But the real drama of 2014 erupted in mid-December when Gov. Peter Shumlin announced he would not pursue a single payer program, the defining policy initiative of his tenure as governor.
Shumlin said now is not the right time: A single payer program would draw down less federal money than he anticipated and he said Vermont can’t responsibly raise the revenue to provide all residents with high quality public health coverage. The revenue models showed that in order to offer a universal health care plan with nominal out of pocket costs, the state would have to impose an 11.5 percent payroll tax on employers and a new income tax on Vermonters. Shumlin said the plan would have caused “economic shock” at a time when the state is already struggling to raise tax revenues to fund government programs.
Shumlin described the decision as the “biggest disappointment” of his career in public service.
The move was lauded by business leaders as pragmatic, but grassroots supporters of health reform, who previously backed Shumlin, organized protests in the immediate aftermath suggesting the decision would end his political career.
Part of the backlash was fueled by the secrecy around the financing plan, which was originally due in January 2013. Shumlin delayed release of the plan that year and promised to offer details about his administration’s plans to shift from a privately funded, premium based system to a publicly funded, tax based system in January 2014. But last year he blew that deadline, too, and decided to delay the plan’s release until after the November election.
In the 2014 legislative session, lawmakers declined to press forward without the administration’s guidance. Instead, they listened to weeks of expert testimony to better acquaint themselves with the complicated issue in preparation for the 2015-2016 biennium, which could be a trial by fire for sweeping health reform in Vermont (some lawmakers have suggested they will press forward with single payer even without a recommendation from the Shumlin administration).
Shumlin’s decision to delay his single payer plan resulted in a backlash from Republicans in the House and Senate, and even a few Democrats, one of whom tried to pry details of the plan from the governor with a public records request that ended in a failed lawsuit.
The closest anyone came during the session to revealing the closely held plan, which the governor said he will release Dec. 29 or 30, was when outgoing Sen. Peter Galbraith, D-Windham, read what he called “the administration’s notional financing plan” on the Senate floor.
When Shumlin ultimately revealed details of the plan several weeks later, it was not substantially different than what VTDigger and Galbraith uncovered.
Vermont Health Connect dysfunction ongoing
Vermont Health Connect, and Shumlin’s health reform agenda more broadly, appeared to be buoyed in April when he brought in former Secretary of Commerce and Economic Development Lawrence Miller to be a special advisor on all things health care related.
Miller’s appearance on the scene coincided with reports that showed the Shumlin administration had mismanaged contractors from tech giant CGI who were charged with creating the online insurance marketplace. Read VTDigger’s investigative story about what went wrong and why.
But throughout the summer, issues continued to mount for the exchange, and by August the state decided to part ways with CGI, and instead hired Optum, which had rescued the federal exchange and several other state exchanges, to take over.
When the website relaunched for the second open enrollment period in November, state officials announced it would only be used for new customers. Renewals would be processed through paper applications, a gauntlet that has created problems of its own for customers.
The Green Mountain Care Board pressed ahead with its efforts to overhaul how doctors and hospitals get paid as well as how they deliver their services.
Vermont launched two shared savings programs for provider networks known as Accountable Care Organizations, which are aimed at containing costs by creating efficiencies through better coordinated care.
The state’s largest hospital system changed its name to the University of Vermont Medical Center and announced plans to build a massive new inpatient facility at its flagship Burlington hospital. CEO John Brumsted hinted the network would expand in the coming year.
The state opened the doors of the Vermont State Psychiatric Hospital at a June ribbon cutting. The 25-bed hospital is the centerpiece of the state’s new decentralized mental health system, which it began building in the wake of the old state psychiatric hospital’s forced closure due to flooding in 2011.
The new hospital has struggled to find enough psychiatric nurses to fully staff the facility since its opening, and the jury is still out on whether it will reduce the amount of time mentally ill patients board in emergency rooms, an outcome state officials and health professionals hope to greatly reduce.
Two suicide attempts in five months at the Brattleboro Retreat, as well as several other violent incidents on its adolescent inpatient ward, nearly led to the hospital losing its federal certification.
Gov. Peter Shumlin intervened on the hospital’s behalf, and it avoided decertification, allowing it to continue to take mentally ill patients in state custody and ensuring its ability to provide mental health and substance abuse services to the region.
