The Senate Finance Committee is considering a drastically pared down version of Sen. Peter Galbraith’s single-payer financing bill — one that doesn’t include a financing mechanism.
Sen. Tim Ashe, P/D-Chittenden, chair of Senate Finance, said a financing plan is important, but it’s not the only policy question lawmakers must answer as part of Vermont’s reform efforts.
“One of our goals this year, and we’ve talked about this before, is to start advancing some decision-making on various aspects of health care reform,” Ashe said. “What we’re attempting to do is flag items that perhaps do not need to wait a year, two years or three years for some resolution.”
The Shumlin administration is planning to announce this spring several financing options for Green Mountain Care, the state’s planned universal health care program.
The Legislature is expected to vote on a financing plan and benefits package for the program during the next biennium.
In that spirit, the committee is considering a strike-all amendment to Galbraith’s Green Mountain Care financing bill, S.252, which caused a stir earlier in the session. It was the first concrete funding plan for universal health care. Among other things, S.252 included a payroll tax.
The only portion of S.252 that’s recognizable from Galbraith’s initial offering is the provision keeping federal employees and military personnel on their federal health coverage, while giving them the option to pay into Green Mountain Care for secondary coverage.
The most noteworthy change the bill makes is giving Medicare beneficiaries the same choice.
Sen. Kevin Mullin, R-Rutland, said not automatically providing secondary or wrap coverage to seniors would hurt Medicare beneficiaries.
“Senior citizens are going to be treated as second class citizens if we pass this bill,” Mullin said.
The actuarial value of Medicare benefits range from 50 percent to 85 percent, lower than the floor envisioned by most lawmakers for the Green Mountain Care benefits package.
Galbraith said that isn’t the case, because Medicare beneficiaries will have the option to pay for wrap coverage through Green Mountain Care.
A recent poll on health care reform conducted by the Vermont National Education Association — which recently jumped into the push for single-payer — found that 88 percent of respondents favored allowing seniors to keep Medicare as their primary coverage and allowing Green Mountain Care to supplement that coverage.
The bill would do that, but require them to pay for supplemental coverage, which most already do.
Robin Lunge, commissioner of Health Care Reform, said the administration doesn’t have a position on the new bill, but said it would affect coverage for Medicare beneficiaries whose coverage is publicly supplemented.
“If you wanted to continue this type of coverage under Green Mountain Care, you would not want to carve out everyone eligible for Medicare,” Lunge said.
The way the bill is written, Vermonters who are dual-eligible – people whose Medicare coverage is supplemented by Medicaid – would lose that coverage, Lunge said.
Actuarial estimates peg the number of Vermonters on Medicare in 2017, the planned launch date for Green Mountain Care, at 129,000 people, and the cost of providing them with secondary coverage through Green Mountain Care would cost $89 million.
There are another 30,500 people with federal health coverage. Providing this group with secondary coverage would cost $23 million.
If those populations are required to pay for secondary coverage, those costs could be offset or recouped.
The new version of S.252 also adds timing elements for the transition to Green Mountain Care that are currently undefined.
The legislation would require the Agency of Human Services to tell lawmakers what aspects of the program’s administration would be contracted out – such as claims administration and provider relations – by January 2015 and award those contracts the following year.
The bill would also add obesity and mental health conditions to the list of chronic conditions in the Blueprint for Health, and it increases the program’s compensation to providers.
It also changes the language defining an “uncovered employee” for the employer health care claims assessment.
That assessment feeds the state’s health care reserve fund, and it’s unclear how the change relates to Green Mountain Care. The administration has suggested that the employer assessment might disappear under a new health care financing system.
The proposed change would bring in an additional $3 million and require employers to pay for approximately 8,000 to 9,000 additional employees.
It would do so by requiring employers to pay the assessment for employees to whom they offer health care, but are instead covered by public insurance programs such as Medicaid.
Galbraith urged the committee to reinsert a set of guiding principles for developing a financing plan included in his original legislation (pages one and two in the linked bill).
“I think it’s useful guidance,” he said.
