Updated 7:20 pm 10/27/14 (Please check back as we are updating this page as the debate reveals more information.)
On Monday, October 27, the Ethan Allen Institute began running a 60 second radio spot throughout the state about the language in Vermont’s single payer healthcare law (Act 48) as it pertains to Medicare.
CLICK HERE to Hear!
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Do the creators of Green Mountain Care, Vermont’s single payer health care law, desire and intend to “take over” Medicare by gaining control of federal dollars and assuming the responsibility for administering benefits to seniors?
Summary Timeline of the Issue
Act 48 of 2011 says clearly, with emphasis added, “Green Mountain Care shall assume responsibility for the benefits and services previously paid for by…Medicare. (Sec. 2 (a)(6))
It says again, “The agency [of Human Services] shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont.” (33 VSA 1827 (e))
In fairness, proponents of single-payer believe that they can deliver equal or better benefits to seniors through Green Mountain Care, and Act 48 states that by law they must do so. The federal application for the waivers demands that the state demonstrate that it can deliver these benefits, and do so without increasing the deficit. The question Vermonters need to ask is, are the folks in Montpelier really competent to do so?
Who Voted For This Language?
Click HERE to see the final House roll call vote for H.202 (Act 48), passed 94-49, May 5, 2011.
Click HERE to see the final Senate roll call vote for H.202 (Act 48), passed 21-9, May 3, 2011
It is important to note that the federal government is under no obligation to give Vermont these waivers, and it appears that they will not.
In order to help assure Vermont receives the federal waivers sought, Senator Bernie Sanders submitted federal legislation (S. 915) in 2011 that would require states to set up single payer systems with federal funds folded into the programs.
Language in Sanders bill states:
“There is hereby established in the United States a State-Based American Health Security Program to be administered by the individual States in accordance with Federal standards specified in, or established under, this Act…. In order for a State to be eligible to receive payment under sectiona State shall establish a State health security program in accordance with this Act.”
“Board shall establish a national health security budget, which, (A) specifies the total expenditures (including expenditures for administrative costs) to be made by the Federal Government and the States for covered health care services under this Act; and (B) allocates those expenditures among the States.”
Then, in December 2013, Sanders introduced another bill with the same purpose (S. 1782), which would create “…the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program… incorporates Medicare, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE…,” according to the bill’s summary.
VIDEO: Press Conference in Montpelier in which Vermont’s federal delegation pledges to help Vermont obtain federal waivers for single payer implementation.
Speaking of Getting Those Waivers
In 2012, Peter Shumlin actually wanted to obtain waivers earlier than the 2017 date allowed by the Affordable Care Act. In a VPR interview he said, “I want to see it [Green Mountain Care] implemented by 2016. If it’s sooner that’s better for all of us…. There’s got to be a Vermont way to find a way around those obstacles [waivers]. We can outsmart the feds.” (VPR, 7/16/12)
In November 2013, Gov. Peter Shumlin attended a meeting of Physicians for a National Health Plan in Boston last November where he was confronted by Dr. David Himmelstein. Himmelstein’s complaint about Green Mountain Care was that it couldn’t really be a single-payer system because the Vermont system would also have to accommodate several other insurance plans, including those of federal employees, military personnel, ERISA and Medicare.
Shumlin replied, “But I’m going to try to get the waivers to get everybody [in Vermont] in the pool — everybody. I want everybody in the pool.” This includes seniors currently on Medicare.
Note: If Vermont fails to get the the waivers to bring Medicare and other federal programs into Green Mountain Care (which appears likely to certain), Himmelstein’s criticism is valid. GMC’s status as a “single” payer system, as well as potential savings from more streamline system, would be null and void.
In May of 2014, Act 48 was amended by Act 144. Sec. 6 of that Act repealed 33 VSA 1827 (e) and amended the following subsection (f) to read: “Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.”
Note: As of this writing (10/26/14) Vermont’s online statutes have not been updated to reflect this change, adding to the confusion over this issue).
Some supporters of Act 48 are now saying this change absolves them from any original “take over” intent. (A “We were against it after we were for it” defense.)
Who Voted for this language:
Click HERE to see the final House vote on H.596 (Act 144), passed 83-45 May 5, 2014
No roll call was taken in the Senate.
Despite changes in the law brought forward by Act 144, in September 2014 Gov. Peter Shumlin and his top health care officials, Robin Lunge, director of health care reform; Lawrence Miller, chief of health care reform; Al Gobeille, chair of the Green Mountain Care Board; and Anya Rader-Wallack, traveled to Washington, D.C. to discuss obtaining waivers to federal programs that would allow Vermont to move forward with a single-payer health care program. According the the Affordable Care Act, these waivers cannot be granted until 2017 at the earliest. (VT Digger, 10/1/14)
No wonder Vermonters are confused!
Although the legislature did repeal the “shall seek permission” language from Vermont statute, the new language does not bar Vermont from seeking those waivers. It is worth noting that Governor Shumlin and his healthcare team went to Washington to discuss getting these waivers four months after passage of Act 144.
Nevertheless, it does not appear likely (nor did it ever) that those waivers will be coming for both practical and political reasons.
Was the intent of those who voted for Act 48 in 2011 to “take over” Medicare. Yes. Is it still their intent? Maybe. Whether passage of Act 148 represented a true change of heart, an election year conversion, or simply a change in strategy to “outsmart the feds” is unknown. Passage of Act 144 does not preclude further attempts in this direction.
The secrecy with which the Administration and proponents single payer healthcare have surrounded almost every aspect of this law has not been helpful to citizens trying to make sense of a complicated issue that will effect us all in a profound way. Vermonters deserve better.
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