Vermont Single Payer Report

Single Payer: Hsiao report on Vermont

We designed three options for health system reform in Vermont. The impacts above indicate that Option 3, the Public/Private Single Payer, will provide the greatest cost-savings to the state, savings that stem from the unique governance structure and management of the single payer entity. Unlike Option 2, which maintains the current multi-payer system, and Option 1, which creates a strictly government-administered program, Option 3 proposes a single payer structure overseen by an independent board with representatives from employers, patients, providers and responsible government agencies. Board members will be charged with establishing a budget for the single payer, recommending updates to the payment rates and benefit packages based. Option 3 further proposes that claims administration and provider relations be
awarded through competitive bidding process.Option 3 proposes to cover only the Essential Benefit Package. This benefit package was designed to provide at least as good coverage as the average Vermonter has now and to promote primary and preventive care. Unlike the Comprehensive Benefit package, however, it provides for limited coverage of vision and dental benefits. We recommend that when and if savings are realized in sufficient quantity, Vermont should consider expanding coverage for these benefits. Long-term care, however, is a more difficult issue that would require detailed and comprehensive study in its own right. International experiencesuggests that successful social models of long-term care insurance are constructed as separate programs from health benefits program, for example those of Germany and Japan, as long term care provision is so fundamentally different from medical services.

But beyond the greater cost-savings, we believe that Option 3 is the most feasible because it is likely to be accepted by the broadest cross-section of stakeholders in Vermont. Through discussions with more than 100 stakeholders we gained a critical understanding of what various competing interests would tolerate, their issues, concerns and hopes, where they disagreed and where they landed on common ground. Political opposition to single payer systems is often rooted in concerns over transparency and accountability. We designed Option 3 to address those issues and to operate with the express input of a broad base of stakeholders. In sum, we believe that Option 3 provides benefits to patients, providers and the system at large, in keeping with both the equity, coverage and sustainability goals of Act 128.

From: Rachel DeGolia, UHCAN


Once again, Vermont is proving to be a national leader in health care reform.  And, this time, it looks like they will create an entirely new health care system – a modified single payer system – that will provide “affordable, universal health care” for all Vermonters.
The whole country has a stake in their success in Vermont. If one state can make real progress on comprehensive health reform, that will help all of us no matter where we are in the struggle in our own states. 
The process, in a nutshell
Right now, legislators and advocates in Vermont are digesting the long-anticipated very dense “Health System Reform Design” draft report that Harvard economist Dr. William Hsiao issued on January 19th.  Of the three options Dr. Hsaio studied, he is urging the state to adopt a “modified single payer.”  There is key political support for a single payer approach – the new Governor, Peter Shumlin, many legislative leaders, and the entire congressional delegation, in addition to or, perhaps, as a result of (!) the tremendous grassroots movement that has been built over many years by health care advocacy groups in the state. 
After Hsaio’s final report is issued in mid-February, the legislators will have to get to work on crafting the actual legislation, a process that is expected to take until the end of the session in May.  The report provides a framework, but many details have to be worked out.  A guide developed by the Healthcare is a Human Right Campaign (run by the Vermont Workers Center) provides a means to assess how well any reform bill meets the principles of the Campaign: universality, equity, transparency, accountability and participation. See the “Detailed human Rights Standards for Healthcare Systems” here:

In Congress, Vermont’s Senators Sanders and Leahy, and Rep. Welch, will soon introduce the “State Leadership in Healthcare Act,” a bill to move up the date from 2017 to 2014 when “state innovation” is allowed under the Affordable Care Act (ACA), thus allowing Vermont to move forward with a single payer system.  Careful consideration is being given to this step due to concerns about what states other than Vermont might do with the authority to waive provisions of the ACA.  
The opposition has not materialized quite yet, but everyone knows that the lobbyists for the insurance companies and others invested in maintaining the status quo – or twisting the reform for their own profit – will be pouring into the state very soon. Our colleagues in Vermont need and deserve our support!
Support Needed!
Grassroots health care justice groups are hard at work organizing key constituencies across the state. All the groups listed below have up-to-date information on the status of the campaign and links to the latest news coverage.
SEND DONATIONS to help pay for more organizers to Healthcare is a Human Right Campaign, 
Contact James Haslam, Executive Director, Vermont Workers’ Center, or 802/861-4892 to:
·  HOST A HOUSE PARTY and have a Campaign Organizer join you via Skype

·  Go to Vermont and VOLUNTEER in person for the campaign in the next few months
Other organizations in the lead:
Vermont Citizens Campaign for Health,
Contact: Richard Davis, RN, Executive Director or 802/251-0195
Vermont for Single Payer, a project of Vermont Health Care for All, the local affiliate of Physicians for a National Health Program, especially focused on mobilizing health providers, 
Contact: Deb Richter, MD, Executive Director or 802/595-2820

Vermont Public Interest Research Group (VPIRG)
Contact: Cassandra Gekas, Health Care Advocate or 802/223-8421, x-4097

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