Single Payer: "We haven't figure it out yet"

October 14, 2014

Rutland Herald

By Neal P. Goswami
Vermont Press Burea

MONTPELIER — Gov. Peter Shumlin is adamant that his plan for a universal, publicly financed health care system is on track to move forward in the coming legislative session. But as the months have ticked by without a financing plan from the governor, some key stakeholders and allies have begun to express doubts.

According to Act 48, the legislation passed in 2010 that laid the foundation for the so-called single-payer Green Mountain Care plan, Shumlin was required to reveal his financing plan in January 2013. The law created the blueprint for the system that would provide universal health insurance coverage to all Vermont residents, paid for by taxes rather than premiums.

But Shumlin has still not released his financing plan, saying he simply can’t do so because it has not been completed. He promises to reveal it to lawmakers and the public in January.

The delay has allowed his political opponents to cry foul and accuse him of withholding the plan to raise the needed $2 billion in taxes from voters until after the Nov. 4 vote, in which he is seeking re-election.

Not so, Shumlin counters.

“I have heard the assertion that we’re somehow hiding the financing plan for political reasons and we’ve got it all figured out and we just don’t want to show it to people. I wish that were true,” Shumlin told the Vermont Press Bureau.

“The toughest thing that I’ve had to do, that my team has been asked to do, is to design a financing plan that actually works,” he said. “I’m being honest with you when I tell you we haven’t figured it out yet. We’re getting closer. It’s much more complicated than it looks. It’s much more complicated than it sounds. Frankly, it’s more complicated than I thought it would be.”


‘Huge’ challenges

The delay has created plenty of time for doubt to fester, and the ground may now be shifting under the governor’s feet.

For one, Shumlin, who once enjoyed approval ratings in the 60s, is now viewed favorably by 45 percent of Vermonters, according to a recent poll conducted by the Castleton Polling Institute for WCAX.

The same poll showed a split electorate when asked about Shumlin’s health care plan. Only a slim plurality of 44 percent favor moving forward with single payer while 42 percent oppose the idea. The question was largely split on party lines, with 72 percent of Democrats favoring the idea and only 11 percent of Republicans backing the idea.

Shumlin’s biggest issue may be that 44 percent of voters who identify themselves as independent oppose his plan and 41 percent of independents favor it.

The disastrous rollout of Vermont Health Connect, the state’s online insurance marketplace that was born under the federal Affordable Care Act, has likely played a roll in poll results.

The website was taken offline in September because of security concerns raised by the federal government. Before that, core functions of the site did not work nearly a year after its October 2013 launch.

Shumlin said struggles with the site have contributed to delays in figuring out how single payer will be paid for.

“Yeah, of course it did. I’ve got the people I’ve hired to help me figure out financing for single payer crisis managing the health website. You know, it’s not a huge state. I don’t have an endless staff,” he said.

“Do I wish we were further along? Yes. Will we be ready in January? I’ve got to be. Have we had our challenges on the health care front? Huge, and we’ve been a little distracted by them,” the governor said. “We haven’t been able … to put all hands on deck on this project because we’ve had to deal with the challenges of Vermont (Health) Connect.”


Health industry concerns

Thomas Huebner, president of Rutland Regional Medical Center, said he has questions about Shumlin’s plan that have yet to be answered.

Among the concerns is whether the system will actually save money. He said uprooting the health care system must cut health care costs rather than just “changing the way the world pays.”

“I am no apologist for the status quo. We really believe that does have to change,” Huebner said. “It’s not a sustainable model.”

Huebner said he also worries whether Shumlin’s plan will improve access to health care for Vermonters. He said Vermont achieved about 90 percent inclusion with the former Catamount Health plan. But since the adoption of the Affordable Care Act and the Vermont Health Connect online insurance exchange, more people are on high-deductible plans, he said.

“I believe that we have slipped back some,” said Huebner, who also serves as chairman of the Legal and Legislative Affairs Committee of the Vermont Association of Hospitals and Health Systems.

Perhaps the biggest concerns for Huebner and other hospital officials around the state is whether Vermonters will be able to continue choosing their own doctors and hospitals, and whether there will be money in the system to pay doctors, nurses and health care professionals enough to keep them in Vermont.

“There is a general worry on the part of people who have been in the field a long time … that they are always underpaid for care delivered and there is cost shifting,” he said.

In Huebner’s case, he says he is raising questions but trying not to formulate an opinion yet on what might be coming.

“You don’t want to be overly judgmental with something that’s not on the table yet,” he said. “Without the full detailed proposal on the table, frankly, all we can do is express concerns.”


Pledges and hedges

Some key lawmakers, including House Speaker Shap Smith, D-Morrisville, are pledging to continue efforts to implement the goals of Act 48, but stop short of endorsing Shumlin’s vision of reform.

“I think that the governor and the Legislature have put in a lot of time to try to move this forward,” Smith said. “We’ve always known that it would be a heavy lift. My commitment is to continue to try to move forward with something that will allow all Vermonters to have affordable health care and to have a system that is more fairly financed.”

He promised the House will carefully dissect whatever financing plan Shumlin submits to ensure that it meets the criteria laid out in statute.

The end result may not be what Shumlin proposes, Smith warned.

“I don’t know what the governor’s going to put on the table, and as is the case in any legislative proposal that any administration puts forward, what gets put on the table and what ends up passing often are different things,” Smith said.

“I’m committed to working with the administration and the governor to move forward with a plan that will increase access for Vermonters to have affordable health care and make more sure that it’s more fairly financed,” he said.

Peter Sterling, executive director of Vermont Leads, a pro-single payer advocacy group, said the cautious statements from lawmakers and concerns raised by stakeholders is not surprising.

“In the absence of information fear takes over in a policy debate,” he said. “Because we don’t have the governor’s finance plan, we cannot answer basic questions that everyone cares about — how much are we going to pay, can I see my doctor and what’s covered?”


Trepidation, anxiety

Even Shumlin acknowledges and accepts the quandary, saying he “can’t blame anyone for expressing trepidation.”

“It doesn’t confuse me that there’s both trepidation and anxiety about what we don’t know,” he said. “My problem is if we’ve learned anything from the Affordable Care Act it’s don’t go out with something that isn’t ready. And we’re not ready.”

The governor added, “Are we more vulnerable because we’re not ready? Maybe, but I really can’t go out there with something that’s half-baked.”

Sterling, who has been working with legislative candidates this election season, says the good news for Shumlin is that voters continue to support the core principals of Act 48 — increasing access and funding health more equitably.

“It’s not like the public has turned on the idea of universal health care,” he said. “The poor rollout of the Vermont Health Connect website has done more to undermine confidence in elected officials than it has to the core ideas of Act 48,” Sterling said.

But the delay and the exchange woes have caused undeniable harm, acknowledged Sterling.

Shumlin hopes to launch his system in 2017, but plenty of hurdles remain. Lawmakers may balk at the idea of raising $2 billion in new taxes from their constituents. But Shumlin has proven to be an adept politician on many occasions.

The federal government must also agree to waivers that will allow the state to funnel the funding for programs like Medicare and Medicaid through the state’s new system. That may be a bigger challenge, particularly if waivers are not granted before President Barack Obama departs office and if a Republican moves into the White House.

Despite the lingering challenges, Sterling said things will be back on track if lawmakers advance a funding proposal during the 2015 legislative session. But it may not be exactly what Shumlin has envisioned.

“I believe, if the Legislature votes on a financing package this session, we will still see a universal health care package in place in 2017,” Sterling said. “It will achieve the goals of Act 48 — it’s universal, it’s fairly financed.”