Correction: State no longer looking to administer Medicare - VTDigger
 

Correction: State no longer looking to administer Medicare

Two recent stories about the relationship between Medicare and Green Mountain Care, the state’s planned universal publicly financed health care program – often called single-payer – were inaccurate. The stories were based on statutes on the Legislature’s website that had not been updated.

The online statutes do not reflect the latest changes made by the Legislature in 2014.

Section (e) of chapter 18, Public Private Universal Health Care System, in Title 33, Human Services, still states online that, “The Agency shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont. If the Agency is unsuccessful in obtaining such permission, Green Mountain Care shall be the secondary payer with respect to any health service that may be covered in whole or in part by Title XVIII of the Social Security Act (Medicare).”

Act 144, which was enacted in 2014, repeals that section, though the statutes have not been updated online.

Section (f) of the same chapter now reads, “Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.”

State officials have said they are no longer seeking to administer Medicare as part of Green Mountain Care, and the law reflects that change.

Two recent stories contain inaccuracies that result from using the out-of-date online statutes:

Feliciano claims Shumlin wants to “take over” Medicare

Senate candidate sparks controversy with Burma Shave signs

Rep. Sarah Buxton, D-Tunbridge, is correct that Republican Senate candidate Bob Frenier’s campaign signs claiming the state wants to administer Medicare as part of single-payer are inaccurate.

Frenier’s other claim, that Vermont seniors on Medicare won’t have the same access to private supplemental coverage under Green Mountain Care remains a hypothetical. Most seniors have supplemental Medicare coverage, often known as Medi-gap plans.

It is currently unknown what Green Mountain Care will cover or what private supplemental health insurance policies will be offered once the program is in place.

Gov. Peter Shumlin has said there is no reason to expect that currently available supplemental coverage options for Medicare would change if the state moves forward with a single-payer health care system.

Anne Galloway

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  • Ross Laffan

    I’m so dissillusioned. I’ll never be able to get my information on Vermont statutes from Burma Shave signs again.

  • John McClaughry

    Sec. 2 (a)(6) of Act 48 of 2011 reads “Green Mountain Care shall assume responsibility for the benefits and services paid for by federal programs, including Medicaid, Medicare, and, after implementation, the Vermont health benefit exchange…”
    Act 144 of 2014, cited by Galloway, repeals 18 VSA 1827(e), (created by Act 48) which required AHS to seek CMS permission “to be the administrator for the Medicare program in Vermont.”
    However the aforementioned Sec. 2(a)(6) declaration of Act 48 has never been repealed (so far as I can discover). It was part of a session law, not codified in the Vermont Statutes. It can be argued that session laws continue in force only until the end of the biennial session, which is debatable, but the crystal clear intent of the promoters of Act 48, starting with Gov. Shumlin, was to divert Medicare funds into Green Mountain Care in line with their oft-stated single-payer maxim, “everybody in the pool.” (“universal access to and coverage for high-quality, medically necessary health care for all Vermonters.”
    Shumlin & Co. now seem to be trying to squirm out of their clearly stated intent to get the state’s hooks on the Medicare payment stream. That’s certainly understandable, with seniors suddenly waking up to the Shumlin plan. This is another example of ill-thought out “grand visions” crashing into political and economic reality.
    Dan Feliciano has done the voters a great service in pointing this out.

    • Jamie Carter

      “Shumlin & Co. now seem to be trying to squirm out of their clearly stated intent to get the state’s hooks on the Medicare payment stream. That’s certainly understandable, with seniors suddenly waking up to the Shumlin plan. ”

      Or it could be that when CMS told them they couldn’t they decided to believe them and drop it?

    • Shame on you, John, for going on the radio today and doubling down on your ridiculous assertion that the statement of intent – NOT STATUTE – included in a bill needs to be repealed in any way. And shame on your for not be absolutely clear that wording you have referred to is NOT statute and never was.

      By the way – the legislative intent is ABUNDANTLY clear in Act 144: Sec 1 (3) “As provided in 33 V.S.A § 1827, Green Mountain Care shall be the payer of last resort for Vermont residents who continue to receive health care through plans provided by an employer, by another state, by a foreign
      government, or as a retirement benefit.” (http://www.leg.state.vt.us/DOCS/2012/ACTS/ACT048.PDF)

      Shame on you, John M., for helping to spread unnecessary fear, uncertainty and dread – all based upon a mistake on your part.

