House health care committee quashes bill to delay single-payer

A bill that would delay the implementation of Green Mountain Care, the state’s planned universal public health care program, won’t make it out of committee.

The bill was sent to the House Health Care Committee, which voted Wednesday on bills it plans to work through before crossover. H.858, which would push the governor’s single payer plan to 2019, didn’t make the cut.

“It’s disappointing but not surprising,” said Rep. Patti Komline, R-Dorset, the bill’s primary sponsor.

Though H.858 had picked up a bipartisan group of sponsors, it was essentially dead on arrival.

One of those sponsors was Rep. George Till, D-Jericho, an obstetrician, said the proposal makes good sense, but he recognizes it is largely a symbolic gesture.

“Moving to GMC is a massive change in our medical system,” he said.

If the point is to cover every Vermonter and lower health care costs, then it’s important to know exactly what those costs are now, he said.

“If you want to ask, ‘Are we making a difference with a new system?’ you have to compare it with new data, you can’t compare it with old data,” Till said.

Collecting the data to understand the current health care landscape, which is still shifting with the implementation of the new health care exchange, isn’t feasible by 2017, when Green Mountain Care is expected to begin, he said.

The rocky rollout of Vermont Health Connect means there won’t be good data on how the exchange has altered health care until 2015, according to Till.

With a two-year lag on Medicare data, an accurate picture of current health care reform won’t emerge until at least 2017, he said.

Till said 2017 is an arbitrary timeline for switching to Green Mountain Care.

“It was a political promise by the governor,” he said. “I think that’s a terrible way to make decisions [about health care].”

He supports universal health care, but he said it’s more important to do it right than to do it quickly.

In the past two years Vermont has had the lowest rates of growth in health care costs since the growth rate numbers were first recorded. Till said that eliminates the urgency of further reform.

“The pressures of double digit increases in spending are not there right not now,” he said. “It takes away the urgency of having to make a change.”

Morgan True

Comments

  1. Glenn Thompson :

    Given the fact, nobody knows or admits to know how Single Payer will be funded until *after* the 2014 elections, it made sense to delay it until it could be known for sure if it is going to work or not and how it will be funded and implemented? Once again, government just blindly picks a date out of thin air and rushes through the process without considering the consequences of what happens if things don’t come off as planned! You would have thought they would have learned their lessons from the current healthcare fiasco which is still having any adverse negative impact on many Vermonters….but I guess not!

    Leads to a final question? Who on the House Health Care Committee was responsible for killing the bill? Names please?

  2. Walter Carpenter :

    “Once again, government just blindly picks a date out of thin air and rushes through the process without considering the consequences of what happens if things don’t come off as planned! ”

    Rushes through the process? This has been going on for thirty years or more here, and eighty years on the national level. Is this too fast? It took Great Britain , for example, less than a year or so to do it when they reformed their health system. Taiwan did it in a year or so.

    • Bob Sterling :

      Well it is a rush job because no one knows how its funded. It creates so much uncertainty in the economy here and know one knows if it really is a good idea. The state already has shortages in providers and with this plan it will be sure to create more.

      https://docs.google.com/document/d/1i9_zKKfKgLZuI2mqGg9tgn3ohVNj45SscRikxWIN364/edit

      • Kathy Callaghan :

        Bob Sterling, can you provide the source of the info in your attachment?

        RSVP. Thanks.

        • Bob Sterling :

          If you click on each link it will bring you to the source

      • walter carpenter :

        “The state already has shortages in providers and with this plan it will be sure to create more.”

        But what if more come in because of what Vermont is doing?

        • Craig Powers :

          Walter please prove that they will. Give us a list of those beating the door down to come here.

          Thanks

          • Julie K. Pease, M.D. :

            I will be there and I know several others who will be there as well.

      • Walter Carpenter :

        “Well it is a rush job because no one knows how its funded. It creates so much uncertainty in the economy here and know one knows if it really is a good idea. ”

        If it is a bad idea, then why are we the only democratic nation which has not yet done it? Clearly, they have thought it was a good idea.

    • David Dempsey :

      Those are entire countries. Vermont is one of 50 states. What happens if the reserves are mismanaged by Vermont, as the health care exchange has been, and claims are not paid timely. Care providers in other states will not be obligated to accept GMC insurance. If the entire country had a single payer plan, that problem wouln’ be an issue. The state spent 3 years getting the health care exchange running and its rollout has been a disaster. What will happen when GMC will have to enroll and pay the claims for every Vermonter? Nobody knows how much it will cost, where the money will come from, and no details about the coverage. The budget will have to be in place 2 years from now when the legislature will be working on the budget for FY 2017. Shumlin is willing to irresponsibaly put the health insurance coverage for all Vermonters at risk to make a name for himself nationally and pad his resume.

