Much ado about MVP and single payer health care reform

IBM is one of the companies in the state that Vermonters for Health Care Freedom says could be hurt by the Shumlin administration's single payer health care plan.

IBM is one of the companies in the state that Vermonters for Health Care Freedom says could be hurt by the Shumlin administration's single payer health care plan.

A nasty tit-for-tat ensued last week between a GOP operative and the Vermont Democratic Party over Gov. Peter Shumlin’s single-payer health care plan, and the Dems, who aggressively counter-attacked, won the dogfight.

Darcie Johnston, a Republican politico and head of Vermonters for Health Care Freedom, an anti-single payer group, issued the first salvo on Wednesday and penetrated the Vermont Dems’ no-fly-zone in cyberspace.

Johnston declared in an email blast that MVP Health Care, one of the state’s three major health insurance carriers, was encouraging large, self-insured employers, such as IBM, Walmart and Home Depot, to leave the state — should Shumlin’s single-payer plan become a reality.

As proof, Johnston cited a reference on MVP’s website to a possible payroll tax on businesses and employees. A section of the site states, “to avoid double-paying, employers may consider getting rid of their self-funded plan or leave the jurisdiction of Vermont.”

MVP’s website also refers to the Hsiao report’s recommendation of a 9.4 percent payroll tax on businesses and 3.1 percent payroll tax on employees. If such a tax were instituted, MVP asserted, companies would have to pay insurance premiums and a payroll tax. The website states: “In this situation, employers would be subject to the likely payroll tax – meaning employers would finance the single payer plan and cover their own employees under their existing plan, essentially becoming a double-payer, unless they choose not to continue with their current plan.”

Johnston interpreted this information as an endorsement of her own view, and then put a partisan twist on it. As she put it: “Governor Shumlin’s reckless push towards a single payer system could very well be the biggest job-killer in Vermont’s history.”

The Vermont Democratic Party pounced on Johnston’s email the next day, accusing her of spreading “misinformation” about the single-payer bill.

Jesse Bragg, executive director of the Vermont Democratic Party, said Johnston’s claim was misleading because the state hasn’t figured out what the financing mechanism for single-payer will be. The Shumlin administration has made cost containment the Holy Grail of his ambitious plan, and the governor has repeatedly said single-payer can’t go forward without bending the cost curve. The financing system would be determined in 2013.

“The legislation authorized the pathway to single-payer, but the specific financing plan has not yet been designed,” Bragg said. “Therefore, claims about the impacts of single-payer financing on individuals or groups are nothing more than fearmongering.”

Bragg said that “far-right groups” like Vermonters for Health Care Freedom are conspiring with special interests (i.e. MVP), and, together, they “are putting corporate profits and the far-right agenda before the needs of working Vermonters.”

On Friday, MVP Health Care weighed in – against Vermonters for Health Care Freedom. Gary Hughes, director of internal communication, issued a statement objecting to the “irresponsible statements” made by the 501c4 group, based in Montpelier. Johnston’s press release was not authorized by MVP, and Hughes said it took one comment on the company’s Web site out of context.

“To state that MVP has advised Vermont employers to leave the state is inaccurate,” Hughes wrote.

In an interview, Hughes said the company continues to participate in the single-payer discussion, and, he emphasized: “We aren’t advising any of our employers to move.” MVP’s website statements, which appear to support Johnston’s contention, have not been removed.

A triumphant riposte was issued by the Vermont Democratic Party not long after the MVP excoriation of Johnston was made public.

“In its short existence, Vermonters for Health Care Freedom has repeatedly distorted the facts, taken quotes out of context, and misled Vermonters in a transparent attempt to derail meaningful, necessary health reform,” Bragg wrote. “We join MVP in demanding that Vermonters for Health Care Freedom stop distorting the truth. If Darcie Johnston cannot stick to the facts, she should stay out of the debate.”

Johnston sent a public apology to MVP, explaining that she misread the aforementioned double-pay/don’t-stay statement on the insurer’s website. Her initial contriteness, however, gave way to a restatement of the gist of her original partisan pitch: Single-payer will hurt big business.

“The single-payer bill has created an enormous amount of uncertainty and confusion for Vermont’s employers, and we regret if we added to that confusion,” Johnston wrote.

Dan Barlow, who handles government affairs for Vermont Businesses for Social Responsibility, also waded into the fray. Barlow said the tactics used by Vermonters for Health Care Freedom are similar to those used in the federal debate over health care reform efforts in 2010.

Because the group is a 501c4 and isn’t under federal law required to reveal its sources of income, Barlow said, “We don’t know who they represent.”

