Correction: State No Longer Looking to Administer Medicare

By Anne Galloway
VTDigger, October 26, 2014

Two recent stories about the relationship between Medicare and Green Mountain Care, the state’s planned universal publicly financed health care program – often called single-payer – were inaccurate. The stories were based on statutes on the Legislature’s website that had not been updated.

Section (e) of chapter 18, Public Private Universal Health Care System, in Title 33, Human Services, still states online that, “The Agency shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont. If the Agency is unsuccessful in obtaining such permission, Green Mountain Care shall be the secondary payer with respect to any health service that may be covered in whole or in part by Title XVIII of the Social Security Act (Medicare).”

Act 144, which was enacted in 2014, repeals that section, though the statutes have not been updated online.

Section (f) of the same chapter now reads, “Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.”

State officials have said they are no longer seeking to administer Medicare as part of Green Mountain Care, and the law reflects that change.

It is currently unknown what Green Mountain Care will cover or what private supplemental health insurance policies will be offered once the program is in place.

Gov. Peter Shumlin has said there is no reason to expect that currently available supplemental coverage options for Medicare would change if the state moves forward with a single-payer health care system.

http://vtdigger.org/2014/10/26/correction-state-longer-looking-administe…

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Vermont Act 144

An act relating to miscellaneous amendments to health care laws.

Sec. 1  Principles for Health Care Financing

(3)  As provided in 33 V.S.A. § 1827, Green Mountain Care shall be the payer of last resort for Vermont residents who continue to receive health care through plans provided by an employer, by another state, by a foreign government, or as a retirement benefit.

Sec. 2 Vermont Health Benefit Exchange

(4)  To the extent permitted by the U.S. Department of Health and Human Services, the Vermont Health Benefit Exchange shall permit qualified employers to purchase qualified health benefit plans through the Exchange website, through navigators, by telephone, or directly from a health insurer under contract with the Vermont Health Benefit Exchange.

Sec. 6  Administration; Enrollment

(e) [Repealed.]

(f) Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.

Governor signed bill: May 27, 2014: http://www.leg.state.vt.us/docs/2014/Bills/H-0596/ACT0144%20As%20Enacted…

Green Mountain Care: http://www.greenmountaincare.org/vermont-health-insurance-plans

Vermont Health Connect: http://info.healthconnect.vermont.gov/healthplans

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Shumlin Won’t Pursue Single Payer If It Doesn’t Help Economy

By Bob Kinzel
VPR, September 12, 2014

Act 48, the law that put Vermont on the path to a single-payer health care system, was passed in 2011. It called on the governor to unveil a single-payer financing plan in January of 2013.

That didn’t happen because Shumlin said he needed more time to develop a plan. Shumlin said he would be ready to release his proposal in January of this year.

But Shumlin missed this deadline as well. He now says he’ll unveil his plan at the start of the Legislative session in January.

Shumlin says there’s no point pursing a single-payer option if the effort will hurt the state’s business community.

“If we come up with a financing plan that doesn’t grow jobs, economic opportunity, and make Vermont more prosperous, trust me, we’re not going to do it,” said Shumlin.

http://digital.vpr.net/post/shumlin-wont-pursue-single-payer-if-it-doesn…

Many consider Vermont to be the trailblazer for a state single payer program, serving as a model for other states to enact single payer reform. Vermont does have lessons for the rest of us. Let’s see what they are so far.

Green Mountain Care is Vermont’s program for Medicaid and for Dr. Dynasaur (Vermont’s Medicaid program for children and pregnant women). Most participants are now required to enroll in PC Plus – a Medicaid primary care managed care program. Vermont Health Connect is Vermont’s health insurance exchange (marketplace) under the Affordable Care Act through which individuals and small businesses can purchase insurance.  Many Vermonters still have access to other programs such as Medicare, employer-sponsored health plans, retiree plans, and federal employee programs such as FEHBP and Tricare. So far this is not really much different than programs in other states – certainly far from single payer.

What about Medicare? Vermont has given up on attempting to become the administrator of Medicare, much less rolling Medicare funds into a universal single payer program. Gov. Peter Shumlin has even stated that “there is no reason to expect that currently available supplemental coverage options for Medicare would change.” Thus apparently they are continuing even the private Medigap supplements and private Medicare Advantage plans.

What about Green Mountain Care – the Medicaid program that was to be the single payer for Vermont? A few months ago legislation was signed by Gov. Shumlin that stated, “Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.” Further, “Green Mountain Care shall be the payer of last resort for Vermont residents who continue to receive health care through plans provided by an employer, by another state, by a foreign government, or as a retirement benefit.” At this point in time, that does not look like a program that is being remodeled to fulfill the role of a single payer.

The original Vermont legislation called on Gov. Shumlin to unveil a single payer financing plan in January, 2013. He missed that deadline and again missed the next one in January, 2014. He now says that he intends to release a plan in three months. We will have to wait to see what that proposal is, but at this late stage he is saying, “trust me, we’re not going to do it,” if the effort will hurt the business community. That seems quite tenuous for having worked on it a couple of years.

Many still talk about the enabling ACA waiver that Vermont will obtain in 2017, but the ACA section 1332 waiver applies only to the subsidies and some specific requirements of ACA. Even combined with Sec. 1115 Medicaid waivers and waivers for Medicare demonstration programs, especially considering the ERISA barriers, we simply do not have enough leeway for states to independently establish their own bona fide single payer systems.

The point is that we must have comprehensive federal legislation if we wish to establish state-level single payer systems. We need need the federal funds currently used in other federal health programs such as Medicare and Medicaid, and we need relief from federal statues and regulations such as ERISA. It would be far better to simply enact a national single payer program, but those who wish to pursue a state model must still advocate for comprehensive federal legislation.

Regardless, we can have single payer if we all work together to create the momentum for federal legislation, state and/or national, but none of us will see single payer if we each confine our activities to our respective states. Many have called for a cooperative effort. This is it!