[T]he legislative committee that oversees health care reform is asking the Shumlin administration to explain the complex language used in its latest health care policy initiatives.
The six-person Joint Health Reform Oversight Committee met at the Statehouse on Monday to discuss the group’s priorities. The committee had not met since January, just after the administration abandoned efforts to implement government-supported universal health care in Vermont.
Rep. Janet Ancel, D-Calais, is the co-chair of the committee with Sen. Tim Ashe, D/P-Chittenden. Ancel said the administration should brief legislators on what a so-called all-payer model means “in real terms for Vermont and for Vermonters.”
According to Lawrence Miller, chief of Health Care Reform for the Shumlin administration, all-payer is a way for regulators to set up health care payments that incentivize making a patient healthy. In the current system, payments are made for each service provided by a doctor or hospital.
Now, health care providers might advise a patient to undergo knee surgery because the procedure generates more revenue, Miller said. An all-payer system would make health care providers more likely to recommend lower cost medical procedures such as physical therapy.
Miller says the system should be called an “all-payer model.” The federal government can’t rubber stamp one specific waiver to make the model happen, he said, so the administration will seek several different approvals through the Centers for Medicare and Medicaid Services in Washington, D.C.
“It’s a huge picture thing,” Miller said. “You’re talking about 20 percent of the economy.”
Gov. Peter Shumlin approved the all-payer system as part of this year’s omnibus health care bill, Act 54. The law requires the secretary of the Agency of Administration to work with the health-care-regulating Green Mountain Care Board to implement the all-payer model as a “cost-containment” measure.
Maryland is the only state that uses the all-payer model. The system has been in place since the 1970s. The federal government allows Maryland’s health insurance regulators to decide how much to reimburse providers for services provided for Medicaid and Medicare patients.
In Vermont, the Legislature’s Joint Fiscal Office estimates that the state needs to reach an agreement with federal regulators by 2015 in order to get an all-payer system up and running by 2017. The state has not yet applied for the federal waivers, according to Miller.
The Health Reform Oversight Committee will meet with Miller and his team Aug. 11 for an all-payer briefing.
CORRECTION: A previous version of this article incorrectly said the committee had not met since July 2014.
