July | August 2017




Vermont’s Single-Payer Health Care Law

By Sarah Bounse, CSG Research Assistant
When he signed a health care bill (http://www.leg.state.vt.us/docs/2012/bills/Intro/H-202.pdf) implementing single-payer care, Vermont Gov. Peter Shumlin praised his state’s legislature for becoming “the first state in the country to make the first substantive step to deliver a health care system where health care will be a right and not a privilege.”
The new single-payer system is scheduled to be in place by 2017, although it could be in place by 2014 if the federal government allows a waiver from the Affordable Care Act.
The new health care exchange, known as Green Mountain Care, will be managed by a five-person board that will oversee the implementation and development process, along with evaluating the effectiveness of the delivery system in maintaining health care quality and reducing health care costs in the state.
Rep. Mark Larson, the bill’s sponsor, told CSG the next step will be the recruitment of the Green Mountain Care board. Larson said a nominating committee that reviewed possible board members’ qualifications will make an announcement regarding the board this week. 
Critics of the new legislation, however, worry about the amount of power the five-person board will hold.
Sen. Randy Brock said the unelected panel would “have almost complete control over all aspects of health care in Vermont. The board could define what constitutes ‘adequate’ care. And, as far as board members are concerned, we can’t vote for them, we can’t fire them and we have to participate on (the board’s) terms. ”
Larson explained the reasoning behind the board makeup.
“As we developed the board, there was pressure to keep it small enough for it to be efficient and keep it large enough to have to have too few people invested with too much authority,” he said. “There was no magic formula to have it five. It was the number people felt most comfortable with.”
A finance plan for Green Mountain Care must be completed by early 2013. Larson said a mechanism is already in place for funding the state's health care system.
“Right now, (funding) is done through insurance premiums, tax dollars and private funding.,” Larson said. “(With Green Mountain Care), we would replace (these other forms of funding) with equitable and broad-based public financing.”
He said the administration has been instructed to consider all funding options, including a payroll tax.
Brock fears the state will not have adequate funding to implement Green Mountain Care. “One of the biggest problems with governmental involvement in health care is that government always over promises and then fails to pay,” he said.
But Larson reiterated the importance of fair forms of funding for the new health care exchange.
“We are talking about raising money in a different way, not raising new money. (We are) looking at finding equitable, fair ways to find money already in the system,” he said.
The central tenet behind Green Mountain Care, Larson  said, is that solving the health care crisis cannot be achieved by looking at the health care system in parts. “We have to look at the system itself and (determine) how to control overall system costs.”
Critics argue other means of lowering health care costs, along with ensuring insurance coverage is extended to those who currently do not have it, are available.
Brock said these options include making pricing more transparent, rewarding healthy lifestyles, encouraging insurer competition and creating a catastrophic loss program to ensure no one is bankrupted by illness, among other strategies.
“But we are not doing (these ideas),” Sen. Brock explained. “Our legislature has been seized with the religious fervor of single payer and is proceeding on a single path.”
But Larson said Vermont is responding to the challenges the state and nation face in addressing the health care crisis.
“We really do see ourselves as responding to the president’s challenge to meet and exceed the goals of the Affordable Care Act,” Larson said. “We certainly believe that we are doing what the spirit of the Affordable Care Act intended and we hope to have the administration’s support in (continuing forward).”

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