*/
MONTPELIER, VT – Vermont legislators were scheduled to vote in early March on a three-pronged bill that would set the state on a course to establish the nation's first state-sponsored single-payer health insurance system.
The bill, H. 202, would allow the state to establish a health benefit exchange, create a five-member health reform board and launch Green Mountain Care, a government-financed health plan available to all state residents.
"Healthcare costs are climbing at a rate of more than 12 times the growth of the Vermont economy, and we're not getting the best value for our money," said Gov. Peter Shumlin. "Too many Vermonters are uninsured or underinsured, and the hundreds of millions of dollars we're spending on our inefficient healthcare system could be used to meet other important priorities."
Anya Rader Wallack, special assistant to Shumlin, said these first steps would provide the framework for a single payer system, which could be operational as soon as 2014.
"We see the health benefit exchange as being a foundation for doing what we want to do in terms of the single payer," she said. "By having the exchange in place, we will see a lot of federal dollars for things like tax credits for people who are uninsured and money to build eligibility and enrollment systems. We feel we can make a lot progress through that structure."
The creation of the health reform board is also vital, Wallach noted, since it "will have the ability to control costs by working with providers to put them on budgets either through accountable care organizations or other mechanisms that would allow for budgeting of total provider payments."
Private health insurers in the state, who might be expected to oppose such a proposal, are supportive of the governor's plans.
"We are not opposed to healthcare reform at all – in fact, we advocate for it. Our own vision calls for transformation of the healthcare system to assure effective affordable care for everybody," said Kevin Goddard, vice president of external affairs for Blue Cross Blue Shield of Vermont. "What we are trying to do is serve as a resource for policymakers as they look at all the important and very complicated issues that are involved."
While the first steps toward a single-payer system are expected to pass, there remain questions about how the effort will move forward in the coming years. Critics point out a lack of specific information on how the system would be funded.
Wallach said discussing how much the plan would cost now is premature, since there is no way to know what costs will be until after the health reform board flexes its regulatory muscle.
Further, there are no provisions in the Affordable Care Act that allow for the creation of single-payer systems in individual states, which means Vermont will need a handful of waivers from the U.S. Department of Health and Human services to move forward.
That said, President Barack Obama has indicated he will work to get states the necessary waivers to allow them to set up their own comprehensive systems.
Still, Wallach warned that these are the early days of reform in Vermont, and the road to a single-payer system will be difficult.
"Our proposal may scare some people who have defined roles in the current system and may see those roles change or disappear. Change and dislocation are scary, and we will be mindful of that as we move forward," she said. "But the prospect of continuing on our current path of an unaffordable, fragmented system that does not treat all Vermonters fairly is far worse."