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By Ellen Schwartz

OneCare Vermont—the private, for-profit company tasked with carrying out the state’s health care payment reform effort—is running into trouble.

Disability rights and public health advocates are raising alarms about OneCare’s low Medicaid quality scores and underwhelming primary care investments. The State Auditor’s Office reports that the company failed to reliably monitor its community-based initiatives, while the members of Vermont’s state workers’ union are opposed to folding their health care plan into OneCare, citing concerns.

Meanwhile, leading lawmakers appear poised to reject the company’s request for a $13 million bailout, financed by Vermont’s Medicaid program.

How is the Green Mountain Care Board (GMCB), which is currently reviewing OneCare’s 2020 budget request, responding to these developments?

Board member Tom Pelham defended the company in a recent commentary, chastising journalists for critical coverage. Last month, board chair Kevin Mullin offered the company public relations advice, aiming to encourage the public to “stop criticizing and become more participatory.”

Based on comments like these, it sounds like some GMCB members are more committed to promoting OneCare than doing their jobs as its appointed regulators.

These statements are all the more troubling when we consider that former board chair Al Gobeille, who laid the scaffolding for OneCare during his time as a public servant, recently left government for a senior executive position with OneCare affiliate UVM Health Network. In addition, Michael Costa, who in his former position with the Department of Vermont Health Access directed about $300 million in Medicaid dollars to OneCare, was recently named to its board.

This revolving door between government and OneCare raises questions about who officials are looking out for and undermines public trust.The Green Mountain Care Board must fulfill its mandate to protect the public good as it regulates health care actors. Rather than promoting OneCare, Board members should support the auditor’s call for the company to open its books and take seriously concerns that OneCare is rolling back its commitment to community health.

Lawmakers also have an important role to play in OneCare’s future.
This session, legislators should reject OneCare’s demand for a Medicaid bailout. Instead, they should increase funding for home and community based services, ensuring raises for workers and continuity of care for patients as we move to raise the state’s minimum wage.

Lawmakers must also assert their power to ensure that the state evaluates all options before renewing an agreement that enshrines OneCare as the manager of Vermont’s health care system.
Earlier this month, GMCB chair Kevin Mullin stated there is no “Plan B” other than the private, for-profit model led by the big hospital networks and embodied in OneCare.

Stepping back, however, it becomes clear that OneCare itself is the Plan B that was adopted in lieu of fully implementing Act 48—Vermont’s landmark 2011 health care law that envisioned a universal and unified public health care system.

With OneCare, our premiums and tax dollars are managed by a private monopoly that responds to its own failures by demanding more public money to prop it up.

It’s not enough to accept this arrangement as a matter of faith. Rather than conceding OneCare Vermont as the only game in town, lawmakers should be guided by Act 48 and its vision of a publicly managed health care system that is transparent, accountable, and equitable.

Ellen Schwartz is the policy coordinator for the Vermont Workers’ Center. She lives in Brattleboro.