With the state’s fiscal year 2019 budget finally set, administrators at both the Green Mountain Care Board and the Health Care Advocate’s office can breathe a sigh of relief.
That’s because layoffs that would have affected both offices have been rescinded in the final version of the state’s spending plan. A total of 4.5 positions had been threatened by cuts proposed earlier this year.
However, that good news is tempered by the fact that financial pressures remain at both agencies. In particular, the care board’s fiscal 2019 budget is nearly $675,000 lower than the current year’s.
“I am not worried at all in terms of the work that we have to do,” said Susan Barrett, the care board’s executive director. “But if there is extra (work), above and beyond, we’ll have to take it on a case-by-case basis. Because we have to do our regulatory work, first and foremost.”
Care board members spent part of their meeting on Wednesday going over details of their roughly $8 million budget for fiscal 2019. That review came only a few days before the start of the fiscal year due to an extended budget impasse that finally ended on Monday, when Gov. Phil Scott said he would allow the Legislature’s latest plan to become law without his signature in order to avoid a government shutdown.
Scott’s efforts to curb state spending had resulted in widespread budget-cut proposals for next fiscal year.
In some cases, those cuts had the potential to impact personnel: Green Mountain Care Board Chairman Kevin Mullin told legislators in February that the budget would eliminate three of the board’s staff positions.
Proposed care board reductions also impacted the Health Care Advocate’s office, which receives funding via the board. Chief Health Care Advocate Mike Fisher had said he would be forced to eliminate 1.5 of his office’s seven advocate positions because of a $110,833 reduction.
But all of those positions have been preserved in the final 2019 budget, said Jean Stetter, the care board’s administrative services director.
At the Legislature’s request, the board preserved its three staff positions by instead reducing board contracts by $211,000. That fits with an ongoing effort to reduce contractual expenses, Stetter said.
The care board, she said, “has been developing internal resources in data, policy and other areas.” The idea is to “use the knowledge that we’ve built in-house to strengthen our systems and lessen our reliance on contracts and contractors.”
Mullin added that “it seems to make real common sense to employ Vermonters to do something rather than pay an outside contractor.”
The Health Care Advocate’s staffing also was restored at the Legislature’s request, Stetter said. The final fiscal 2019 budget maintains the advocate’s fiscal 2018 funding.
Fisher said he’s been forced to fight annual proposals to reduce his office’s budget. Once again, he said, “I’m very appreciative that the Legislature has kept us whole.”
But he also said his office – which advocates for individual Vermonters on health care matters and also participates in policy debates – remains busy.
Health care affordability issues are the No. 1 issue spurring calls for assistance, Fisher said. And he said it’s hard to keep up with that demand or reach out to more Vermonters without occasional funding increases.
“Level funding at a time when health insurance costs are going up, as well as other costs, does create stress on an organization,” Fisher said.
The Green Mountain Care Board also has felt that stress.
The board has broad authority over accountable care organizations, hospital budgets, insurance rates and expansion projects undertaken by health care providers. The board also is deeply involved in implementing Vermont’s all-payer model, a new method of compensating health care providers.
The care board also periodically takes on new health care studies, reports and projects as mandated by the Legislature. Since the board’s creation in 2011, “the role has expanded and changed over the years,” Stetter said.
She produced several charts showing that the board’s work has made a difference in controlling the rising cost of health care.
For example, the board approved lower-than-proposed insurance rate increases for 2018. For Vermont Health Connect customers, that saved $14.4 million in Blue Cross and Blue Shield of Vermont premiums and $1.8 million in MVP Health Care premiums.
Also, the growth in Vermont hospitals’ net patient revenues “has decreased since the Green Mountain Care Board has been in existence,” Stetter said. “It’s one metric that we have to demonstrate that the work of the board is increasing the value to Vermonters through lower health care costs.”
At the same time, the care board’s appropriations have been declining. The board’s fiscal 2019 budget features a 4.1 percent decrease in support from the state’s general fund, and it also contains less federal funding.
In some respects, the board simply is working within the realities of the state’s tight budget. “We’re doing our part to be frugal,” Barrett said.
Care board officials also will keep a close watch on projects that may reach beyond their core duties and mission, Barrett said.
“But I’m confident in our staff,” she said. “They’re nimble. They’re smart.”
