October 27, 2013

Vermont thinks big on health care

The state looks ahead to a universal health care system.

By Dave Gram
The Associated Press

MONTPELIER, Vt. — As states open insurance marketplaces amid uncertainty about whether they’re a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.

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Workers at the Vermont Health Connect call center in Burlington, Vt., talk to customers on Oct. 1. Gov. Peter Shumlin said recently that the Vermont Health Connect health insurance marketplace’s performance is improving.

The Associated Press

just the facts

While states implement health insurance marketplaces this fall, Vermont is considering a bigger goal that more fully embraces government-funded health care.

The state plans a 2017 launch of the nation’s first universal health care system. It’s a sort of a modified Medicare-for-all.

The plan is seen as especially ambitious in the current atmosphere surrounding health care in the United States, with some states and some in Congress balking at the federal health overhaul.

National experts say Vermont’s plan has gone unnoticed amid the national debate over the federal law.

Democratic Gov. Peter Shumlin is continuing to vow to make Vermont a place where “health care is a right and not a privilege.”

The state has a planned 2017 launch of the nation’s first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.

The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.

In such a setting, Vermont’s plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.

The result will be health care that’s “a right and not a privilege,” Gov. Peter Shumlin said.

Where some governors have backed off the politically charged topic of health care, Shumlin recently surprised many by digging more deeply into it. In an interview with a newspaper’s editorial board, he reversed himself somewhat on earlier comments that Vermont would wait to figure out how to pay for the new system. He said he expects a payroll tax to be a main source of funding, giving for the first time a look at how he expects the plan to be paid for.

The reasons tiny Vermont may be ripe for one of the costliest and most closely watched social experiments of its time?

It’s the most liberal state in the country, according to Election Day exit polls. Democrats hold the governor’s office and big majorities in both houses of the Legislature.

It has a tradition of activism. Several times in recent years, hundreds of people have rallied in Montpelier for a campaign advocating that health care is a human right.

It’s small. With a population of about 626,000 and just 15 hospitals, all nonprofits, Vermont is seen by policy experts as a manageable place to launch a universal health care project.

“Within a state like Vermont, it should be much more possible to actually get all of the stakeholders at the table,” said Shana Lavarreda, director of health insurance studies at the University of California at Los Angeles’ Center for Health Policy Research.

Vermont’s small size also is often credited with helping preserve its communitarian spirit. People in its towns know one another and are willing to help in times of need.

“The key is demography,” said University of Vermont political scientist Garrison Nelson. Discussions about health policy “can be handled on a relative face-to-face basis,” he said.

Vermont also has little income diversity, Nelson said. In general, people with lower incomes who don’t pay into a health care system make it costlier for other people.

Then there’s the fact that Vermont is close to universal health care already. Lavarreda noted that the state became a leader in insuring children in the 1990s. Now 96 percent of Vermont children have coverage, and 91 percent of the overall population does, second only to Massachusetts.

At this stage, no one knows whether state-level universal health care will succeed, and it’s an open question as to whether Vermont can work as a model for other states.

(Continued on page 2)

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