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Vermont Single-Payer Law Has a Long Way To Go

Margaret Dick Tocknell, for HealthLeaders Media, June 8, 2011

The next step is to get the five-member Green Mountain Care Board up and running. That is the healthcare board charged putting together the nuts and bolts of statewide healthcare reform and ensuring that H202 delivers what it promises, including cost containment and payment reform. A nine-member committee, packed with reform supporters, has been appointed to vet potential GMC board members.

The Green Mountain Care Board will have a great deal of power. Beginning in January 2012 it will review insurance rate requests and later on in the year it will turn to hospital budgets. In between it will set the benefit package for the program. And yet with the exception of a few whimpers, the provider and payer industry has remained quiet on the issue. The Vermont Medical Society and the Vermont Hospital Association supported the reform efforts.

On the payer side, even the giant Blue Cross Blue Shield of Vermont supported the proposal.

Kevin Outterson, an associate professor in law and public health at Boston University has studied H202 and followed the legislative process. In an interview with HealthLeaders Media, he attributed the provider and payer support to the long standing connections within the small state as well as the size of Vermont's provider market.

He notes that the Blues plan has a deep relationship with the physicians and hospitals throughout the state and that there are only four significant hospital systems in Vermont. "The state needs every hospital to participate in the single payer so Green Mountain isn't going to squeeze out or bankrupt the hospitals."

In addition, BCBSVT hopes to snag the contract for the payment system for the new single-payer plan.

Major employers such as IBM are more reticent, according to Outterson. "They are worried about the cost and taxes." Financing is a huge unknown, but payroll or income taxes and some pooling of federal funds such as Medicare and Medicaid is expected. In media interviews Gov. Shumlin has expressed a preference for getting the cost containment measures in place first and then turning to the financing issues.

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