Uncertainties abound, with this exception: The inevitability of more polemical battles over single-payer health care.

Follow Anne on Twitter @GallowayVTD

Comments

  1. Jeff Bartley :

    We don’t know who funds VPIRG either.

    • Zack Smith :

      VPIRG canvassers come around annually door-to-door, asking for contributions. I gave them $25 last time to keep up their good work looking out for the citizens of this state. So maybe they just get their money from people like me who have nothing to gain financially from their work-which is more than I can say for right-wing “pacs” secretly financed by a few annonoymous wealthy contributers whose interests ARE PRIMARILY financial gain.

  2. Drew Smith :

    I FOUND THIS AT ANOTHER SITE. I THINK IT NICELY SUMMARIZES THE CONTROVERSY:

    “The statement in question at the MVP site:
    “Financing: How the Green Mountain Care Board chooses to fund the single payer system is something that will be investigated in the coming years. The Hsaio report recommends a payroll tax of 9.4% (and a tax on employees of 3.1%) in 2016 to pay for the system. In this situation, employers would be subject to the likely payroll tax – meaning employers would finance the single payer plan and cover their own employees under their existing plan, essentially becoming a double-payer, unless they choose not to continue with their current plan.

    If this is the case, to avoid double-paying, employers may consider getting rid of their self-funded plan or leave the jurisdiction of Vermont. Click here to see how the single payer law would affect employers who terminate their self-funded plan or leave the jurisdiction of Vermont.”

    I then went to the VT Health Care Freedom site and found this:
    “MVP: SELF-FUNDED EMPLOYERS SHOULD CONSIDER LEAVING VERMONT TO AVOID SINGLE PAYER TAXES”

    So the tempest in the teapot is the substitution of the word “should” for “may”. It is an arguable point that the word should is a recommendation, whereas “may” is an opinion. The bottom line for all to realize is that if an ERISA waiver is granted, employers may leave the state of Vermont. Additionally, if a ERISA waiver is not granted, but self insured employers are burdened with additional taxes to support the single payer health system, these employers may indeed leave Vermont.”

    Until we have a clear answer about how much Green Mountain Care (GMC) will cost, and who will pay for it, I think there are reasons for concern that some employers may leave, or at least some will avoid coming to Vermont if the taxes to support the GMC are considered excessive.

    • Dan Allen :

      Hi Drew,

      I don’t think it is fair to say the whole tempest in a teapot boils down to substitution of “should” for “may”.

      What Darcy did was take a common-sense statement from MVP, spelling out options in case Vermont’s single payer becomes a problem for them, and turned common-sense into something closer to an unjustified, panicked warning to flee, based on Darcy’s imagination of how single payer will unfold. The difference is not just one word, but context, and overall message. The fact that MVP disavowed association with Darcy’s statement is proof enough that MVP’s message was distorted by Darcy.

      I am surprised I would need to point this out.

      Regarding uncertainty of how healthcare will be funded in Vermont, we all have the same questions. The goal in Vermont is to make the system work here as well as some other places in the world that prove what is possible, better than the impossible-to-sustain, unfair, uneconomical, irrational, cater to rich executives system used throughout the rest of the United States. You are against that?

      Thanks,
      Dan

  3. walter carpenter :

    “We don’t know who funds VPIRG either.”

    You could probably find out much easier than you could Vermonters for Health Care freedom.

    “some will avoid coming to Vermont if the taxes to support the GMC are considered excessive.”

    The thing to think about is that businesses coming here, staying here, or starting up here will no longer have to face 10, 20, 30% premium increases, whether they are self-insured or not.

  4. It certainly is true that should some form form of single payer health care insurance pass in Vermont then some businesses may leave the state and others may not come … the exact same situation that exists today.

    On the other hand businesses may stay or come to Vermont based upon a business manager’s ability to focus on business and not health care insurance.

    But the biggest rhetorical mistake that can be made (by politicians, reporters and others) is that this is a Democratic vs. Republican thing. Makes it easier to cover for sure (much like a 15 minute presser with the guv), but it doesn’t accurately describe the constituencies involved.

  5. Bob Zeliff :

    Responsible big business like IBM and other are interested giving their employees the best health care for the best cost. They are much more pragmatic than political.
    IBM, like others, self insure. They in fact are their own “single payer”.
    They do this so they can reduce costs….just like Vt want to do with Green Mountain Care self insurance/single payer.
    I suspect they will sit back and see if GMC is better/more cost effective than their own “single payer” plan.
    I also believe Vt GMC will,over time, be more cost effective than private single payer plans.
    If and when this happens, companies like IBM will join GMC.

