Editor’s note: This op-ed is by Richard Davis, a registered nurse and the executive director of Vermont Citizens Campaign for Health.
It is clear that the legislature is moving full steam ahead and there is little doubt that the governor will be signing H.202 very soon. One of the most often asked questions about this bill is, “When will it affect me?” Here are some tentative answers based on a document created by the Joint Fiscal Office titled, “Draft H. 202 TIMELINE (as passed by Senate Health & Welfare). Keep in mind that everything is a moving target and subject to change.
If we assume that Shumlin signs H. 202 into law right after the end of this legislative session, the first official event will be the appointment of a nominating committee to vet nominees to the Green Mountain Care (Vermont’s new health care plan) board.
Once the nominating committee does its work sorting through applicants to the high-profile, powerful Green Mountain Care board, it will recommend the appointment of five members of the board to be hired by October 2011. At that point, the full board will begin its work. The board will then have the power to begin the approval process for insurance rate increases, provider rate setting and payment reform.
In May 2012 legislation will need to be passed that finalizes exchange-related implementation. There are many requirements that states must meet, according to federal law, relating to setting up an easy-to-use insurance marketplace, known as the exchange. That marketplace must work in concert with Vermont’s new health care plan.
I won’t get into exchange issues here because they are so complex. It is important to understand that exchanges must offer at least two insurance plans, and Vermont eventually would like to have only one operating insurance entity. There is a way to make that happen, but it requires special permission from the federal government, one of the so-called waivers.
The board will begin the work of approving hospital budgets and certificates of need in July 2012. Those are duties that were previously within the purview of the Public Oversight Commission, which will be eliminated.
In September 2012, the board will produce a draft of GMC benefits so that work can begin on a financing plan. The board will then approve benefits to be offered in the exchange in October.
The next major step in the process will happen at the beginning of a new legislative session in 2013 when the administration delivers a financing plan to the legislature. This is where the rubber meets the road and it will most likely take the entire legislative session of 2013 for a Green Mountain Care budget to be developed. If all goes according to plan, a budget for the system will be enacted in May 2013.
All of these activities depend on the outcome of waiver requests. Exchange waivers could be granted as early as the fall of 2013, but other more critical waivers may not be able to be secured until 2017. The hope is that the 2017 date will be moved up to 2014 so that Vermont can implement something close to a single payer system rather than just a redesigned insurance marketplace.
Once the state has everything in order relating to exchanges, then exchange coverage benefits and coverage under GMC could begin in January 2014. That would be the earliest date that all of the health care reform efforts in Vermont would actually bear fruit. People would be able to have new health insurance coverage that is comprehensive and affordable while providers would be paid at a rate that reflects reality and, perhaps, not be forced to subsidize the health care system.
If the federal waivers are not enacted in 2014 then the fruit bearing part of GMC, the time when Vermonters are actually able to sign on to the program, will have to wait until 2017.
While that seems like a long time to wait, we have to keep in mind that everything we do now will make a new system possible. We must keep the process active and all of us must stay engaged. Each step along the way makes the next step possible.
It would be better to have all of this begin in 2014, but if we have to wait until 2017 our biggest challenge will be to remain focused. Sadly, people will suffer and die as a result of a delay, but Vermont will still have the chance of becoming the first state in the nation to offer its people affordable access to comprehensive health care benefits under a single payer insurance system.
