Libertarian gubernatorial candidate Dan Feliciano says Gov. Peter Shumlin is planning to “take control” of Medicare benefits as part of a single-payer health care program. A Shumlin campaign official called the claim untrue and a “scare tactic.”
Feliciano said he is “ringing the alarm bell” on Shumlin’s plan to use a federal Medicare waiver to “offset the costs of the single-payer program,” he said at a news conference Tuesday in Montpelier.
The Shumlin administration is seeking an all-payer waiver to allow Vermont to set Medicare reimbursements — or what and how the program pays doctors and hospitals. Administration officials say the waiver would not allow them to change Medicare’s benefits.
“Medicare benefits are protected by federal law, and it’s never been our intention to take away or reduce people’s Medicare benefits,” said Robin Lunge, director of Health Care Reform for the Shumlin administration.
Legislation passed this year clarifies Green Mountain Care’s relationship to Medicare, making it the secondary payer for Medicare beneficiaries in Vermont. That means services or costs that Medicare doesn’t cover, which Green Mountain Care may, would then be paid for by Green Mountain Care.
However, Feliciano contends Vermont will use a potential all-payer waiver to put federal Medicare dollars in the General Fund and use them to pay for a universal, publicly financed health care program — often called single-payer.
That contention is based on his understanding of how Maryland’s all-payer waiver works, Feliciano said.
But nothing in the Centers for Medicare and Medicaid Services description of its agreement with Maryland indicates that the program’s benefits can be altered, or that Medicare money can be used to pay for services to non-Medicare beneficiaries.
Maryland is the only state with an all-payer waiver, which it has had since 1977. The waiver allows Maryland to set the rates for Medicare payments to hospitals. It’s part of an all-payer system that requires that “all third-parties pay the same rate” for hospital services, according to CMS.
Under a modified waiver agreement this year, Maryland will use the waiver to make capped, or global, payments to hospitals. The payments are adjusted based on the population a hospital serves and patient outcomes.
If the agreement doesn’t save Medicare money and improve care for its beneficiaries in its first five years, the modified waiver won’t be renewed, according to CMS.
Vermont is aggressively pursuing similar value-based capped payment models, and the all-payer waiver it is seeking would allow the state to set reimbursements for all health care providers — unlike Maryland, which just sets reimbursements for hospitals.
“If Medicare in Vermont continues to pay providers through a fee-for-service model, that undermines the providers’ ability to move to new payment models,” Lunge said.
Fee-for-service is a term for the current payment model in which doctors and hospitals are paid for each component of a service.
The news conference at the Statehouse drew three reporters, Felciano, his wife, Carol, and Darcie Johnston, his de facto campaign manager, as well as a couple from Grand Isle who are covered by Medicare.
Kay Trudell, 67, said Johnston invited her and her husband to the event, which she attended because she’s against the Shumlin led “socialist takeover of medicine.”
Trudell said she’s concerned that Shumlin and his administration aren’t being honest with Vermonters about how a single-payer program would impact Medicare.
“I don’t want (Shumlin) experimenting with our Medicare dollars,” Trudell said.
Peter Sterling, director of the single-payer advocacy group Vermont Leads, said Feliciano is using scare tactics to rile Vermont seniors a month before the November election.
“There’s no evidence that the administration would be able to do this even if they wanted to,” Sterling said, adding that he hasn’t seen any indication that the administration or other elected officials want to change Medicare benefits.
Scott Coriell, Shumlin’s campaign manager, issued the following statement in response:
“Vermonters deserve better than a scare tactic from their gubernatorial candidates. Green Mountain Care would do nothing to change Medicare. Seniors will still access care through Medicare as they do today. In fact, seniors will have the added protection of Green Mountain Care which will serve as supplemental coverage beyond the benefits of Medicare. I am glad that Dan sees the benefits of Medicare, a government-run health care program that provides universal access to seniors and asks them to pay based upon their ability. We think such a system makes sense for all Vermonters, not just seniors.”