      • John McClaughry

        Due to the need to maintain a respectable level of civility on this site, I will pass over offering my candid and indeed indelicate response to this typically ignorant and intemperate outburst.

        • John Greenberg

          John,

          I’m sure we can live without your “candid and indeed indelicate response,” but you owe Rama and other readers some justification for your calling his comment a “typically ignorant and intemperate outburst.”

          Skip the invective and get to the evidence.

      • David Dempsey

        Rama,
        I emailed my two representaives after I read this article. and asked them if they knew that act 144 changed act 48 regards to the state administering medicare funds. It might be abuntantly clear to you but neither of them knew that and they said they would look at the bill. I also was unaware about act 144. I’m not sure how I missed the details of act 144, but I’m in good company with my ill informed representatives.

    • Bob Zeliff

      It is sure a pleasure to see that John McClaughry and his Ethan Allen institute cohorts have be come advocates and protectors of the USA one true single payer system…Medicare!

      Glad you all have finally seen he light!

      I hope you will support Medicare for All in the future. More republican need to make the shift for the good of the American people.

  • Walter Carpenter

    This is another example of ill-thought out “grand visions” crashing into political and economic reality.”

    But, as Anne pointed out here in her article, it is not true.

  • The official online version of Vermont’s statutes is kept at LexisNexis (as pointed out by the state’s legislative website) – http://www.lexisnexis.com/hottopics/vtstatutesconstctrules/. It takes several clicks to reach the appropriate spot.

    Here is the link to Act 48 of 2011 – http://www.leg.state.vt.us/DOCS/2012/ACTS/ACT048.PDF – I AM NOT A LAWYER, but it does appear the language Mr. McClaughry is referencing was explanatory text and never intended to be entered into statute. This would mean there is nothing there to repeal.

  • Jim christiansen

    So, is everybody in or not? If not, who,and why please? Does this have an effect on projected costs vs revenue required?

    This is what happens when politicians don’t deliver on their promises and leave an information vacuum.

    It is very frustrating for the citizen who tries to keep up but can’t even expect to find up to date information on the States web page.

    Thanks for the clarification Anne, but this issue is still clear as mud to most Vermonters?

  • Jim christiansen

    By the way, a Town library or Cemetary trustee Board can get in hot water from the Sec. Of State if they don’t have the minutes of their last meeting on the available Town web site within 5 days.

    Where does accountability for the State to provide accurate and timely information regarding legislative sessions rest?

    • Randy Koch

      I would say the state does a great job reporting legislative sessions on line. Beats driving to Montpelier and pawing through xeroxes of bills.

  • Ann Raynolds

    If a previous report in the VTDigger is accurate, then just recently Robin Lunge and administration officials who traveled to Washington seeking discussion of a Medicare waiver, came back with the understanding that it is too complicated to unhook one State’s Medicare from the New England system. This is no big deal really, because we who have Medicare always knew we would get the Medicare benefits as well as any supplemental benefits which our Green Mt. Care card might provide AND that we could also purchase more supplemental insurance if needed. Gov. Shumlin on Saturday in Proctor at a Bernie Sanders rally assured everyone of this exact plan.
    Those of you readers opposed to a Universal Health Plan can scratch off trying to rile up seniors about changes in their Medicare insurance. I, for one, want to work to see everyone has as good a Health Plan as the national government provides for us seniors on Medicare!

    • Craig Powers

      Ann:

      You are not seeing the forest through the trees.

      Without you seniors, and your medicare dollars in the VT single payer system, how can you possibly think/believe there will be enough money to support it long term (or even short term)?

      Should we just turn over 75% of our paychecks to Montpelier? Would that make you happy?

      • Jamie Carter

        I’m confused…can you provide me with a break down in numbers supporting your assertion that if Medicare dollars do flow through GMC the system can’t work?

        Medicare dollars will still pay for seniors in Vermont whether GMC administers the payments or not… It doesn’t change the math, only how the program will work… unless I’m missing something.

