Sunday, January 22, 2012

Vermont wants to be a single payer state

The State of Vermont is fast on its way to not only achieving compliance with health care reform requirements, but to becoming a single-payer state, and other states should perhaps take note of, or at least admire, its pro-active approach. On January 17, 2012, the 5-member Green Mountain Care Board issued its report to the Vermont General Assembly, detailing how it is laying a foundation for fulfilling the purposes of Act 48, a bill signed last May by Vermont governor Peter Shumlin.

The stated purpose of Act 48 is to provide Vermont residents with high quality, publicly-financed health care by maximizing the receipt of federal funds, including those available via the Patient Protection and Affordable Care Act (ACA). The Act states that "Vermont must begin to plan now for health care reform, including simplified administration processes, payment reforms, and delivery reform." Furthermore, with Act 48, Vermont is establishing a universal health care program, called "Green Mountain Care," that is to provide health benefits via a single payment system.

As a result, Vermont's director of health reform, Robin Lunge, will oversee the integration of multiple payers into the Vermont health benefit exchange.

A bill is now under consideration (H.559) by the Vermont legislature that, among other things, merges the individual and small group insurance markets, gives the Green Mountain Care Board authority over health insurer rate review, hospital budget review, and certificate of need processes, bans discretionary clauses in health insurance contracts, and restricts the amount of insureds' out-of-pocket expenditures for prescription drugs.

According to Lunge, the Green Mountain Care Board is tasked with controlling costs, establishing a health benefit exchange in 2014, and establishing a single-payer system when federal waivers are available under the ACA, which is currently 2017, although Lunge said that a Congressional delegation has introduced a bill to move that date to 2014. Lunge has stated that Vermont's goal is one of "an exchange on steroids," one that pushes for health reform and moves toward a single payer system and reduces system complexity.

Cost now appears to be foremost on the Board's agenda. Lunge said that Vermont wants to pay "for value, not volume," and that its goal is not to spend more once it is in the new single-payer system. It is the goal of the Green Mountain Board to figure out how to do that, she added.

For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.


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