit a report to the Vermont Legislature for approval by Jan. 15, 2013.

Dubbed “Green Mountain Care,” the system that is set to replace the state’s current fee-for-service model does not immediately provide universal coverage for Vermonters. It is set to become operational in coming years after obtaining a federal waiver for the state system. Part of the plan involves working with the federal government to obtain the necessary waiver, as well as figuring out how Medicare and Medicaid benefits will be assessed. All residents will become eligible for the universal healthcare program in coming years, which provides benefits to the maximum extent allowable under federal law and waivers.

Critics of the bill claim the plan lacks specificity about benefits, access or how it will be funded. The fate of the private insurance market remains a concern for some, as well as the freedom to choose providers or whether residents can access healthcare across state lines with the program.

MVP Health Care, a nonprofit health plan offered in Vermont, is among a number of providers awaiting the details of the state’s universal plan.

“The point is, there are still an awful lot of questions, most importantly, how is this going to be paid for?” MVP spokesperson Mike Traphagan asked in an interview. “The devil’s in the details. It’s a wait-and-see.”

In an op-ed written earlier this week on the state's website, Lt. Gov. Phil Scott said the system is akin to buying a car without knowing the price. “I feel as though we’re ordering a car without knowing whether it’s a Yugo or a Rolls Royce, whether we can actually afford it, or whether we’ll even get what we need,” Scott wrote.

Shumlin said he was aware of the concerns and they will be addressed.

“[P]eople have legitimate questions about how a single-payor plan will be financed and operated, and we will answer those questions before the legislature takes the next step,” Shumlin said. “But input from providers, business and healthcare consumers will be specifically important to assuring that our reforms are good for our healthcare system and good for our economy,” he added.