A bipartisan group of doctors, patients and legislators gathered at the Statehouse on Wednesday to speak out against a law that gives the Green Mountain Care Board the power to regulate physician rates.
Their overarching message?
Change the law or the Shumlin administration and the board can expect a lawsuit.
“If the provision is not repealed, it’s infringement on the economic freedoms of these doctors, and they may proceed to a legal challenge to protect their constitutional rights and the constitutional rights of patients,” said Darcie Johnston, director of the anti-single payer group Vermonters for Health Care Freedom, who organized the press conference.
The provision in question was written into Act 48, the landmark health care bill enacted in 2011 that set Vermont on a path towards a universal health care system and created the Green Mountain Care Board to control growing costs.
The particular sections of the bill that Johnston and company take issue with give the board the power to “set reasonable rates for health care professionals” and establish that, “except for cost-sharing, Vermonters shall not be billed any additional amount for health services covered by Green Mountain Care.”
Green Mountain Care is the universal health care program that the Shumlin administration says it plans to implement in 2017. That is when the state could first receive a federal waiver to deviate from the requirements of the Affordable Care Act.
Rep. Cynthia Browning, D-Arlington, proposed a bill this session that would have limited the board’s authority to regulate rates. Specifically it would have prohibited the board from interfering “with the ability of any Vermont resident to enter into a voluntary financial arrangement with the Vermont-licensed health care professional of his or her choice.”
The bill was turned into an amendment, and the House voted it down.
“I think it’s very important that Vermonters have choice,” Browning said. “We have choice in many of our school systems, and I think we should have choice in health care. I had not earlier realized that the Green Mountain Care Board was given the power to regulate the rates not just of providers who are asking for reimbursement within their system, but even of providers who are not participating.”
A group of physicians support Browning’s bill, including Bob Emmons, a Burlington psychiatrist with 24 years of experience. He warned that the board’s ability to regulate rates could affect the way physicians practice medicine.
“The scientific evidence available does not demonstrate that the move from big insurance to big government will help physicians to take better care of their patients,” he said. “When the state controls how doctors are paid, it opens the door for the state to use an elaborate system of financial rewards and punishments to manipulate the clinical decision-making of doctors.”
While Emmons said he would like to work out this issue by talking to state officials, he is not averse to settling the matter in court.
“It seems to be difficult to get people in state government to change course based on feedback from physicians,” he said. “It would seem to me it’s unconstitutional for the state to interfere with the right of two individuals to enter into a private financial arrangement.”
The Green Mountain Care Board has not exercised the authority to regulate provider rates. Board Chair Anya Rader Wallack said the board is cautiously moving forward with this power and is first researching variations in the marketplace.
Wallack did say, however, that it is a crucial tool for controlling health care costs.
“I think it’s going to be a very important mechanism for us and the state in the long run to make health care pricing more transparent and more understandable and reasonable across providers, and to me that’s a really central goal of the law,” she said. “I think it would be a mistake to do away with it. Our approach to this has been cautious and to remain that way, but the underlying authority to address what is now a totally irrational system is important.”
Wallack, who had a large hand in crafting Act 48, also supports the provision that limits providers from billing Vermonters for additional amounts under Green Mountain Care. The idea, she said, is to ensure that providers don’t rip off Vermonters.
