Vermont and its educators lead the way on single payer

By Mary Ellen Flannery
NEA Today, June 27, 2014

The same state that led the nation on same-sex marriage is now tackling another social justice issue: health care coverage for all of its residents.

Led by Gov. Peter Shumlin, with the strong support of VT-NEA and its leaders, the state of Vermont is moving effectively toward becoming the first in the U.S. with a universal, publicly funded healthcare system. Also known as “single payer,” a universal system promises to contain the out-of-control costs of health care while delivering high-quality, comprehensive, and affordable care to all Vermonters, no matter their family income, employment status or background.

“Many people may have been surprised and a little curious (to hear) Vermont-NEA was backing the move toward universal, publicly funded health care,” wrote VT-NEA President Martha Allen this spring. “After all, the thinking goes, members of the state’s largest union already have comprehensive and affordable health insurance, so why on earth would they support Vermont’s efforts to become the first U.S. state to go down this road?

“The answer, of course, is that the creation of Green Mountain Care is good for Vermonters.”

Proponents of universal health care in Vermont, including many doctors and small business owners, began decades ago to pursue a unified health care system. In 2011, they won a key victory: Passage of Act 48, a state law requiring creation of a “universal and unified” health care system for the “public good” of all Vermont residents. Called “Green Mountain Care,” the new program must, by law, cover residents “in a seamless manner regardless of income, assets, health status, or availability of other health coverage.” It also must work to contain costs, provide patients with choices, and preserve and enhance primary care in Vermont’s communities.

“There’s no reason that anybody in Vermont, regardless of who they are, where they work, or what their health status is, should be without comprehensive, affordable health care,” said Mark Hage, VT-NEA’s health-policy expert. “We’ve been a leading player here to expand access to public health care  for Vermonters. This has always been important to us as a union. We believe it’s the right thing to do.”

If all goes well with the General Assembly’s next task—finding the money to pay for roughly $2 billion program— Vermonters will be enjoying Green Mountain Care in 2017, the first year that states may be permitted to enact a single-payer system under the federal Affordable Care Act (ACA). At that point, it could be a model for other states interested in following its lead.

“Vermont is a very progressive state,” said Ida Hellender, of the Physicians for a National Health Program. But the essential ingredients of Vermont’s health care system can be found anywhere: “They have doctors, they have hospitals, they have the same kinds of bodies that the rest of us do…”

Opportunity knocks

NEA has long believed that “affordable comprehensive health care … is the right of every resident,” and that belief has been codified among the NEA resolutions adopted by the NEA Representative Assembly (RA) each summer. NEA also has resolved to support a single-payer system for the United States, and to support the reform efforts that will move the U.S. closer to that goal. That includes technical and financial support for the current efforts in Vermont.

There are few things about Vermont that make it a likely pioneer of universal, publicly funded health care. For one thing, with a population of about 625,000, it’s small. (By contrast, its neighbor Massachusetts has 6.6 million residents.) “It’s possible to actually talk to almost every Vermonter about the benefits of Green Mountain Care,” said Peter Sterling, director of Vermont Leads, a nonprofit organization that advocates for universal, publicly funded healthcare. (To sign Vermont Leads’ petition for universal, publicly funded health care for all, or to contribute financially to its advocacy efforts, visit its website.)

For another thing, Sterling pointed out, Vermont already has very popular and very successful state-funded healthcare systems. Its program for kids who live in poverty, “Dr. Dynasaur,” has provided excellent care for 25 years (without deductibles or co-pays), helping to make Vermont’s children “the healthiest kids in the nation,” according to data collected by the U.S. Centers for Disease Control and Prevention. Additionally,  another state-funded, comprehensive program called Catamount Health, which existed for several years until the start of Vermont’s ACA-mandated “state exchange,” covered Vermont working families who weren’t  Medicaid-eligible.

But 47,000 Vermonters still lacked health insurance at last count, and many tens of thousands more have private insurance but can’t actually afford to use it—and it’s only getting worse for them. Nearly 90,000 Vermonters now pay for their insurance through Vermont Health Connect, an ACA-mandated “state exchange” or online marketplace, and its prices are expected to soar next year. Blue Cross Blue Shield of Vermont, which sells nearly two-thirds of the policies on the state exchange, has asked state regulators for a 9.8 percent increase; its “silver plan” would go from $425 a month to $471.

Vermont and its residents spend almost $5 billion each year on health care costs, up from $2 billion in 2000. Per person, they spent $7,876 in 2010, up from $3,776 in 2000, according to the Green Mountain Care Board.

“I hear from a lot of people who can’t afford the out-of-pocket costs. Nurses tell me that they give their patients dollars, so that they can afford their prescription drugs. If somebody has a $20 co-pay to see their mental-health specialist, they’re just not going to go,” said Sterling. “Vermont is not a wealthy state. A lot of providers are saying that their non-Medicaid eligible patients, lower-middle income people, can’t get the recommended care because they can’t afford the costs.”

Even VT-NEA members aren’t immune from these cost increases. While their collectively bargained contracts often provide affordable, high quality health benefits (in many cases, they have deferred salary increases to keep those benefits), it’s becoming harder to retain these high-quality benefits with premium co-pays that are affordable. Cost pressures, of course, are also hurting retired members.  .

Moreover, while most Vermont teachers and educational support professionals are insured through the Vermont Education Health Initiative, a unique health care trust run by VT-NEA and the Vermont School Boards Insurance Trust, eventually certain provisions in the ACA, and in state law, will hasten the dissolution of that trust, compelling almost all of those educators to join the state exchange.

“It won’t happen overnight, but it will happen,” said VT-NEA’s Hage. At that point, what’s already clear should become obvious to all VT-NEA members: The state needs a unified, universal health care system that its residents can actually afford and enjoy. And when that happens, VT-NEA will make sure its members, active and retired, do not suffer in the transition to a universal system.

“Vermont-NEA’s members have been at the forefront of social justice issues for more than a century, and have done great work to ensure that working people and their families are treated fairly, compensated justly and allowed to live with dignity,” said Allen. “We pledge to continue that great tradition and will not waver in our commitment to making sure Green Mountain Care brings comprehensive, affordable benefits for all of us.”

Vermont and its Educators Lead the Way on Single Payer