    The whole discussion about double taxing is a premature red herring to confuse people. I personally like the idea of maintaining the existing form of medical care payment. The employee pays a portion directly and the employer pays a portion too. just like today.

    • Doug Hoffer :

      I’m not so sure IBM is purely pragmatic in this particular case. IBM operates successfully in many countries with some form of national or universal health care system. In the U.S., however, IBM has resisted a move in that direction. We can only hope the company chooses to work with us instead insisting on being treated separately.

    • @Mr. Zeliff: IBM is not a “single payer.” It is a “self-insured health plan.” These are very different concepts, and the distinction is extremely important to maintain in order to have a rational discussion about what Vermont is attempting to do.

      “Single payer” is used to describe a situtation where all practitioners and hospitals file their claims with, or are paid by the same payer. Where all patients are covered by the same payer. In other words, the terminology relates to the perspective of the providers and patients dealing with one payer.

      If one considers IBM a “single payer,” then one would have to consider any employer offering only one plan a “single payer,” and that would mean that we already have a single payer system, because everyone is covered by only one plan. I’m sure that is not what you actually mean when you say “single payer.”

      In the past, when people described Vermont moving to a single payer approach, they would use IBM and other large employers as examples of “self-insurance,” and note that the state would basically be “self-insuring” like those large employers.

      That, too, is a questionable description because the state cannot on its own afford to “self-insure.” More than 50% of the revenues required to truly self-insure all of our citizens, using a single payer, would come from the federal government (Medicaid, Medicare, Tricare, VA, federal employees, and, post-PPACA, federal subsidies for individuals and small businesses). That’s why we need Congress to pass legislation authorizing Vermont to have waivers from these existing federal laws, allowing us to spend the funds through a single payer, state-operated program.

      So, in summary, IBM self-insures, but is not a single payer. Vermont may get a single payer, but cannot (absent massive state tax increases) self-insure.

      Got that?

  6. Perhaps a reporter should interview both large and small self-insured companies in Vermont and find out what there reaction is to GMC.

    It is clear that the VT Democratic Party and VT Businesses for Social Responsibility are going to try to bully any company that says anything negitive about GMC. Truth is businesses hate uncertainty and that is exactly what the democrat legislature and Gov. Shumlin have created when they pass GMC.

  7. The truth is that Vermonters for Health Care Freedom seem willing to make up facts to support their case. Even MVP Health Care – an organization that has some questions about Vermont’s reform plans – has called this group’s tactics “irresponsible.” Let’s have a debate on the facts. Scaring people into agreeing with you is not good for public policy.

  8. Dan Allen :

    The whole point of Vermont’s pursuit of single payer is to develop a more affordable, economical healthcare system. Seems to me that naysayers are saying it can’t be done, crying ‘foul’ for what they anticipate will be failure, before there is information available to know whether it will be a failure.

    Meanwhile, Darcy Johnston’s wild overstatement of MVP’s comment on their website is irresponsible and discrediting of her cause. Her attack with the MVP statement as ammo reminds me of Brian Dubie’s claim that the papers in his hands listed the names of 700 dangerous inmates who were going to be released by Peter Shumlin.

    I am all for serious criticism of single payer. Serious criticism helps us all find a good result. Distorted, overblown, misleading attacks, like the one initiated by Darcy last week, damage democracy, by undercutting the public’s ability to be informed.

  9. Jim Eckhardt :

    Dan,

    With all due respect. Wendy Wilton has asked for a “debate on the facts” several times. Every time she does the opposing team recoils. I for one would love to see a debate between Mrs. Wilton and let’s say anbody in the Shumlin administration or even Doug Hoffer or Franco. How about you Dan? You state that HCF makes up facts to support their case. What do you think the administration is doing when they keep stating that they will improve outcomes and improve costs? If they have no plans by their own admission how can they make such a claim (especially since it has not worked anywhere else)? They are clueless as to whether either of those things can or will really happen. Yes the accolades and scare tactics from all sides should stop, but, unfortunately when you ram a bill through at this speed and with so little information this is what you can naturally expect. A serious lack of facts and a serious overflow of emotion. Therefore it started as a bad ideological bill and ended as a bad idealogical Act.

    • Ron Pulcer :

      Rep. Eckhardt,

      With all due respect, wouldn’t YOU be a better person to “debate” the healthcare bill (although you did not vote for it)? As a member of the House Healthcare committee, you sat in all of the committee meetings and hearings day after day, whereas Treasurer Wilton did not. It seems to me, that between the two of you, you should be more of an “expert” on H.202 and Vermont’s Single Payer planning process than Treasurer Wilton.

