Editor’s note: This commentary is by Robert Roper, the president of the Ethan Allen Institute. He lives in Stowe.
[T]here is some confusion out there, particularly among seniors, about what will happen to Medicare if Vermont adopts the single-payer health care program, Green Mountain Care. Does the state intend to “take over” Medicare?
On the heels of this question getting some necessary public attention from Libertarian gubernatorial candidate Dan Feliciano, the single-payer advocacy organization Vermont Leads posted, “Just in case you’ve seen this… you should understand the state has no desire (or ability) to take over Medicare.” Robin Lunge, the Shumlin Administration’s director of health care reform, was quoted as saying, “It’s never been our intention to take away or reduce people’s Medicare benefits.” (VTDigger, 10/7/14)
These statements range from dishonest to misleading.
First, Act 48 as passed in 2011 – which the Legislature wrote and voted for and Gov. Shumlin signed into law – states pretty clearly “Green Mountain Care shall assume responsibility for the benefits and services previously paid for by… Medicare….” [(Sec. 2(a)(6)]
And: “The agency shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont.” [(18 VSA 1827(c)]
Beyond what’s written in the law, Gov. Shumlin attended a meeting of Physicians for a National Health Plan in Boston last November where he was confronted by Dr. David Himmelstein. Himmelstein’s complaint about Green Mountain Care was that it couldn’t really be a single-payer system because the Vermont system would also have to accommodate several other insurance plans, including those of federal employees, military personnel, ERISA and Medicare.
Shumlin replied, “But I’m going to try to get the waivers to get everybody [in Vermont] in the pool — everybody. I want everybody in the pool.” This includes seniors currently on Medicare.
There are reasons for such insistence. Getting these waivers and incorporating the federal dollars into Green Mountain Care would be critical to the overall financing of single-payer, as well as for, as Himmelstein pointed out, realizing potential savings from the efficiencies of having just one payer.
It is also important to consider that the federal government may not grant Vermont the waivers it desires. It’s under no obligation to do so.
So, yes, the proponents of single-payer do “desire” to take over Medicare. They want to take over the Medicare revenue that currently flows into Vermont and put it into Green Mountain Care, and to take over responsibility for administering health care benefits to Vermont seniors.
Do they have the “ability” to do this at present? No. But it is written into the law that the state is legally bound apply for the federal waivers to get that ability by 2017, which is the earliest possible date at which the federal government is legally able to grant Vermont any waivers under the Affordable Care Act:
The director, in collaboration with the agency of human services, SHALL obtain waivers, exemptions, agreements, legislation, or a combination thereof to ensure that, to the extent possible under federal law, all federal payments provided within the state for health services are paid directly to Green Mountain Care. [(Sec. 2(a)(6)]
In fairness, proponents of single-payer believe that they can deliver equal or better benefits to seniors through Green Mountain Care, and Act 48 states that by law they must do so. The federal application for the waivers demands that the state demonstrate that it can deliver these benefits, and do so without increasing the deficit. This is what Robin Lunge was hedging at when she said it was not their intention to take away or reduce “benefits.” What they intend is to take control of delivering those benefits.
It is also important to consider that the federal government may not grant Vermont the waivers it desires. It’s under no obligation to do so. Some feel that if the Republicans take over the Senate after November the odds of Vermont obtaining Medicare waivers will go from slim to not likely. But, you never know, and the state is going to try.
Three years after its passage there are still a number of basic unanswered questions regarding single payer even. All Vermonters deserve an honest and open discussion about the costs and impacts of what moving to a single-payer system will mean and for whom. The place to start is with the facts about what is written in the law.
Proponents of a single-payer system no doubt believe transitioning the financial and administrative responsibility for Medicare benefits to Green Mountain Care will be a “big nothing-burger” for Vermont seniors. But, as we’ve seen, nothing-burgers can turn into big something-burgers pretty quickly in Vermont. After all, these are the same folks responsible for administering the Vermont Health Connect website, which has so far cost taxpayers $100 million dollars — and it still doesn’t work.