      • Walter Carpenter

        “Should we just turn over 75% of our paychecks to Montpelier? Would that make you happy?”

        I am curious how it is that we can afford to pay for private health care now. Isn’t the total about $2.6 billion, without adding in the unaffordable deductibles and other co-pays on top of this? If we keep going along this road with private insurance, we shortly will be handing over 75% of our paychecks, but to private insurers.

    • Yes Ann and Walter…the opponents of real health care reform, due to ideological or financial reasons, have a history of trying to create an “irrational fear” regarding systemic change.
      Two examples:
      In the 50’s and 60’s it was the fear of “socialized medicine” implying communism during the height of the cold war.
      Later, in the 90’s it was the “Harry and Louise” ads that were telling people that they couldn’t choose there own doctors under the Clinton plan. (Out of network anyone?)
      The concerns about Medicare are the latest attempt to cultivate such a climate of fear with seniors about Green Mountain Care. Also the opponents of GMC and some of the media talk about the cost of 2 billion as if it will be in addition to the 2.6 we are already spending, not replacing it.

  • Patricia Crocker
  • Wendy wilton

    Then, why did the Shumlin administration recently have meetings in DC about Medicare and the ‘all payer waiver’ if the intent is not still in the offing?

    And why couldn’t Sarah Buxton specifically explain that the Medicare language was removed from the law…did she not know? And why didn’t Robin Lunge reference this change in her recent interview about the Medicare issue? Isn’t she a lawyer and top legal beagle for this initiative?

    And finally, how will the Single Payer system be effective if over 30% of Vermonters, covered by Medicare, will not be managed through Green Mountain Care? First, the taxpayer group will not be able to shoulder the Medicaid burden alone and secondly, the system will still have multiple claims systems. Wasn’t the key argument for single payer about getting all claims processed in a common format?

    I don’t think I’d be betting the current crew under the dome couldn’t revamp the law to include Medicare if the green light comes from Obama. However, the timing will be dependent upon the mid-term election? Stay tuned!

  • Mary Alice Bisbee

    The whole made up problems that the right is finding with Medicare coverage are easily noted in the above comment by Wendy Wilton. Please note, GMC is not going to “manage” anyone’s care, including Medicare. GMC will “pay” for care, not manage it. As someone on Medicare for several years knows: I am not a case and I don’t want to be managed! I love my Medicare and think everyone should have it.

    Medicare should have been the model for the nation instead of the ACA but we all know we got the best health care program that insurance company lobbyists could buy. This is why we need to keep on the straight and narrow and vote for Peter Shumlin and Dean Corren to captain our ship forward. The same goes for state representatives and senators.
    The people have spoken and will continue to be heard!

    • Craig Powers

      Mary Alice…

      Everybody’s in …but DON’T touch MY COVERAGE! Sounds a touch selfish to me since you are clamoring for us to vote for politicians leading us down a completely undefined path.

      Oh, and while we are at it, let’s exempt teachers, and state employees, and union members, and military personnel , etc, etc ,etc…

      That will leave very few to financially shoulder the GMC burden. That is not OK or fair.

      • Walter Carpenter

        “Everybody’s in …but DON’T touch MY COVERAGE! Sounds a touch selfish to me since you are clamoring for us to vote for politicians leading us down a completely undefined path.”

        It may be different, at least in America, but it is hardly undefined. In a way, it is simply following where Medicare led and where we should have gone as a nation.

    • “Medicare should have been the model for the nation instead of the ACA but we all know we got the best health care program that insurance company lobbyists could buy.”
      Also those who have vested interests in the current convoluted systems. Remember Rich Tarrant and IDX.

  • Kathy Callaghan

    “However the aforementioned Sec. 2(a)(6) declaration of Act 48 has never been repealed (so far as I can discover). It was part of a session law, not codified in the Vermont Statutes. It can be argued that session laws continue in force only until the end of the biennial session, which is debatable, but the crystal clear intent of the promoters of Act 48, starting with Gov. Shumlin, was to divert Medicare funds into Green Mountain Care in line with their oft-stated single-payer maxim,….”

    Anne, this bears further investigation. We need the absolute truth on whether the Medicare provision was actually repealed or not – on a formal basis – in statute. So far it appears to be a “he said – she said – they said” situation without any evidence in fact.

