MONTPELIER — There aren’t many people who
feel positive about the health of health care in
Vermont.
House Speaker Shap Smith was blunt in his
assessment: "The status quo is broken."
Many businesses struggle to afford the ever-
increasing cost of providing health-insurance
coverage for employees, according to Vermont
Chamber of Commerce President Betsy Bishop. "I
don’t know how we are going to get this burden
off the backs of employers," she said.
Absent change, trends suggest the burden will
grow heavier.
A state analysis of health care expenditures
predicts the costs are on course to increase by
$1 billion between 2009 and 2012.
Sen. Jane Kitchel, D-Caledonia, cited more
symptoms of an ailing health care system.
Access to primary care is shrinking, some
hospitals are struggling, and 7 percent of
Vermonters remain uninsured, the co-
chairwoman of the Legislature’s Health Care
Reform Commission said. "It is not sustainable,"
she said.
None of these problems are new, but what is
different as 2011 dawns are new opportunities
and drivers of change. Here’s what is on the
horizon:
• Peter Shumlin, who becomes governor Jan. 6,
had pledged an all-out push to bring a single-
payer health system to Vermont. He wants
employers freed of the burden of providing
health insurance to their workers so Vermont
businesses can compete on equal footing in the
global economy. Shumlin hired a special
assistant to coordinate his administration’s
reform efforts.
• By February, Dr. William Hsiao, a Harvard
economist and consultant hired by the
Legislature, is to deliver three designs for more-
efficient and -effective health care systems that
cover all Vermonters. One design will be a
single-payer system. Another will combine the
private insurance market with a public option.
Option three is expected to be the one Hsiao and
his colleagues think is viable and practical.
• The 2009 federal health reform act requires
states to take steps in 2011 to plan for health
benefit exchanges or marketplaces where
individuals and small businesses will be able to
shop for health-insurance coverage beginning in
2014. "The exchange is a way we access federal
subsidies for individuals and small businesses,"
Kitchel said. "It is significant money. We will
move forward on the exchange."
With impetus for change coming from three
directions, Rep. Mark Larson, D-Burlington,
predicted: "The potential to do some substantial
work on health care is significant."
Anya Rader Wallack will be the point person for
the Shumlin administration’s multi-pronged
health reform initiative. It will be her job to
make sure the work on the health benefit
exchange at the Department of Banking,
Insurance, Securities and Health Care
Administration meshes with any change in the
way Vermonters gain health insurance coverage
that emerges from the consultant’s
recommendations and from the Legislature.
She will try, also, to ensure progress on an
exchange and a single-payer system ties in with
the spread of health information technology and
with ongoing efforts at the Department of Health
and the Department of Vermont Health Access to
refocus medical care on prevention, health
outcomes and management of chronic conditions
rather than crisis treatment.
"It is bold," Wallack said of the assignment
Shumlin set for her and the rest of his health
care team. "Is it mission impossible? No. If the
mission is to put Vermont on a path toward
single-payer and make significant progress, we
can do that."
Wallack grew up in Vermont but now lives in
Rhode Island and runs a health care consulting
business — Arrowhead Health Analytics — in
Massachusetts. She agreed to work for Shumlin
for a year, spending at least three days a week
in Vermont. She began gearing up for her new a
ssignment immediately after he announced her
appointment Dec. 13. "We will really kick in once
the governor is sworn in," she said.
Wallack’s determination doesn’t lessen the
obstacles that could slow or trip up health
reform.
"We will run into barriers," she acknowledges.
Jim Hester, who is departing for a federal health
reform job after four years as executive director
for the Health Care Reform Commission, outlined
some challenges he sees.
"It is a formidable task to simultaneously build
on what we have done, build a bridge to what
the federal government has done and chart a
course to the next stage of health care reform
— and to do it in the face of state budget
issues," Hester said.
Craig Fuller, who with his wife, Jeanne Keller,
runs Employer Health Alliance, added, "We have
all these decisions that we have to make and all
these decisions that we could make — and we
have a lot of new players."
With a new governor, new commissioners and
new heads of both the Senate and House health
committees, Fuller suggested it would take time
to get everyone up to speed and educated.
Would there be enough time in this legislative
session also to come up with a big bill and sell it?
"Something can be done," Fuller said. "Something
has got to be done."
The time is right for change, said Kitchel, who
spent her professional career in the Agency of
Human Services before becoming a state
senator.
"We are going to probably have the best
information to make future decisions that we
have ever had," she said. That’s thanks to the
Vermont-specific data Hsiao and his colleagues
will have gathered and analyzed, Kitchel said.
"We will be in a position to have informed
decision-making."
Wallack reminded about the need: "If we do
nothing, we aren’t any closer to solving the
problems."
Health reform to-do list
Here are some of the health care issues the new
Shumlin administration and the Legislature are
expected to take up in 2011:
• HEALTH BENEFIT EXCHANGE: The Shumlin
administration will recommend how to set up
Vermont’s exchange: a marketplace called for in
the federal health reform law where individuals
or small businesses could shop for health
coverage. One of the decisions will be whether
the exchange is run by the state or some non-
profit entity. Legislature will review and enact a
framework for the exchange.
• HEALTH DESIGN OPTIONS: Lawmakers will
review and take action on recommendations
from Harvard economist Dr. William Hsiao about
how to transform the health care system.
• PAYMENT REFORM: Lawmakers will review
designs they requested from executive branch
for how to change the basis for paying doctors
and other health care providers. The report
should also spell out how a test of a payment
reform system could occur beginning in January
2012.
• HEALTH FUNDING SHORTFALL: Lawmakers must
find remedies for the revenue shortfalls p
rojected for Medicaid and Catamount Health.
• HEALTH INFORMATION TECHNOLOGY:
Lawmakers may consider the need for
protections of privacy and security in light of the
proliferation of electronic medical records.