Gov. Peter Shumlin relished his biggest moment of triumph since he was elected in November by a narrow margin. On Wednesday, he signed a bill that he said will create “the first single payer system in America.”
Shumlin, flanked by dozens of supporters and Democratic lawmakers on the Statehouse steps, profusely thanked the advocates and legislators who helped to pass H.202, a bill that sets in motion the creation of a single-payer style health care system. More than 100 onlookers marked what several lawmakers called a historic moment.
“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long — to have a health care that is the best in the world that treats health care as a right and not a privilege, where health care follows the individual not the employer,” Shumlin said.
Shumlin, a Democrat, campaigned on the creation of a single-payer plan that would contain rising health care costs, integrate the fractious medical system and guarantee universal access to medical care. With the enactment of H.202, the governor takes the first step toward realizing that campaign pledge. The Democratic majority in the Vermont House and Senate passed the bill in May.
The legislation sets up a framework for developing an implementation plan for Green Mountain Care, a universal, unified health care system. The bill creates a five-member board that will oversee the development of a benefits package, a reimbursement system for doctors and hospitals, and a financing system to support the universal health care plan. The law also contains provisions for Vermont’s federal insurance exchanges.
The governor described the single-payer system that has yet to be designed as “a huge jobs creator” that is “sustainable, that spends our health care dollars making Vermonters healthy not on insurance company profits and not on waste and inefficiency.”
The governor spelled out a vision in which health insurance coverage would be decoupled from employment and the financial burden now borne by employers would be lifted; in which providers who are having difficulty surviving in the current system are compensated fairly; and in which uninsured and underinsured Vermonters will have access to health care. The bill lays out a timeline for the implementation of the complicated plan over a three-year period. Though the Shumlin administration hopes to launch Green Mountain Care in 2014, it could be 2017 before the system is in place because of certain federal requirements.
“As a business person … I know firsthand that the biggest obstacle to job growth is the 10, 20, 30 percent increases in insurance premiums,” Shumlin said. “Where we as employers so badly want to cover our employees and consistently send more money to insurance companies for less and less coverage asking Vermonters our employees to pay more and more of their share in an unsustainable system that will both bankrupt us and make it impossible for our small rural providers who do such a great job providing quality care to survive in a small rural state.”
The governor pledged to “get this done in Vermont” despite daunting obstacles. A few of those roadblocks include intense opposition from prominent insurance companies, insurance brokers and some large employers (most notably IBM); skeptical doctors and hospital administrators; and requirements that the state obtain eight federal waivers before it implements Green Mountain Care.
Shumlin acknowledged that his administration “has a few challenges” and that H.202 is the beginning of a long, difficult odyssey no other state has undertaken, in which critics would attempt to undermine his administration’s efforts to create a single-payer system. The Shumlin administration also faces pressure from the activists who created a groundswell of grassroots support for single-payer. Some observers say advocates may demand health care benefit levels that could prove financially unsustainable.
The bill, Shumlin said, is for the 47,000 uninsured and 150,000 underinsured Vermonters “who know that if they get sick, as unfortunately we all do, that when that day comes, they may lose their house their car, their economic security because underinsurance is no insurance at all.”
“That’s what we need to fix,” Shumlin said. He described the bill as “both an opportunity and an obligation.”
After he finished his short speech, the governor served as emcee for the hourlong oratory prelude to the signing. Shumlin introduced a cancer survivor, activists and key lawmakers to the crowd, each of whom took a turn at the mic before the governor signed H.202 and handed the pen to Dr. Deb Richter, an advocate who has lobbied for a single-payer system for 20 years.
In her remarks, Richter said for the first time, health care in Vermont will be considered a public good rather than a commodity to be sold.
“We’re going to hear all kinds of scare stories – that this is a thoughtless experiment or that this is too bold,” Richter said. “I want to remind you that every other industrialized country does what we are trying to do. They do it for far less money, they live longer and they do it for far better care. So it’s time for Vermont to join the rest of the industrialized world.”
