Burlington Free Press
Written by The Associated Press

MONTPELIER — Lawmakers have taken the
first step toward a single-payer state
health care system, with a House panel
voting to set up a five-member board to
design a benefit package and figure out
how the system would work.

The House Health Care Committee’s 8-3
vote in favor of the bill late Thursday night
set up expected debate in the full House
on March 23 on a bill that would set
Vermont on a path toward Gov. Peter
Shumlin’s goal of providing health insurance
to every resident.

"We’re happy. The administration is
happy," said Steve Kimbell, commissioner
of a state agency involved in health care
who has been lobbying lawmakers on the
issue. But he added that administration
officials would study the bill to see what
improvements might be needed.

The committee’s vote was along party lines,
with Democrats, a Progressive Party
member and a liberal-leaning independent
supporting the measure and three
Republicans opposing it.
Rep. Mike Fisher, D-Lincoln, the panel’s
vice chairman, was elated.

"What’s most important to me is it plans the
creation of a single structure to deliver
health care to all Vermonters," he said.

Supporters argue that the single structure
will save administrative costs and make for
a more transparent and responsive system.

Republicans complained that the effort was
moving too fast, and a skeptical Democrat
said he voted for the bill only after getting
fellow committee members to step back
from using the term "single-payer," even
though the bill still pushes strongly in that
direction.

Rep. George Till, D-Jericho and a
practicing obstetrician-gynecologist, said
he shared Republicans’ complaint that the
bill did not address how to pay for the new
health care system. Shumlin and his aides
have said Vermont’s health reform effort
will be a three-year process, with financing
decisions coming in 2013.

The committee agreed to ask for some cost
data to be produced by legislative research
staff and the administration next month.
The Legislature’s Joint Fiscal Office will try
to estimate the expected administrative
savings.

For all the talk by Shumlin and others of
single-payer health care, Vermont would
continue to have more than one entity
paying for state health services, Till said.
He said 20 percent of those services are
provided to non-Vermont residents who
visit hospitals and other providers near the
state’s borders.

"You can’t force people living outside
Vermont into our system," he said.

Another huge source of uncertainty is
whether the state will get the needed
federal waivers to put its own universal
health system in place and, if that
happens, how much federal money will flow
into Vermont to help support the state’s
effort.

"There are too many big unknowns for me,
for our business community and for our
doctors and hospitals," said Rep. Vicki
Strong, R-Albany, who voted against the
bill.

Backers say many of those unknowns —
what health services will be covered and
how the payment system will function — will
be determined by a new five-member
state board the bill calls for setting up.

Among other key provisions of the bill:
— Setting up a "Vermont health benefit
exchange," something states are required
to do under federal health reform
legislation passed last year. Private
insurers would sell their products through
the exchange and would have to meet
certain state mandates for minimum
coverage. It would begin offering health
coverage to individuals and small groups
by Jan. 1, 2014.

— Meanwhile, planning would begin for
setting up Green Mountain Care, the
"universal and unified health system" that is
the goal of the legislation.

— Much of the planning of the system’s
specifics would be carried out by the five-
member Green Mountain Care Board,
which would begin operations this July 1.