Financing and benefits are one thing, but how will Green Mountain Care, the Shumlin administration’s universal health care system, be governed?
For those closely watching the runup to universal health care in Vermont, a great deal of attention is being paid to developing a financing plan and benefits package.
There’s good reason for that. Designing those components is a prerequisite of getting the program off the ground. But how the system will be managed after its creation is already on the minds of some in the administration, including Michael Costa, deputy commissioner of Health Care Reform, who is charged with designing finance options for the program.
“The governance structure of Green Mountain Care is just as important as how you pay for it,” Costa said.
The pressure to develop funding sources and benefit packages for consumers is heightened by the tight time frame for transitioning to Green Mountain Care and the many unknowns that must be pinned down before those components can be passed into law.
In order for Green Mountain Care to launch, the chain of events for the financing plan looks like this: The administration will present funding source options, the Legislature will decide what they like and vote on it. Then the Green Mountain Care Board must approve it.
The launch route for the benefits package is slightly different. The administration will present its package to the board, the board must approve it and then the Legislature reviews the health care plan when lawmakers approve an appropriation to pay for it.
But the laser focus on the 2017 go-live date obscures the fact that the same process must be repeated in perpetuity.
In any given year, if the revenue stream falls short of the program’s costs, lawmakers will have to decide whether to raise more money or cut services.
Act 48 provides an advisory role for the Green Mountain Care Board in those decisions, but ultimately the process will become a budget negotiation between lawmakers and the administration.
To be clear, administration officials are thinking about creating a system that is sustainable.
However, much of the conversation around programmatic sustainability for Green Mountain Care, at least publicly, pertains to what the financing mechanism will be and the level of benefits it will need to cover.
There is also tremendous focus and effort on the spark that ignited the march toward health care reform — controlling costs.
But a consideration that hasn’t entered the public discussion is what the program’s governance structure will look like.
Costa says the composition of the governance structure for single payer will have a major impact on whether the program gets bogged down in a political dogfight each year.
“You want to design a finance system that minimizes the potential of conflict between the administration the Legislature and the Green Mountain Care Board,” Costa said. “I would anticipate that the financing plan delivered in January 2015 will talk a fair bit about the governance structure and how it’s going to work not just in year one, but in years three and five and 10.”
Costa declined to provide details about the administration’s approach to the governance structure because he doesn’t want to get out in front of the process Gov. Peter Shumlin has laid out for the financing plan.
