The board issued a news release Monday containing a new document with what it called justification for the vote it took last week, when it held a 30-minute meeting that was originally scheduled to be a three-hour deliberation.
The “justification” decision is dated Oct. 31 but outlines arguments the board did not address during the Wednesday meeting — or during the public comment period that preceded it — and says the decision from Oct. 26 is still effective.
One of the new arguments is that the all-payer model will increase how much Vermont Medicaid pays doctors and hospitals. The public insurer currently pays less than the federal Medicare program and commercial insurance companies. Hospitals say that costs them money and forces them to shift their losses onto commercial insurance customers.
Al Gobeille, the chair of the Green Mountain Care Board, had said at a Sept. 28 news conference announcing a deal allowing the all-payer model that it did not require the Legislature to increase what Medicaid pays.
During the public comment period, skeptics had criticized the all-payer plan for not increasing Medicaid reimbursements.
Additionally, the Green Mountain Care Board did not mention Medicaid reimbursements in the news release it issued immediately after voting to sign the all-payer agreement with the federal government.
But the justification decision says: “The board will annually provide its recommendations to (the secretary of the Agency of Human Services and the Vermont Legislature) to increase Vermont Medicaid reimbursement rates to levels more comparable to” what Medicare pays doctors.
The decision says “the state intends” for the increased Medicaid payments to be consistent for a full year, and that even though the payments will increase, they will not be counted toward the state’s goal of making sure health care costs grow at no more than 3.5 percent per year.
The decision advocates for Vermont Medicaid to pay comparable amounts to the federal Medicare program’s fee-for-service rates. The board and Gov. Peter Shumlin had said the all-payer model is designed to move the state’s health care system away from fee-for-service medicine.
Gobeille was out of the office Monday and Tuesday and unavailable for comment. Susan Barrett, the executive director of the Green Mountain Care Board, declined to comment or have another staff member comment on the justification decision.
Shumlin tried to impose a 0.7 percent payroll tax on employers in 2015 to increase what Vermont Medicaid pays doctors and hospitals to the same fee-for-service amounts that the federal Medicare program pays.
After the payroll tax failed, Shumlin recommended a new tax this year on independent doctors and dentists as a way to increase what Vermont Medicaid pays doctors and hospitals. That measure also failed.
Medicaid is a $1.7 billion a year program that has a significant impact on the Legislature’s annual budget process.