    Can you please follow up and let your readers know definitively if this provision has in fact been repealed?

    Thank you.

    • Jamie Carter

      Why do we need a clarification, The feds already told them no… regardless if it was part of the law or not, it’s a big fat no. Done deal, VT can not administer medicare benefits in VT only. Period.

      • Karen McCauliffe

        Jamie, I do not know that they have said no. The waiver was to be sought at the end of Obama’s term. It is no done deal as you state. Let us see the documentation from CMS. It is just hearsay at this point until we have seen the written documentation from CMS. If there was even written documentation then the waiver can be applied for repeatedly.

        It was always Vermont’s goal to roll Medicare into its single payer program. Vermont is the second oldest state so many are on Medicare. Also note their numbers on percentage on Medicare and Medicaid is a little low as with the ACA Medicaid expansion in Vermont, over 30% of Vermonters are on Medicaid.

        “Some of the potential waivers include:

        – Medicaid waiver
        – SCHIP waiver
        – Waiver to locally manage traditional Medicare
        – Medicare Part D waiver to include seniors in single drug formulary for the state
        – Waiver from some workers compensation laws
        – Waivers for multiple provision of the Affordable Care Act

        For example, Medicaid and Medicare cover roughly 35 percent of people in the state, while the individual exchange created by the ACA will likely only cover about 5 percent. Since the goal of the Vermont plan is to produce greater efficiency by centralizing, standardizing, and simplify the administration of the health care system, the more people that can be brought into the new unified Green Mountain Care plan,the better it will function. If HHS does not grant those waivers, it will leave a third of the state outside the plan and it will serious hamper its effectiveness.”

        http://fdlaction.firedoglake.com/2011/05/26/vermonts-road-to-single-payer-waivers-waivers-and-more-waivers/

        • Jamie Carter

          “Jamie, I do not know that they have said no. ”

          They did, read the Burma Shave article on VT digger for the relevant comments from CMS.

          • Karen McCauliffe

            Jamie, Again it is only hearsay, please show me the documentation from CMS that they denied Vermont to roll Medicare into Vermont’s “single payer”. No documentation has been shown by CMS in the article that you referenced me to, it was only “hearsay” from Robin Lunge.

          • Jamie Carter

            You can lead a horse to water but you can’t make it drink.

            Die of thirst for all I care…

      • Kathy Callaghan

        Jamie, administrations change, rules change, personnel change, laws change, politicians change, everything can change on both the state and federal level.

        • Jamie Carter

          You are correct Kathy, but you can only deal with whatever problem is actually occurring. There is an infinite number of possibilities that may occur down the road… let’s deal with those when we get there.

    • Peter Yankowski

      Shouldn’t the Governor’s counsel or the Legislative Counsel’s office be able to provide a definite answer to the question?

    • John McClaughry

      Sec 2 of Act 48, signed into law by Gov. Shumlin in 2011, begins with “ROAD MAP TO A UNIVERSAL AND A UNIFIED HEALTH SYSTEM”. Sec. 2: Strategic Plan.
      In this plan the legislature (triumphantly) declared how single payer health care was to work in Vermont. It gave instructions to various administration officials about how to move forward, among them “Green Mountain Care shall assume responsibility for benefits and services previously paid for by the federal programs, including Medicaid, MEDICARE, and, after implementation, the Vermont health benefit exchange.” (See Acts and Resolves, Seventy First Biennial Session, 2011, page 242-244, published by the Secretary of States, 945 pages.)
      This section binds the implementers of GMC to assume responsibility for Medicare, as urged by the Hsiao Report of 2011 that served as the supporting document for GMC (Option 3).
      This section states clearly and explicitly what the governor and other backers of single payer health care envisioned, and serves as a “road map” for getting to that goal.
      What was repealed in 2014 was 33 VSA 1827(e), (incorrectly cited by Galloway) that required the administration to “seek permission” of Washington for incorporating Medicare into GMC. I do not know what prompted this inconspicuous repeal , but I lean to the explanation that mentioning Medicare in connection with GMC might be politically disadvantageous to the administration . If that is the explanation, the administration erred in failing to remove the Road Map” which explicitly states that the state shall “assume responsibility: for Medicare, thereby perpetuating the political vulnerability.