      • Walter Carpenter :

        “Care providers in other states will not be obligated to accept GMC insurance.”

        How will that be different than it is now? I have experienced this before. And what if care providers, especially in the border states, do take GMC?

        “What happens if the reserves are mismanaged by Vermont, as the health care exchange has been, and claims are not paid timely.”

        What would you do if an insurance company did this, which I and so many other Vermonters have experienced before?

        With single-payer this is one reason why you have a legislature which you can utilize in this case — that is if it ever does happen. You also have a board, the GMCB board, with oversight of the system, which is very open to the public, to ascertain that this does not happen. If it does, and I am not saying it never will, they would be a good starting point. The exchanges are much different. The botched rollout was a private contractor which bungled its job and did not fulfill its contract.

        • David Dempsey :

          Walter,
          The Shumlin administration so far has offered no details on how the single payer plan will work. Shumlin has made statements that individuals will have to pay some things out of pocket, but no details about that either. He also said that one private insurance company will administer the plan, but again no details. I am not against the idea of single payer, but it needs to work right when it goes live. My point about the exchange is that we had three years to build the health care exchange, which is far less complicated that single payer, and failed to have a working product. If the details of how the single payer will work are not discussed until after this years elections, there will only be two years to get the plan details worked out, get the software tested and be fully functional from day one. I hope we can, but I am not very confident about it.

    • Ralph Harper :

      Horrible health care systems with necessary parallel private systems to assure adequate and timely access to care …wake up and take off your blinders Walter !

  3. Wayne Andrews :

    Walter: You are way off base. Vote now and figure out how to pay for it? Go to your bank ask for a loan and see if the bank operates the way you endorse. How gullible do you think we are?

    • Walter Carpenter :

      “You are way off base. Vote now and figure out how to pay for it? ”

      Wayne, if President Kennedy did as you say we should here, we would never have gone to to land and walk around on the moon. We would have been too afraid of how to pay for it.

  4. Cynthia Browning :

    I supported H.858 to push back the date for the state health insurance program.

    We need to understand our current system as it absorbs recent changes. It is risky to undertake more changes before we know where we are and what is needed. Especially when the proposed state run system is so undefined in benefits, cost, and financing.

    Our system of health care and health insurance needs to work well and reliably for Vermonters. If it takes more time to design and implement it sustainably, won’t that be worth it to get it right?

    Rep. Cynthia Browning, Arlington

    • Richard Ratico :

      It is well known that the ACA (Obamacare), though a good first step, is a program hobbled by compromises made to vested interests. Those vested interests have produced a medical system that is the most expensive in the world, which simultaneously fails to provide better outcomes than systems in countries using single payer.

      The ACA was a bandaid. It was the best that could be achieved on the national level given the near paralysis in Washington.

      Vermont is proving yet again it has the vision and courage to do big things for it’s citizens when other states won’t. It will lead the nation in reforming health care as it has led the nation on other issues.

      Transparent attempts to stall or stop progress towards single payer should be recognized and thwarted as they have been here by the House committee.

  5. John Greenberg :

    What am I missing here? Legislators take weeks of every legislative session to figure out THIS year’s spending and taxing.

    The transition to single payer is scheduled for no sooner than 3 years from now. Why is it surprising that there are no plans on the table for something that’s that far out, especially considering that US healthcare dynamics are in major transition nationwide due to the Affordable Care Act?

    Could someone explain why this “debate” is about anything more than pure partisan politics and ideology?

    • Craig Powers :

      You might run your business by the seat of your pants but most of us do not.

      We would like to know the tax/cost ramifications (for business and personal) to prepare for the massive change.

      Do us a favor and stop projecting the complete falsehood that this is so easy. If it was so easy why hasn’t been put on the table?

      Talk about BEING partisan!

      • John Greenberg :

        Craig Powers,

        If your comments are addressed at mine, I have no idea where you get the idea that I am “projecting the complete falsehood that this is so easy.” I never said or suggested that.

        Quite to the contrary, actually. Moving to single payer would be a major change, which will involve a lot of moving pieces. Many of those pieces are already in motion, for reasons unrelated to single payer, and some due to the planned transition. But the fact remains, the playing field is dynamic, not stable or predictable.

        If a funding “plan” were put on the table today, just how accurately do you really think it would project the reality of 3+ years from now? Economists can’t accurately predict what will happen in the next 3 months (indeed, they often can’t tell us what happened in the LAST 3 months until significant time has elapsed), but you want to have a plan on the table that allows you to plan for 3 years from now?? Good luck.

        Your desire to know “tax/cost ramifications ” is no doubt admirable, but that doesn’t make it feasible. In this, it joins many other uncertainties that confront us. Welcome to the modern world.

