Bill outlines governor's health care path

By Nancy Remsen
Burlington (Vt.) Free Press, Tue, Feb 8, 2011

MONTPELIER — The woman who Gov. Peter Shumlin hired to guide his health reform effort presented lawmakers Tuesday with the administration’s roadmap — an 80-page bill — leading to a consolidated, publicly financed system that would provide medical coverage to all Vermonters.

“We don’t think we have all the answers, but we think we are putting in front of you a solid proposal for moving forward with major, meaningful health reform,” Anya Rader Wallack, Shumlin’s special assistant on health reform, told members of House Health Care and Senate Health and Welfare committees. “We know you will find ways to change and improve it.”

Democratic legislative leaders embraced the bill as a framework they would use to speedily write their own version. House Speaker Shap Smith, D-Morristown, wants the House Health Committee to vote out a bill by the second week in March.

The proposal created plenty of unease — among lawmakers as well as special interest groups for businesses and hospitals.

Rep. George Till, D-Jericho, a doctor and member of the House Health Care Committee, said the bill asked Vermonters to agree to build a new system without knowing fundamental information such as how the system would be financed or how payments to providers would change.

Others who are anxious to see a single-payer system cheered the bill.

“I feel pretty positive about it,” Dr. Deb Richter of Montpelier said. “Everything in there I feel we can work with.”

The bill would move the state through three stages in four years to reach the target of a single-payer system. Planning would dominate the first stage that would commence in July, with the first structural changes taking place in 2014.

A new, independent Vermont Health Reform Board proposed to begin work later this year would be charged with developing ways to contain health costs by reforming the way doctors and hospitals are paid and setting budgets for health expenditures.

“We need to do that as soon as possible,” Wallack said.

In prepared remarks, Wallack acknowledged the legislation would scare some who are wary of change and disappoint others who want to move faster toward a single payer system.

Wallack asked all sides to “work with us to build a better system.”

She stressed Shumlin’s resolve concerning this initiative — in case anyone thought the administration might give up because of the hurdles ahead.

“Make no mistake, we are committed to reforms that get us as many of the benefits of a single payer as possible under current federal law, and to asking for a waiver from federal law so that we can gain the full benefits of a single payer when that option is available,” she said. “We are committed to this goal and we are giving you a plan for how we will reach it.”


Betsy Bishop, president of the Vermont Chamber of Commerce, agreed with Till that the bill left critical decisions for the future. The proposal says the administration would have until January of 2013 to deliver a plan for financing a publicly run system.

“It is difficult to build a system and say we will talk about how to pay for it at a later date,” Bishop said. “I hope to persuade them to have that conversation this year.”

Sen. Kevin Mullin, R-Rutland, noted that many important and potentially controversial decisions wouldn’t be up for discussion this year. They are given to the Vermont Health Care Reform Board, a sixmember panel that the governor would appoint.

“We will see if the Legislature is willing to give up all that authority,” Mullin said.

Bea Grause, president of the Vermont Association of Hospital and Health Care Systems, complained about the Shumlin administration’s proposal to increase a tax on hospitals and reduce reimbursements under a state health insurance program — all to help balance next year’s budget.

“We can’t really separate this bill from the budget,” Grause said. “We are willing to build a better mouse trap,” she continued, “but the state doesn’t have a good track record.”


House Health Care Committee Chairman Mark Larson, D-Burlington, is the sole sponsor of the Shumlin bill in the House. He sees it as the catalyst for a decision about the future of health care in Vermont.

“We need to make a decision about where we are going,” Larson said. “Dr. Hsiao started the conversation,” Larson said, referring to William Hsiao, a Harvard researcher the Legislature hired, who reported two weeks ago that a singlepayer system was the best way to fix the state’s broken health-care system.

“The administration moved that conversation forward when it provided one answer on how to get there.” Larson said.

Cassandra Gekas, health care advocate with the Vermont Public Interest Research Group, called the introduction of the bill “a historic moment for Vermont” because it set out “the most ambitious plan to implement federal health care reform in the nation and will position Vermont as a leader.”

James Haslam, director of the Vermont Workers’ Center that has campaigned to win support for the idea that health care is a human right, said introduction of the bill signaled how much had been accomplished.

His organization, however, is preparing for a fight to win passage of Shumlin’s plan.

“The people who don’t want to move in this direction have a particularly loud voice,” Haslam said. “We are pushing more of the grassroots organizing that got us here. That is going to be really critical.”

Contact Nancy Remsen at 578-5685 or


Health reform bill

The Shumlin administration released its health-care reform legislation Tuesday. The bill sets out a three-step process to move the state to a single-payer health system over four years. Here’s the timeline:

Stage one

- After July 1, establish a six-member, independent board to set cost containment targets, create system-wide budgets, review state regulators’ decisions on insurance rates, pursue reforms in the way hospitals and doctors are paid to focus on outcomes rather medical procedures.

- Effective July 1, authorize and begin planning a health benefit exchange, a “mar­ketplace” where Vermonters would be able to compare health insurance coverage. Al­though the exchange might offer multiple in­surance plans, the bill proposes the ex­change would require a common claims process and other administrative simplifica­tion.

- By Jan. 15, 2013, deliver to Legisla­ture details of how the exchange would ac­commodate Medicaid, Medicare, private in­surance, associations, state and local government workers and teachers. Also de­liver to lawmakers two financing plans — one if the state receives federal waivers and can set up a single-payer system in 2014 and one if the state doesn’t receive waivers.

Stage two

- On Jan. 1, 2014, launch Vermont Health Benefit Exchange, with coverage ex­tended to employers with fewer than 100 workers, plus government workers, teachers and Vermonters on Medicaid, Medicare and other state health insurance programs. Pri­vate insurers would be required to sell their products through the exchange. Federal tax credits would be available to reduce the price of coverage for uninsured individuals up to 400 percent of the federal poverty level.

($43,320 for an individual.)

Stage three

- 2014-17: As soon as allowed under federal law or by a waiver, launch Green Mountain Care, a publicly financed health in­surance program offering “essential” benefits to all Vermont residents. Health care would no longer be connected to employment.

What they’re saying

“We are asking everyone involved in this discussion to step back and look at the big picture and work with us to build a better system. We need to cover everyone and control costs. This can’t be done overnight, and it can’t be done recklessly, but it must be done.”
— Anya Rader Wallack, special assistant for health care to Gov. Peter Shumlin

“It is difficult to build a system and say we will talk about how to pay for it at a later date. I hope to persuade them to have that conversation this year.”
— Betsy Bishop, president of the Vermont Chamber of Commerce

“It is truly a historic moment for Vermont. The governor has released a comprehensive health reform bill ... that is by far the most ambitious plan to implement federal health care reform in the nation and will position Vermont as a leader.”
— Cassandra Gekas, health care advocate, Vermont Public Interest Research Group

“It creates a starting point. ... I don’t think it does much but create a panel that will make all the decisions. Now we will see if the Legislature is willing to give up all that authority. I’m trying to be optimistic that we do more good than harm.”
— Senate Assistant Republican Leader Kevin Mullin of Rutland

“This is a road map. It is up to us to make sure there are no detours we need to take.”
— Senate President Pro Tempore John Campbell, D-Windsor