Vermont House Passes Single-Payer Health Care Bill March 27, 2011
Posted by rogerhollander in Canada, Health.Tags: chris garofolo, health, health care, health care reform, health reform, healthcare, healthcare reform, single payer, sintle-payer, vermont, vermont health, vermont law, vermont legislature
add a comment
(Roger’s note: Vermont’s state legislature taking this bold step brings to mind Canada’s revered Tommy Douglas, when his leadership led to the passing of a single payer plan in the Province of Saskatchewan in 1962. This turned out to be the domino that that began the overwhelming popular drive for Canadian national health care, and which led to the passing of Canada’s single payer universal coverage national health plan. But that was then and this is now. Today in the United States the giant blood-sucking private health insurance and pharmaceutical industries virtually own a gutless president and the majority of legislators in both pathetic political parties. This was evidenced in the debate that led to the passing of the Obama health legislation last year, a debate in which a public plan or single payer plan was off the table from the beginning; and where the Democratic members of the House who were considered the most progressive and principled caved in the end and supported legislation that enshrines the power of the health insurance industry. Nevertheless, the Vermont action can very well be a first step towards setting an example for a health care plan that is single payer, universal and economic; which in turn can generate public opinion to put on the pressure in other jurisdictions. That is, if the gigantic insurance and pharmaceutical industries don’t find a way to snuff the breath out of the Vermont initiative before it has a chance to come to life.)
Published on Friday, March 25, 2011 by the Brattleboro Reformer (Vt.)
MONTPELIER — The Vermont House of Representatives passed a bill calling for a single-payer system Thursday afternoon, putting the state on a path to become the first in the nation to adopt universal access to health care.
Lawmakers voted 92 to 49 after nearly two days of debate, including discussion on the floor until the early morning hours on Thursday.
Advocates hail the measure as the solution to control costs by reducing administrative overhead. However, critics said it leaves too much financial uncertainty and could hurt the economic growth in Vermont.
The legislation proposes to develop a unified health system where all Vermonters are eligible for benefits under a universal coverage program called Green Mountain Care. Democratic leaders are optimistic the single-payer plan will contain the skyrocketing costs of health care and put the state on a more sustainable fiscal path.
“I think that we all know, and there was universal agreement on the House floor, that the current system will bankrupt us. Costs of health care in Vermont are going up $1 million a day. They are $2 billion more than they were 10 years ago. We have a problem, we need to solve it,” said House Speaker Shap Smith, D-Morrisville. “This is just the first step in the process. This will be a long road ahead, and we have much work left to do. But we have taken a bold step forward today.”
The measure also designs a four-year timeframe to establish a publicly funded system, beginning with the creation of the Green Mountain Care Board on July 1 with a budget of $1.2 million. The five-member board will design a more sensible payment plan for health care providers, control the overall cost to align it closer to Vermonters’ ability to pay and recommend a benefit package for every resident.
However, the bill does not require the governor to propose a payment plan for the single-payer system until 2013, which sparked outcry from House Republicans. Paying for the reform is the most controversial portion of the bill and it will not be addressed until Gov. Peter Shumlin campaigns for his second term next year.
Shumlin, the first-term Democrat who made health care reform a cornerstone of his gubernatorial campaign last year, said the House has moved Vermont in a historic direction toward fixing a broken system.
“This is a really important step for Vermont. If we want to create jobs, if we want to be the state that makes the difference in controlling health care costs so that we can grow jobs and economic opportunities … this is an extraordinary moment,” he said.
Thursday’s otherwise civil debate turned into a political war of words after Rep. Thomas Burditt, R-West Rutland, said promoting universal coverage is the “keystone in the arch of socialism,” drawing criticism from Democrats and independents supporting the measure.
“I take offense at the remarks … that we’re socialists, that we’re communists,” said Rep. Paul Poirier, I-Barre. “I ask all members to respect other people’s points of view.”
Cooler heads prevailed as lawmakers wrapped up the roll call vote shortly after 3 p.m. The legislation heads to the Senate, where it is expected to pass with some possible changes.
Republican critics called on Senate members to “correct the errors” on the bill, particularly the cost burdens on state government.
Opponents said it is not feasible to implement a single-payer system as a stand-alone, suggesting instead an amendment to protect self-insured employers in the state. GOP lawmakers pressured their Democratic counterparts to listen to the hundreds of small businessowners voicing concerns over self-insurance.
“Risk and uncertainty are two barriers to economic growth and this promise would help alleviate these concerns,” said Rep. Oliver Olsen, R-Jamaica. “Self-insured businesses represent nearly 20 percent of all employers in Vermont, which is a large portion of our economy, and they are worried about how this bill will affect their ability to do business in Vermont.”
The amendment, proposed by Stowe Republican Heidi Scheuerman, was soundly defeated.
