Single payer reform moves forward in VT

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This week I was in Montpelier for a CSG/Eastern Region state capitol visit. House committees were debating their single payer reform bill, H202. Virtually all the discussion revolves around how to do it, not whether to do it. More than once I heard policymakers remark that this is a huge undertaking, but “we have to do it”. At a press conference a small business owner said that health benefits for his 52 employees have risen between 11 and 30 percent each year for the last decade. He hasn’t been able to increase wages, only continue offering health benefits. He said “H202 is an economic development bill dressed up as health care reform.”
They are beginning by setting up the framework to implement in 2017. Discussions this week revolved around timing and governance and staffing for the Green Mountain Care Board that will shepherd the plan. Questions included whether the Board should include one member from each stakeholder group (this is how we usually structure such things in CT, groups become massive and unwieldy and we get gridlock over and over – they quickly dismissed this idea), people with relevant expertise (health care finance, policy, etc.) or a set of good, smart people with guidance about working toward the greater good. Questions also revolved around the wisdom of ceding control of a large public trust to a non-elected board (similar to our SustiNet debate). Answers included that this happens in other areas, such as utility rate setting, and that this will be a law and can be changed by lawmakers if necessary.
Vermonters – legislators, staff, agency staff, advocates – are all exceptionally smart, knowledgeable about health policy as well as how it operates in the real world. Among them, Anya Rader Wallack who worked on our SustiNet plan, is leading the effort for the Governor’s office. I feel so much better after these trips – it’s restorative – kind of a spa trip for policy geeks.
Next week – New Hampshire.
Ellen Andrews