A group of nonprofits are calling on Gov. Phil Scott to abandon Vermont’s all-payer system and the state’s partnership with OneCare Vermont.
The state’s health care experiment has added extra bureaucracy and cost, resources that should be directed to increasing Vermonters’ access to health care, five organizations argued in a statement issued Monday.
OneCare Vermont, a company that oversees the state’s health care reform efforts, collects money from insurance companies, Medicaid and Medicare and distributes it to hospitals in monthly payments. It was created to encourage hospitals to slow health care spending and improve care, by providing regular fixed payments.
Instead, the administrative costs are “sucking money out of the system that could be used for health care,” said Deb Richter, a primary care doctor who chairs Vermont Health Care for All. In Vermont, she said, 40% of Vermonters have "terrible insurance. Seven percent have no insurance. And OneCare doesn't change that.”
Group representatives — which include two organizations that have been advocating for single-payer health care, the Vermont Chapter of Physicians for a National Health Program and Vermont Health Care for All, as well as the racial justice organization Justice for All and the League of Women Voters of Vermont — said they hope to generate public pressure that will ultimately persuade legislators to cut bureaucratic costs and increase access to primary care.
A fifth group that signed on to the release, the Vermont Workers’ Center, is holding a march in Bellows Falls on Saturday to protest OneCare.
“OneCare's a threat. They're being handed the entire health care system,” said Mark Tully of the Workers’ Center. Achieving the Workers’ Center goal, Medicare for All, requires abandoning the current system, he said. A single-payer system is managed by the government and provides universal coverage; all-payer is run by a private company, OneCare, and doesn’t have any impact on who can get health insurance.
The organizations asked Scott to leave the agreement with the Centers for Medicare and Medicaid Services immediately, or simply not renew the five-year contract, which ends in 2022.
OneCare Vermont CEO Vicki Loner said results of the reform effort shouldn’t be judged prematurely. “It’s going to take some time; that’s why this is a five-year effort,” she said. Thousands of doctors and hospitals had agreed to be a part of the system, she said.
OneCare has come under fire from state officials and health care providers in recent weeks. Last month, primary care doctors objected when OneCare changed the way they’d be paid, saying an unfair burden was being placed on independent practices. After a public scuffle, the two sides hashed out an agreement at the behest of regulators. During the annual budget process, hospitals said they were losing money by participating in OneCare, and the costs were too high during the pandemic.
In mid-September, the state received a letter from the federal government admonishing OneCare for failing to meet its targets for two years in a row.
“I’ve seen the benefits [of OneCare], but operationally we need to do much better,” Mike Smith, secretary of the Agency of Human Services, said in response to the letter.
Loner said the standards set by the federal government are “very ambitious,” and the health care industry is still righting itself after the pandemic.
The group of nonprofits contended that the all-payer system, which is being implemented by OneCare, has proven to be too costly and hasn’t improved care — and regulators have no method of determining whether the effort is working. In 2018, Vermonters paid more than $9,000 per person for health care, nearly $2,000 above the U.S. average, according to a report from the state auditor, Doug Hoffer.
The effort adds bureaucracy and layers of increased cost across the system, they said. Administrative and staffing for OneCare cost $19 million in 2020 — more money than the initiative saved. Hospitals pay dues to participate in OneCare. The all-payer system also requires more Green Mountain Care Board staff, covered on the taxpayer dime, to regulate the entity.
The organizations also said OneCare hadn’t done enough to support primary care, and the administrative costs could be better spent on increasing health access more broadly.
There were some good signs, according to Loner. “We are seeing some really promising signs in people getting more timely access to primary care, more screenings, some good indicators in diabetes and high blood pressure metrics,” she said.
According to Richter, “promising signs” aren’t enough.
“You’re putting money into this private, for-profit entity, without any savings,” Richter said. Three years into a five-year experiment, “they have not improved quality. They have not lowered cost,” she said.
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