House, Senate Ponder Single-Payer Details

April 10, 2014

Vermont Public Radio
By Peter Hirschfeld

Less than three years from now, Vermont is scheduled to make the transition to a single-payer health care system. And while the all-important question of how to pay for it has been put off until 2015, lawmakers say it’s time to start making some tough decisions about what that future system will look like.

Act 48 is the landmark statute that set Vermont on a course toward a publicly financed, universal health care system. But the law left plenty of details to be worked out. And Sen. Tim Ashe, chairman of the Senate Committee on Finance, wants to lend shape to the single-payer structure.

"Act 48 envisions a future health care system where every Vermonter has a decent health insurance plan as a right of being a citizen of Vermont. The challenge then is, how do we realize that vision when so many people have so many different relationships to health insurance today?" - Chittenden Sen. Tim Ashe.

Ashe, a Chittenden County Democratic/Progressive, helped craft a wide-ranging bill that aims to crystallize that vision. The bill, for instance, makes the state’s single-payer plan the coverage of last resort for Vermont residents on federal health care plans – like federal employees or members of the military. That means that the federal plan would continue to cover the individual, and that single-payer coverage would kick in only for things that weren’t covered by the underlying federal policy.

“What we are trying to do is bring clarity to those many active military people and the thousands of federal employees that live in Vermont, that their primary coverage, which they currently enjoy through the federal employee health benefit program, or through TriCare (military health benefits), will continue, that we are not going to disrupt that for them or make them pay twice for it,” Ashe says.

The legislation also enforces new timelines on the Shumlin Administration for selecting the vendor that will administer the single-payer system. Under the Senate’s version of the bill, the administration would have to begin the selection process before the end of next year.

The legislation won approval in the Senate last month, and is now under review by the House Committee on Health Care, which looks poised to make some significant alterations.

Rep. Mike Fisher, a Lincoln Democrat and chairman of the House Committee on Health Care, says that lawmakers have learned a lot since they passed Act 48. And he says the Senate bill provides a way for legislators to put some of that knowledge to use.

“What do we now know three years later that informs the decisions that are in front of us about the next steps?” Fisher says. “And I think that’s the goal of the bill.”

Fisher says he doesn’t think lawmakers should mandate any timelines for selecting an administrator for the single-payer plan, which will be called Green Mountain Care.

“We have learned some things from the launch of Vermont Health Connect,” Fisher says. “I want them to be putting RFPs out for administrators of Green Mountain Care when they have the terms of those contracts ready.”

But Fisher says it is appropriate for legislators to require the administration to deliver a more finely tuned analysis of how a publicly financed system would affect businesses in the state.

“We don’t know exactly what the revenue package will look like, but when we do have revenue packages in front of us, we need to fully understand the impacts on the business community,” Fisher says.

Fisher, Ashe and other House and Senate leaders will meet later this month to reconcile their competing versions of the bill.