Richter thanked Shumlin who made a pledge “if he were elected governor he would make Vermont the first state in the nation to enact a publicly financed system that pays for health care for all Vermonters. How many politicians do you know who really do what they day they’re going to do?”
House Speaker Shap Smith, D-Morrisville, praised the House and Senate health care committee chairs before he launched into a speech excoriating critics of single payer.
“It’s amazing that we’re here and that we could be debating the fact that there could be something wrong (with) passing a law that creates coverage for all Vermonters,” Smith said. “It should be at the very core of what we believe in as citizens. It should be not debatable. It should be a fundamental principle for not only all Vermonters, but for all Americans. All of the other industrialized countries get it and thank God we here in Vermont get it, too.”
Smith chastised “those who say this may bring uncertainty.” He talked about rising health care expenditures and the cost of medical insurance premiums as more troubling uncertainties than the unknowns associated with creating a single-payer system.
“What is it like to face the uncertainty of not having health care coverage at all or having health care coverage that doesn’t really provide you with health care in the first place?” Smith said. “That’s uncertainty.”
Smith said the bill will remove uncertainties for Vermonters who are worried about having coverage and will create “commonsense payment reform” in which providers are paid for performance not for the number of patient visits.
Senate President Pro Tem John Campbell said he was proud to be part of a “courageous stand” on the second historic piece of ground breaking legislation enacted in the last two years, and he compared the passage of single-payer health care bill with the gay marriage law that was enacted in 2009.
Campbell warned, however, that “the next few years are going to be very difficult.”
“There are many people out there who would love to see us fail,” Campbell said. “We have to look at them and figure out why. There may be some insurance companies out there that are afraid they may lose some business. For that I’m sorry, but I have to look at people who are walking around without health care coverage who aren’t able to get in to see a doctor who are suffering from cancer and other maladies they may not be able to get treatment for just because we have a broken health care system. We can’t sit by folks we all have to get involved; we all have to be ready to fight the fight that surely will be coming over the next two or three years.”
Shortly after the ceremonial signing, MVP Health Care President and CEO David W. Oliker issued a statement blasting H.202.
Oliker said the Shumlin has not yet addressed the “legitimate and lingering concerns” of the bill’s critics. He emailed a list of questions to the press corps that he said had yet to be answered. Oliker takes issue with significant omissions in the legislation. The bill doesn’t spell out how the system would be paid for; it doesn’t address how Vermonters who work for out-of-state businesses would be affected; it doesn’t say whether physicians would leave Vermont if a unified reimbursement system is implemented; and it doesn’t include information about the economic impact of the plan.
“MVP Health Care is committed to continued participation in the dialog around these important questions,” Oliker wrote in a statement. “We are also committed, as we have been for more than 20 years, to our Vermont communities and members. MVP will continue to serve our customers and make investments to drive innovation that improves the quality of care in Vermont and enhances access to affordable health care.”
There is also pressure from the other side of the issue. Shortly before the signing, members of the Health Care is a Human Right Campaign” held a rally and outlined the steps the Shumlin administration still needs to take to satisfy their concerns.
“H.202 is the result of the work of a grassroots movement of Vermonters,” said David Kreindler, a leader in the movement, “but that work is far from done.” Kreindler said he was pleased that the bill mandated that the group’s five human rights principles – universality, equity, accountability, transparency, and participation – be incorporated into Vermont’s new health care system. The challenge, he said, would be in what the bill didn’t state.
“The struggles that we face in the coming years are mainly the issues that were not defined yet by H.202 but must be defined before we have a healthcare system,” said Kreindler.
At the conclusion of the address, Mary Gerisch, another leader in the movement, reminded the group of their ultimate goals. She said: ““The reason it’s so important is … the real cost, worth far more than dollars, is the lives of the human beings that are left ruined in bankruptcy and even death by the lack of a universal healthcare system. Those are the costs that we must curtail.”