      If the bill was “rammed through”, without enough detail, as you state, then it seems to me the current ongoing debate is really just based on everyone’s own assumptions and expectations, and not necessarily the GMC Board’s final recommendations. And in the case of of Vermonters Fro Healthcare Freedom, they are adding their own “spin” to this debate.

      Rather than having a formal debate, why doesn’t each side put together a list of questions and concerns that they want to see answered by the GMC Board. I would think that if that were to happen we could come up with a pretty comprehensive list, and it could help make the planning process better (participatory democracy).

      I would venture to guess that there could be some overlap in questions from both sides (we all would like to see more details). I support the GMC single payer process, provided in the end it can design a sustainable, quality healthcare system that covers everyone, and is equitable in financing. However, I also want more details. But I can be patient and wait. I would rather wait for healthcare professionals or public health economists (or whoever is hired for GMC) to design a healthcare system, versus a part-time legislature.

      The difference in approach, as I see it, is that some people will constructively criticize the GMC plan, and others will just try to kill it any way they can (even if it means taking a MVP webpage quote out of context).

      • Dan Allen :

        There must be someone in Vermont state government responsible for organizing questions from the public and providing answers in an open, systematic, trackable manner.

        My questions are:
        1. Who is that person or office?
        2. What is their response to the questions or concerns specified by Representative Eckhardt, Vermonters for Healthcare Freedom, and other dissenting/concerned voices?

    • Dan Allen :

      Jim,

      Thank you for replying. I think you are asking good questions, raising good points.

      I guess I don’t understand what is so bad about the Vermont health care law signed by Governor Shumlin on May 26. The law starts us down a road we can turn off from, if, for example, we cannot get the cooperation we need from the federal government. All we are trying to do is find a way to make it work. No one wants to impose onto Vermont a monster like the federal health care overhaul bill of 2010. As a small state with a relatively low poverty rate, Vermont is in better position than possibly any other state to put together a solution to the healthcare financing problem that is destroying our economy and standard of living, not to mention the damage our current system does to us morally. In spite of loud, out-of-state funded “free speech” objecting to potential pitfalls, the fact is that public healthcare is a popular idea in Vermont, as evidenced by Peter Shumlin’s election. You say that public healthcare has failed wherever it has been tried. That is just plain not true. Just because you can find legitimate criticisms of public health systems around the world, it doesn’t mean each and every one of those systems is a failure.

      Regarding a lack of answers from Governor Shumlin’s team, my feeling is we need to give them some time. They have acknowledged they will need to pull off some minor miracles to make this work. They have earned a right to take their shots at those miracles, following the roadmap set out in the recent law. Short of those minor miracles becoming reality, this initiative is not going to get far, because the law requires more votes by the legislature before single payer becomes reality. From what I have seen, the Vermont legislature can be relied upon to make good decisions as more proposed answers are put onto the table.

      As for more public debate needed, that is interesting. Can you explain more about the recoiling from debate you mentioned? Anne Galloway’s recent comments about difficulty getting past superficial answers in limited Q&A at press conferences might be pointing to the same pattern you mention.

    • Dan Allen :

      Jim, I looked up Wendy Wilton’s analysis at this link:
      http://vthealthcarefreedom.org/sites/default/files/Green%20Mountain%20Care_0.ppt

      I don’t see what exactly there is to debate about her superb analysis. She mentions the basic problem in making Vermont’s plan work is “The rate of growth in health care costs is rising faster than the economy which is tasked to support those costs.” Her analysis spells out this fact with numbers and her commentary.

      The debate over the feasibility of cost containment is extremely well-documented. There is no dispute regarding the need for lowering costs.

      What is your position on health care as a human right in Vermont? One way to contain costs is to deny coverage to some citizens. If you are going to provide some level of coverage for everyone, single payer offers attractive means for managing costs and quality, especially in contrast to the current system that pays out $6 million to a CEO as reward for profits extracted from the process of caring for other human beings.

  10. walter carpenter :

    “I suspect they will sit back and see if GMC is better/more cost effective than their own “single payer” plan.”

    Rama, I suspect you’re right. IBM will probably sit back and watch it and, if they can figure out how to manipulate the new system, which they probably will, they will jump right in. As Doug points out, they operate in many nations with single-payer/universal health care systems. The big thing about losing employer-sponsored health care is that it is, just as often as not, a weapon against workers as much as a help for them. I’ve been a victim of this. And, even with their self-insured program, whether it is called single-payer or not, IBM does not insure every employee that works for them. Many are temporaries and do not qualify for the “benefits.”

    “(especially since it has not worked anywhere else)?”

    Jim, exactly where and how has it not worked?

