Gov. Peter Shumlin and his top health care officials were in Washington, D.C., last week to discuss waivers to federal programs that would allow Vermont to move forward with a single-payer health care program.
Traveling with Shumlin were Robin Lunge, director of health care reform; Lawrence Miller, chief of health care reform; Al Gobeille, chair of the Green Mountain Care Board; and Anya Rader-Wallack, a consultant managing a large federal grant funding health care innovations.
The government won’t grant waivers to the Affordable Care Act before 2017, but the state will continue to position itself to receive one for the next several years, Lunge said.
To proceed with single-payer, Vermont will need a waiver from provisions of the Affordable Care Act and a renewal of its Medicaid global commitment waiver, which expires in 2016.
That waiver allows the state flexibility in how it spends federal Medicaid dollars as long as it meets the program’s basic requirements.
Vermont will also apply for what’s known as an “all-payer waiver,” which would allow the state to set reimbursement rates for Medicare. The state already sets Medicaid rates and regulates commercial rates.
The all-payer waiver could allow Vermont to reduce cost-shifting among payers, as currently happens to commercial insurance carriers when government programs underpay, Lunge told state lawmakers Tuesday at a legislative meeting.
Maryland is the only state with an all-payer waiver, which it has had since 1977.
It has used the waiver to ensure that Medicaid, Medicare and private insurance all pay roughly the same rate, according to Robert Murray, who spent nearly two decades working for Maryland as a hospital regulator and now consults for the Green Mountain Care Board.
Such a waiver could ultimately allow Vermont, if it transitions to a universal publicly financed health care program — often called single-payer — to pay the vast majority of people’s health care costs with capped payments to doctors and hospitals, though the details of such an arrangement will take years to finalize, Lunge said.
The all-payer waiver will help Vermont reform how health care services are paid for even if it never moves to single-payer, Lunge said, adding that the two are complimentary but not contingent on each other.
The Shumlin team met with U.S. Secretary of Human Services Cynthia Burwell and officials from the Centers of Medicare and Medicaid Services. Lunge and Miller also met with officials from the Treasury Department and the Office of Budget and Management.
Beyond starting preliminary negotiations on the federal waivers, Vermont officials pushed for federal funding for health services IT projects to be extended.
If Republicans gain a majority in the U.S. Senate in the November election, Lunge said she doesn’t see that having an adverse affect on Vermont’s waiver prospects.
“The most interest in a waiver is from Republican states” that want to walk back aspects of the law, Lunge said, “If anything, that might loosen up the waiver process.”