Rep. Michael Hebert, R-Vernon, spoke from the floor about his issues with the uncertain cost of such a health care network.
“I have a tremendous number of questions. And I’m not in opposition to health care finance reform, I’m just in opposition of us going down a road where we don’t know what it costs,” he said. “There are just so many unanswered questions and I’m really concerned with this five-member board. They’re going to have the authority to rule on every aspect of our health care in the state of Vermont.”
Meanwhile, Democrats hailed the swift-moving bill as a vote for hope and not fear. Supporters hugged outside the House chamber following the passage, a sense of pride on their faces as they praised the landmark health care measure.
“Today, Vermont’s House of Representatives showed America our small state has both the courage and conviction to lead the way nationwide on the creation of a unified single-payer health care system,” said Rep. Valerie Stuart, D-Brattleboro. “I thank the members of the [House Health Care] committee that created this piece of legislation with all my heart.”
The benefits under Green Mountain Care would not take effect until after Vermont receives a federal waiver under the Patient Protection and Affordable Care Act of 2010. By 2014, the bill established a health care exchange as required by federal law.
Vt. Senate gives final nod to universal health care bill in 21-9 vote April 30, 2011
Posted by rogerhollander in Health.Tags: affordable care, anne galloway, health, health care, health care reform, health reform, healthcare, healthcare reform, obamacare, peter shumlin, roger hollander, single payer, universal health care, universal healthcare, vermont, vermont health, vermont senate
add a comment
Roger’s note: I confess that I don’t understand the ins and outs of Obama’s Byzantine insurance industry dominated health care legislation, or how a Vermont single payer universal coverage plan can occur in that context. As a Canadian, however, I cannot but think of Tommy Douglas. Tommy Douglas was a clergyman and an unrepentant socialist who happened to be the Premier of the Canadian Province of Saskatchewan in the 1950s. Against massive resistance and fears of economic collapse, he introduced universal health care into the province, which became the catalyst for its adoption by the entire country. The domino theory at work. Do Canadians value their system of single payer universal health insurance? Would they support going back to private health care? In 2004 the CBC polled Canadians on who what the greatest Canadian of all time. Tommy Douglas won hands down. We can only hope that what the governor and senate have now accomplished in Vermont will be more than symbolic, that it will introduce genuine universal coverage where no one is left unprotected and health care costs come under control through the limitation of windfall profits by private insurers. Americans will then see what they are missing and demand single payer universal health care on a national basis. I love what Dr. Richter said: You go for what you want, not for what you think you might get – that’s what the bill does. Would that that great advocate of change you can believe in, Barack Obama, had had the courage to do just that instead of compromising the principled position of universal care from the very beginning of the congressional process.
by Anne Galloway | April 27, 2011
Gov. Peter Shumlin, a Democrat, campaigned on a promise to create a single-payer system in Vermont that would contain health care costs and give all of the state’s residents universal access to medical care. On Tuesday, Shumlin made good on the first step toward fulfilling that promise, and just five hours after the Senate vote, he marked the legislative victory in an appearance on MSNBC’s “The Rachel Maddow Show.”
Shumlin said in a statement to the Vermont press: “Today the Legislature took a huge step toward making Vermont the first state in the first in the nation to control skyrocketing health care costs and remove the burden of providing health care coverage from small business owners. This bill is good for Vermonters and Vermont businesses.
Many Vermont businesses, however, believe otherwise. Though small employers have said they will benefit, some larger employers actively lobbied against the bill. Opponents of H.202 argued that the legislation would leave businesses in the lurch during the transition period between 2013 and 2014 when the state is required under federal law to participate in insurance exchanges. The opposition was led by insurance brokers (the Fleischer Jacobs Group, Business Resource Specialists), business associations (Vermont Chamber of Commerce, Vermont Grocers’ Association and Vermont Retailers Association), large employers (Dealer.com, Biotek, Rhino Foods and IBM). The Senate debate on Monday and Tuesday centered on changes to the legislation that would have made it more palatable to these groups.
Sen. Vince Illuzzi, R/D-Essex Orleans, who proposed two amendments that would have made the bill more business friendly, said companies are afraid “we will end up with a plan most won’t be able to afford.”
The legislation sets the state’s health care system on a new trajectory. Instead of continuing to use an insurance model for covering the cost of care, the bill moves the state toward an integrated payment system that would be controlled by a quasi judicial board and administered by a third party entity. The system would be funded through a broad-based tax.
The universal health care system would be implemented in 2014, if it clears 10 very high hurdles, including the receipt of a federal waiver. Otherwise it wouldn’t kick in until 2017.
Longtime single-payer advocate Dr. Deb Richter was ecstatic about the Senate passage of the bill.
“I’m absolutely thrilled,” Richter said. “It’s one of the best days of my life. I’ve given 400 speeches over the last 10 years and it feels like the work was worth it. We have a ways to go, but this is a step in the right direction.”
