Hamilton E. Davis is a former lawmaker, managing editor of the Burlington Free Press and chairman of the Vermont Hospital Data Council, the predecessor to BISHCA.
Just a minute or two after 10 o’clock Thursday morning the U.S. Supreme Court ruling upholding virtually the entirety of President Obama health care reform program fell like a thunderclap in Vermont, as well as the rest of the country.
There had been some speculation in the country that Obamacare would be upheld, but the broadest consensus was that the court would strike down the individual mandate in the bill, and that there was a good chance that it would kill the program outright.
As it happened, the decision was announced just as a forum on Vermont health reform was winding up in Burlington. More than 200 or so members of the business community were milling around in the vast ballroom of the Burlington Hilton hotel when the first reports came in.
The forum, sponsored by the health insurer MVP, had pretty much mirrored health care reform in both the state and the country over the last six months or so.
The attendees heard from Steve Kimbell, Vermont commissioner of the Department of Financial Regulation, a key member of Gov. Peter Shumlin’s reform design team. They also got a comprehensive overview of the reform situation from Susan Gretkowski, MVP’s government affairs strategist in Vermont. And they asked questions of a panel comprising Betsy Bishop of the Vermont Chamber of Commerce, Frank Fanshawe, vice president of government affairs for MVP, and Daniel McCauliffe, a dermatologist from Rutland.
While MVP was careful to maintain a balanced tone to the presentations, the overall sense of the questioning from the audience was hostile to much of the reform project. The gathering broke into spontaneous applause on three occasions, all of them full-throated denunciations of the single payer idea. Hence the sense of shock when the news of the court’s decision was broadcast.
Effect in Vermont
How will the decision affect Vermont? One clear loser was Sen. Randy Brock, the Franklin County Republican who is running against Shumlin in the governor’s race. In his comments since the end of the legislative session, Brock had made it clear that he hoped to make opposition to single payer reform a major plank in his bid to unseat Shumlin. Making the race a referendum on single payer was one of Brock’s best hopes. He could still try to do that, but he won’t have any cover from the high court and that will hurt him.
Brock maintained his determination to fight through the election against what he called “Titanicare.” But he also indicated that he will pivot from health care to jobs and Shumlin’s management of the economy and the environment for business in the state.
Brock was in attendance at the MVP conference and he held a press conference within half an hour of the Supreme Court’s decision. He maintained his determination to fight through the election against what he called “Titanicare.” But he also indicated that he will pivot from health care to jobs and Shumlin’s management of the economy and the environment for business in the state.
According to early polls, Shumlin is running ahead of Brock by 60 percent to 27 percent, an enormous gap, while Shumlin’s favorability rating — at 65 percent — is even higher.
The court’s decision won’t have any immediate effect on the planning process for health reform in Vermont, but it clearly provides encouragement to the planners and to supporters of single payer. For the time being, at least, they can continue on a track they expect will lead to an infusion of hundreds of millions of dollars into the state’s health care system by 2014 as support for the insurance exchange.
There remains the possibility that Mitt Romney will defeat Obama in November and if that happens both the overall program, and in particular, funding for its various components, will be threatened. But for the summer and fall, the Shumlin team will enjoy full sunlight.
While Shumlin can look forward to his November test with even greater confidence (if that is possible), he should not, however, be sanguine about the proceedings of yesterday’s MVP forum itself. The reason: There was that overlay of hostility on the part of at least a fair sampling of the business community. Moreover, the hostility appeared to be based to some extent on a misunderstanding of the Vermont effort.
For example, there was considerable discussion of the proposition that the Vermont plan will duplicate the Canadian single payer system, which has its own problems in the form of long waits for care and other issues. Whatever the merits of that case, the Vermont planners have made it clear that they intend to depart significantly from the Canadian model, particularly on the issue of fee-for-service reimbursement.
A large part of the planning effort in Vermont to date has focused on the need to design a new reimbursement system, one that shifts at least some of the risk for the cost performance within the system to doctors and hospitals. In other words, the first test for the Vermont system will be to control costs, a commitment that Gov.Shumlin reiterated yesterday.
In short, Shumlin probably needs to work much harder to build support in the business community for his program, not because he needs it to beat Brock, but because he needs the business community on board to drive single payer through to completion.
One of the tactical issues the governor ought to think about is his emphasis on not only getting to single payer, but getting there as soon as possible, preferably by getting the necessary waivers by 2014.
That seems very unwise. The dramatic reductions in the inflation rate in health care costs in Vermont over the past few years have been encouraging, but the real tests for cost containment won’t be faced until the economy fully recovers and that demand is supplemented by the tens of thousands of Vermonters who will enter the system once insurance is available with federal subsidies on the exchange.
It is fair to assume that a new reimbursement system for providers and potentially far-reaching restructuring of the delivery system will make serious cost management possible, but there is no way that those new systems can be designed, installed and tested and tweaked by 2014.
Shumlin needs to let his base know his commitment to the final step of single payer, but in real life, he will need every one of those three or four years after the exchange goes live in 2014 to get ready for it.