      • John, you’re neglecting to mention that Act 144 of the 2014 session (http://leg.state.vt.us/DOCS/2014/ACTS/ACT144.PDF – wrong link was provided in a previous comment) under the intent section states quite clearly in Sec 1 (3) “As provided in 33 V.S.A § 1827, Green Mountain Care shall be the payer of last resort for Vermont residents who continue to receive health care through plans provided by an employer, by another state, by a foreign government, or as a retirement benefit.”

        I pointed this out above in a comment you responded to, so I know you are well aware of this fact.

        So even IF your argument that statements of intent for a specific piece of legislation had to be repealed for a change in law to become effective (which is hogwash), Act 144 which changed the actual statute regarding Medicare did also restate the legislative intent to match what is on the books.

  • Chet Greenwood

    Gov Shumlin could not be more explicit when he insists that he will do everything in his power to bring control of Medicare and tri-care to Vermont, including getting help from our Washington delegation.
    Whoever manages the money WILL manage healthcare!

    Political insanity:
    “Voting for the same people over and over and expecting different results.”

  • Walter Carpenter

    ” Gov Shumlin could not be more explicit when he insists that he will do everything in his power to bring control of Medicare and tri-care to Vermont,”

    And how is he going to do that with Medicare being federal? Please tell me. I am curious to know.

  • Whether the plan to go with a full blown single payer model with “everyone in” has craned inot politiical relaity once again is of less concern to me that the clear intent. This would make the third time it has happened and the supporters of singel payer keep coming back to the idea. Given their way, they will eventually enact the plan, so if one is opposed to the idea, we need to kick these guys out of office and drive a stake through the heart of the whole nonsense by enacting a patient choice model.

  • paul lutz

    I see a disturbing trend; the Gov continues to lie and hide the truth and people who are blindly for single payer coverage will continue to drink the kool aid.

  • Glenn Thompson

    Headline reads,

    “CORRECTION: STATE NO LONGER LOOKING TO ADMINISTER MEDICARE”

    {{{{{{shaking head in total confusion and disbelief}}}}}}}

    Didn’t I read in one of those other two similar articles a Shumlin “quote”….Single Payer will include *EVERYONE*….*EVERYONE* including *EVERYONE* on MEDICARE???? I’m assuming Medicare will be administered by the feds and Medicare subscribers will be exempt from this Single Payer fiasco? Thus the word *EVERYONE* is incorrect! Which is it????

    I’m reading all the comments by those who support or oppose single payer and not one person fully understands how this boondoggle is suppose to work! This is government at its extreme worst!

  • According to a Burlington Free Press article from 10/25, quoting Robin Lunge, the Shumlin Administration’s lead, there’s no attempt, nor intent to include Medicare:

    “We have not requested approval to run Medicare and we do not intent to run Medicare. Act 48 (the 2011 state law that authorized planning for Green Mountain Care) requires us to look into the Medicare contract for processing claims, which we did and determined it did not make sense. Medicare claims processing is done regionally. Vermonters on Medicare will continue to have Medicare after implementation of Green Mountain Care.”

    Presumably, this also includes Medicaid (even though I understand Vermont is already the payer for Medicaid, it would not be under GMC).

    This of course puts Dean Corren in a bit of a pickle because just this past Friday he said that both Medicare and Medicaid would be “folded in” to GMC and that would allow some of the desired efficiencies and cost containment. Maybe he will clarify in the coming days.

    Regardless, it would be really nice to have a clear answer on all and for now Robin Lunge’s comments appear to be the clearest. In turn, Vermonters should be asking whether GMC still works without Medicare and Medicaid.

    Full disclosure: I am a candidate running for the legislature in Windsor County.

  • Andrea DeSantis DO

    Regardless of that guarantee of coverage, the transitioning back and forth between employer based plans, green mountain insurance and medicaid/medicare will be costly and filled with administrative hassles. I also worry that it does not solve the problem of medical bankruptcy, nor does it make our jobs as physicians any more efficient. Multiple plans cause big administrative headaches for the providers of care.

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