    • That wasn’t my quote, but as my name is being taken (to the woodshed as usual) …

      Losing company based insurance only sucks when there’s nothing to take its place.

  11. Bob Zeliff :

    Ms Keller

    No I’ve not got that!

    IBM self insures. It takes take risk of the variables of the insurance claims. It does not go out to bid for Medical Insurance. It does go out to bid for companies to administer IBM’s defined insurance. Different companies compete for that privilege. IBM is the single payer to their administrator. If IBM chose to administer it them selves they also would be the single payer to the Doctors, Hospitals, etc.

    This is just like what Vermont is considering. It is not clear if Vermont will administer the plan it self or do like IBM domes…ie hire a company to administer the plan to Vermont definition. Just like IBM.

    It is not true that Vermont could not afford this. We are paying over $5B now…it will cost less just like the reason IBM does it. It cost less. You do try to confuse and scare people by implying that Vermont would be so foolish to attempt to covering people in existing programs/contracts all at once. Getting the waivers from medicare etc is part of that. As I suspect you well know, it will take a few years to carefully phase this in so ,hopefully, in the end all Vermonters will have health care at considerable savings and without the plethora of caveats that come with the Insurance company plans of today.

    i thing you make your living in association with the medical insurance industry and would better understand the benefits of self insurance.

  12. Ellen Oxfeld :

    There are many reasons employers are in Vermont, and given a choice between a self-funded plan and paying a payroll tax, I would guess many would do much better with the payroll. We should keep in mind that many self-insured plans are already well over the numbers cited by Hsiao in his report for a possible payroll tax (I work for Middlebury College, which is an ERISA employer, and that is the case here).

    Consider something else. When you have a self-funded plan you have to do all the calibration yourself each year — what will be in the plan, what will be out, who will be covered, how much they will pay, etc.? This is also a major administrative burden and cost in itself for ERISA employers that would be saved if they pay into the single payer.

    We should also remember that the funding mechanism for a single payer plan is likely to be a payroll plus something else — because there are people with sizable incomes who are not on a payroll, and they would also have to pay into the plan.

  13. Wendy Wilton :

    Whether or not an employer has an advantage under single payer vs. self-insured is a matter of how well employees are compensated.

    If the majority of a company’s employees earn under $40k per year, then a payroll tax at 11% of gross payroll is far cheaper than providing an insurance plan. If a company’s employees are better compensated (over $40k per year or more)then it is more advantageous to offer insurance.

    Hence, the payroll tax-funded scenario for GMC may be a policy direction that will favor lower wage job growth, and discourage higher wage jobs. If a higher payroll tax than 11% is needed to fund GMC, this favors the lower wage growth direction even more. It would be relatively easy for a business owner to move to NY or NH and keep the low wage jobs and service point in VT.

    Ellen, my numbers show that a payroll tax at the proposed levels is insufficient to support GMC, so an additional tax of some kind will be required. But even an income tax will not provide an avenue for folks who have high assets and low incomes to contribute. It will be like the state payment fiasco on property tax all over again…this time in health care. If not addressed, it may be easy to ‘game’ the system. Currently, high asset individuals can access Catamount as there’s no test for assets–only income. It’s something to think about.

  14. walter carpenter :

    “That wasn’t my quote, but as my name is being taken (to the woodshed as usual) …”

    Oops, Rama, my apologies. Did not intend to take your name to the woodshed. It was a gaff of trying to do too much in too little time, seeing that quote, then reading your earlier post above, liking it, and the wires just crossed wrong. Sorry about that.

  15. Jim Eckhardt :

    Walter,

    Don’t take my word for it ask Gov, Shumlin. Oh here is what he says.

    Shumlin admits that anxiety is warranted. Echoing comments he has made repeatedly, the governor said, “For those who mistrust what we’re doing, I say, I don’t blame you. I don’t blame you, because, as I argue, government has gotten health care reform wrong every single time”.

  16. walter carpenter :

    “Don’t take my word for it ask Gov, Shumlin. Oh here is what he says.”

    Jim, thanks much for the quote. I had not heard or seen it before, but do believe that Shumlin is right because guv. has generally tried its best to avoid doing it right every single time to favor certain special interests, like the health insurance companies. Therefore it has “gotten health care reform wrong every single time.” Shumlin is doing something different and working to get it right.

  17. Eric Rosenbloom :

    For what it’s worth, Darcie Johnston is apparently working with consultant Kurt Luidhardt of The Prosper Group in Greenwood, Indiana, who has done work for US Rep Dan Burton, US Rep Michael Grimm, Christine O’Donnell, Sharron Angle, Governor Bob McDonnell of Virginia, and Governor Rick Scott of Florida.

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