  6. Marjorie Power :

    It’s not all about spending. Under the current sytem, not all Vermonters get care. If savings are the only criteria, we could just give up funding health care altogether. Just think how cheap that would be.

    • rosemarie jackowski :

      Tim… They don’t get care because of the mind-numbing lack of compassion that perpetuates the Capitalistic, for profit health care system.

      • Walter Carpenter :

        “Tim… They don’t get care because of the mind-numbing lack of compassion that perpetuates the Capitalistic, for profit health care system.”

        Well, said, Rosemarie. Tim, while Vermont had (before the AC anyway) fairly good public and public-private programs, or good for the USA, like Catamount and VHAP, you had strict income limits which determined your eligibility. That and what Rosemarie said is why so many Vermonters were shut out from access to care. With the ACA, I know some middle-aged Vermonters, for example, who now have insurance for the very first time in their working lives.

  7. The ACA has been the largest stumbling block to a single payer system because of what has been said above by Richard and Walter, the compromises with the insurance company lobbyists have shown us all where the real money is going; into the insurance company coffers, whether they are non profit or for profit. If we can free ourselves from lobbyists and high paid executives, just maybe we can get it right. With so many folks needing insurance perhaps some of the high rollers need to realize that it is about time they paid their fair share to help those who are unable to help themselves. Or is that old biblical concept too hard for others to understand? Bravo, to the committee for deep sixing the bill.

    • John Greenberg :

      “Never mind nearly 50% of the country pays no taxes now …” Since there are far fewer than 50% of Americans who are unemployed, and since everyone who is employed pays the payroll tax, your figure is off by a substantial margin. You are referring to ONE tax: namely, the federal income tax.

      You also fail to note that 50% of the Adjusted Gross Income reported to the IRS goes to taxpayers reporting more than $75,000, but they account for only 21% of the returns. Put less statistically, the bulk of the income in the United States goes to high-income earners. It’s hardly surprising, then, that they’re the ones who pay the income-based taxes.

  8. victor ialeggio :

    two suggestions, Mr Smith:
    1. Severance Tax on Mineral and Water Extraction — Vt is one of only 11 states without one. We give those resources away.
    or,
    2. Land Value Tax (in lieu of that antiquated Puritan leftover, Property Tax) — when the site or location value of land is improved by public works or custodianship, its economic rent is a logical source of public revenue.

    Nothing represents a panacea, but either of the two of these might mke it possible to extend universal medicare to all Vermonters.

  9. Patti Komline :

    This bill, to require that Green Mountain Care will start no sooner than 1/1/19, was sponsored by 10 people. Two independents, three republicans and five democrats. Four of the sponsors sit in House Ways and Means and we have listened to hours of testimony related to the transition to this new health care program.

    I was inspired to introduce this bill after hearing the comments made by the democrats in my committee. These concerns aren’t partisan. They are founded on education and common sense. In order to plan for where we are going we need to know where we are. Since this is the first year of the ACA (Obamacare) we need time to gather data. We also want to make sure that changes are implemented smoothly and we’ve learned that getting ahead of ourselves can be challenging. Lessons should be taken from the Exchange roll-out.

    Interesting to note – out of the eleven people in House Ways and Means, four sponsored this bill, two would not because they don’t support Green Mountain Care at all. Therefore, the majority of this committee (probably the most informed House committee regarding health care financing at this point) doesn’t support the timeline and direction we are moving towards.

    It is very disappointing that House Healthcare didn’t choose to ask any of us why we felt strongly enough to sponsor this bill.

  10. Richard Ratico :

    Patti,

    I followed the VT. Digger link to your bill, H. 858. There’s just one page. It’s obviously what one of your own sponsors, Rep. George Till, calls it. He said, “… it is largely a symbolic gesture.”

    I found this information online while trying to understand the work of the Vermont House:

    http://www.leg.state.vt.us/HouseClerk/Vermont%20Legislative%20Process.htm

    The document states, “The Legislature as a whole, therefore, relies on its committees to work out the frivolous or less important measures and to report those deserving the consideration of the entire House or Senate.”

    I’m sure the House Health Care Committee has plenty to do without chasing you and your bills sponsors to ask you why you think your bill is important. If your bill was more than “largely a symbolic gesture”, I think it’s safe to say you and your cosponsors should have done more to promote it yourselves.

    It’s also safe to say it did not deserve the consideration of the entire house and, yes, it was frivolous.

  11. Ellen Oxfeld :

    Also, I would point out that it is just 2014 now. 2017 is still three years away. I am not sure why Rep. Komline is already wanting to delay another two years.

    I would also point out that the problems with the exchange have little to do with how a single payer system would work. Indeed, one reason to move to a single payer system is that it is less complex than the multiple payer, multiple plan, model of the exchange, and works on a different set of assumptions: that we can directly fund a health care system for Vermonters.

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