Ambiguities in Act 48, the state’s universal health care law, have left some lawmakers wondering what the process for launching a single-payer program will look like.
Rep. Janet Ancel, D-Calais, is concerned about the timing involved in developing a financing plan and benefits package for the program, known as Green Mountain Care, she said at a Tuesday meeting of the Joint Health Care Reform Oversight Committee.
The benefits package comprises what services the program will cover and what percentage of those it will pay for. The financing plan is how the state will raise money to pay for those services.
Lawmakers, the Shumlin administration and the regulatory Green Mountain Care Board are expected to tackle both this biennium.
Act 48 sets out a process whereby the administration will present a financing plan, the Legislature will vote on it, and the Green Mountain Care Board must approve it.
The administration will present a benefits package to the board, the board must approve it and then the Legislature must make an appropriation to pay for it.
But which should happen first is not defined in the law, and Ancel said there are “sequencing issues” that aren’t resolved with only three months until the session starts.
Sen. Tim Ashe, D/P-Chittenden, said the legislative money committees can’t move forward with their work on how to pay for Green Mountain Care until the board approves a benefits package.
Al Gobeille, chairman of the Green Mountain Care Board, said he doesn’t see it as a linear process. If lawmakers want to tweak what the board approves, they can do so through new laws. There’s nothing precluding them from doing so before the program’s launch or in subsequent years, he said.
“If there was a new mandate that affected all coverage in the state … that would have to be fused into the benefit,” Gobeille said.
Ashe said if that’s how they proceed “it’s going to be ugly,” because the board was intended to depoliticize decisions about what’s covered through Green Mountain Care.
If it is understood that the board-approved benefit package can be changed through new laws, then “we’re going to get pounded by every group that wants this or that covered,” Ashe said.
Rep. Mike Fisher, D-Lincoln, chair of the House Health Care Committee, said it’s going to take discipline for lawmakers to stay within what can feasibly be paid for with taxes.
Robin Lunge, director of Health Care Reform, updated lawmakers on how the administration sees the timeline and key steps for implementing Green Mountain Care.
The much anticipated financing plan will still be unveiled to lawmakers in January, she said.
It will not be a single proposal, but rather a range of scenarios based on what percentage of health care costs the program will ultimately cover, Lunge said, leaving room for the Green Mountain Care Board to do its work.
Administration officials will then submit a proposal for the benefits package to the Green Mountain Care Board during the first quarter of 2015.
Officials are still developing a benefit package but will begin gathering public input before the end of the year. The proposed benefits package will be presented to the board during the first quarter of 2015.
Lunge did not have details on what form public engagement would take, but she did say they would use “straw people,” or archetypes such as a working single mother, so people can get a sense of how the program would affect them.
In addition, there is a set of five triggers the board is expected to use as a rubric in determining whether it should approve the financing plan and benefits package.
Those include the program not having a negative aggregate impact on the economy; lowering administrative costs; reducing the rate of growth in health care spending; being sustainably financed; reimbursing providers at a level that maintains a high-quality health care workforce; and, covering at least 80 percent of medical costs.
While the last is easily tracked, others have ambiguities of their own. Gobeille said the administrative costs trigger is especially “grey,” leaving a lot of room for interpretation.
The Green Mountain Care Board will request money to hire its own consultants, as the Legislature and administration have done, to do an economic analysis of what they’re ultimately presented with, Gobeille said.
Ashe said he’s concerned the program could be derailed if the board interprets the trigger differently than the Legislature or can’t approve a benefits package during the upcoming session.
But Sen. Jane Kitchel, D-Caledonia, said the board’s role was written into the law purposely so it could independently evaluate the program.