A universal health care system is the only way to cover everyone and contain costs, Richter said.
The passage of H.202 marks the first time any state in the country has attempted to provide universal care and a cost containment system that addresses administrative costs, hospital budgeting and uniform payments to doctors, Richter said.
Whether the federal government will give Vermont a waiver to adopt a universal health care system in 2014 is an open question. Richter said the state has a 50-50 chance of getting the exemption from the Affordable Care Act. Even so, she believes Vermont’s attempt to create a single-payer system is worthwhile.
“You go for what you want, not for what you think you might get – that’s what the bill does,” Richter said.
The Senate debate focused on the state’s implementation of the insurance exchanges that are required under federal law. The Affordable Care Act has mandated that states provide an actuarial value for insurance products (the insurance equivalent of a per unit price mechanism that allows consumers to compare the cost of on the shelf grocery items). The federal government has set up very general guidelines for the actuarial levels for insurance products insurers must provide under the exchange. The idea is to create an easy system for comparison between health insurance benefit plans that offer a dizzying array of deductibles, co-insurance, co-pays and premiums. The products, under the federal requirements, range from bronze (60 percent actuarial value) to silver (70 percent), gold (80 percent) and platinum (90 percent). It also puts minimum requirements on the “qualifying plans.” Many of these mandates are already in Vermont law. Insurers, for example, are not allowed to “cherry pick” consumers who are healthy and create pools without a cross-section of the sick and healthy populations.
Read this summary of the ACA requirements from Kaiser Foundation.
The Affordable Care Act requires individuals without insurance to buy into the exchange or face a $695 fine. Families of four with incomes of less than $88,700 qualify for tax credits. Businesses with more than 50 employees that do not buy insurance face a penalty of $2,000 per worker.
The fight between employers and proponents of H.202 was about the potential for mandatory inclusion of businesses that have between 50 and 100 workers in the exchange. Sens. Hinda Miller, D-Chittenden, and Illuzzi argued that requiring companies of that size to participate in the exchange could jeopardize their economic viability. Employers in that range tend not to self-insure and so are not protected under the Employee Retirement Income Security Act.
The federal law allows states some flexibility. States can decide what benefit plan levels can be offered, for example. They can also determine the size of the businesses that must be included in the exchange. The Shumlin administration pushed for intent language in the bill that could have led to the inclusion of businesses with 50 to 100 employees into the exchange. Proponents of H.202 have said it’s important to include these 28,000 workers in the state’s insurance exchange in order to build toward a single-payer system.
An amendment proposed by Sen. Diane Snelling, R-Chittenden, and approved by the Senate struck the intent language. The Green Mountain Care board, which will oversee the health care reform effort including the exchanges, is charged with producing a report that would outline the impact of excluding the 50-100 employee group on the exchange, which the Shumlin administration wants to use as a stepping stone toward the single-payer system.
Illuzzi proposed two amendments that would have forced the state to include a broader array of insurance carriers in the exchange, would have specifically allowed health savings accounts and high deductible plans under the exchange and would have allowed “nonqualified” plans outside the exchange. H.202 allows for two carriers.
“Let’s not kid ourselves it will be more than one carrier,” Illuzzi said on the Senate floor. “It will likely be Blue Cross Blue Shield. It will be two carriers in name only. Both will be required to offer same (plans). It will be a change without a difference.”
Anya Rader Wallack, Shumlin’s special assistant on health care, said she was impressed by the Legislature.
“A lot of people worked very hard educating themselves in a short period of time,” Wallack said. “This isn’t simple stuff. I was impressed with the amount of effort both bodies have put into this.”
The Shumlin administration was heavily involved in drafting the bill, H.202. By the time the legislation reached final passage it had changed somewhat from its original incarnation, which was based in part on recommendations from Professor William Hsiao, the renowned Harvard economist who created a single payer system for Taiwan.
Over the next year, the Shumlin administration will hire a director of health care reform and the chair of a quasi-judicial board. The board would be in place by January 2012 and would begin the arduous task of sorting through the maze of federal laws, waivers, benefits, provider reimbursements, system financing and cost containment options.
H.202 will be read in the House Health Care Committee on Wednesday morning. Rep. Mark Larson, D-Burlington, said he expects the bill will go to conference committee in several days. He expects to have no major beefs with the Senate version.
“The core composition of the bill remains identical to what passed in the House,” Larson said. “There are differences between the two bills but they are things we can work out.”
Larson said those details include a change in the dynamic of the board. “We want to make sure it’s an independent board.”
He also referred to the so-called “Mullin” amendment, which set conditions for implementation of Green Mountain Care, the single-payer style system that would be created under H.202. Larson said he thinks the new criteria for the implementation standards need to be more clearly defined.
“It has to be clear what hurdle has to be overcome,” Larson said.