Running head: VERMONT SINGLE-PAYER HEALTH REFORM 1
VERMONT SINGLE-PAYER HEALTH REFORM 5
Vermont Single-Payer Health Reform (Green Mountain Care)
In efforts to increase health care coverage and introduced universal health care coverage, scholars and various players in the United States (U.S) have suggested the adoption of a single-payer health care system. Canadian health care system is one of the most referenced successful single-payer health care systems (Ivers, Brown & Detsky, 2018). In efforts to replicate the vast benefits offered by such a system like ease of obtaining care, affordable, and high effectiveness, Vermont state government passed a policy reform starting the earliest state-level single-payer healthcare system in the U.S. The rationale of this reform which was dubbed as Green Mountain Care (GMC) was to make a system where Vermonters would get universal health coverage. Additionally, it was aimed at creating technological advancements to the then already subsisting system.
Adoption of the Reform
Signed by Governor Peter Shumlin on May 26, 2011, this Vermont Health care reform was described as near-universal coverage to Vermonters that would help them significantly reduce health care spending (Fox & Blanchet, 2015). The GMC was to assist in controlling the health care costs through cutting fees to providers and also wholly modifying the Vermont state health care system. At the same time, the spring aimed at extending the coverage to all the Vermont residents. Despite failing later in 2014, various adoptions strategies had been suggested to achieve the goals of this health reform.
The major components of Green Mountain Care, as provided by the federal health care policies, established propose coverage from private insurers, state-sponsors, and multi-state plans. It could also contain tax premiums to offset premiums and make them more affordable for the uninsured Vermonters. This reform was managed by a board of five members that were tasked with setting reimbursement charges for hospitals and also streamlined management to a single and unified system. Under this new state exchange, the residents and smaller employers could then compare prices among the different plans and enroll in one of their choice (Fox & Blanchet, 2015).
The eventual goal of the reform was to have a single-payer system that was state-funded and operated. The plan was to be gradual, characterized by an evolving financial structure that would mandate some conditions (Fox & Blanchet, 2015). By securing a federal waiver related to exchange, this reform could kick in 2014. Since the state could not get another waiver until 2017, the Green Mountain reform needed to consider costs of coverage. A board was set to consider these costs and factor in savings from the reform, and suggest sources of capital (McDonough, 2015). Despite all these efforts, the governor pardoned the reform, citing that it was running the state to the financial crisis.
As identified earlier, the Green Mountain care had a funding program that would help in its implementation. In a report submitted by Vermont governor to the state legislature, it contained a comprehensively detailed financial plan and incentives to fund the reform (Shumlin, 2015). The first source of revenue was the Federal Matching Assistance Percentage (FMAP). As per the calendar year 2015, the FMAP share of Medicaid for Vermont was 56.18%, which represented a consistent decrease since the year 2009. The second source of revenue is a similar Enhanced FMAP (FMAP for Children’s Health Insurance Program CHIP), which as per the 2015 financial year, Vermont was to receive 74.95% (Shumlin, 2015).
Considering the reduction in the state Medicaid revenue, this demanded more public financing. The lost Medicaid funds would be replaced from fungible funds from GMC funds. According to the initial report, it was estimated that the state would apply $637 million as revenue to GMC in 2017. However, this value was much less, with the actual value being $341 million, hence requiring an increased publicly financing by $296 million (Shumlin, 2015). This increment meant increased tax revenues if the coverage was to remain affordable.
Despite this single-payer health system failed, it left remarkable has implications in the Vermont health care system. Even after failing to achieve this single-payer system in Vermont, the policymakers shifted their energy towards achieving the goals of this reform without having to disrupt the existing payment system. They focused on encouraging the largest payers in the state to move from fee-for-service to risk-based contracting. This pursuit would encourage the providers to offer higher quality care, hence improving Vermonters’ health, which was the state’s goal. This idea attracted large accountable care (ACO) known as OneCare Vermont (Hostetter, Klein & McCarthy, 2018).
Despite this OneCare having engaged over half of Vermont’s physicians and nearly all the healthcare facilities in its complex, it had failed to make financial muscles in its ealrier contracts with payers. Under this model, the big three payers (Medicaid, Medicaid, and Blue Cross and Blue Shield) of the state steadily grew the figure of people under care in under risk-based contracts, providing the additional monetary muscle to the ACO (Hostetter, Klein & McCarthy, 2018). This helped OneCare to organize care for persons considered as high medical risks. In turn, OneCare would take its financial risks as well as those of the providers. With such progress, OneCare visions that it will be able to unit mental and health serve patients with the most complex needs (Hostetter, Klein & McCarthy, 2018). It’s undeniable to Vermont HealthCare reform provided a blueprint for health, that OneCare Vermont has used to change the healthcare delivery significantly. This blueprint has seen public and private payers support providers in helping patients to manage their health conditions throughout the state.
Fox, A., & Blanchet, N. (2015). The Little State That Couldn’t Could? The Politics of “Single-Payer” Health Coverage in Vermont. Journal Of Health Politics, Policy And Law, 40(3), 447-485. doi: 10.1215/03616878-2888381
Hostetter, M., Klein, S., & McCarthy, D. (2018). Vermont’s Experiment in Community-Driven Health Reform. Retrieved February 14 2020, from https://www.commonwealthfund.org/publications/case-study/2018/may/vermonts-bold-experiment-community-driven-health-care-reform
Ivers, N., Brown, A., & Detsky, A. (2018). Lessons From the Canadian Experience With Single-Payer Health Insurance. JAMA Internal Medicine, 178(9), 1250. doi: 10.1001/jamainternmed.2018.3568
McDonough, J. (2015). The Demise of Vermont’s Single-Payer Plan. New England Journal Of Medicine, 372(17), 1584-1585. doi: 10.1056/nejmp1501050
Shumlin, P. (2015). Green MountainCare: A Comprehensive Model for Building Vermont’s Universal Health Care System [Ebook]. Retrieved from https://hcr.vermont.gov/sites/hcr/files/pdfs/GMC%20FINAL%20APPENDICES%20123014.pdf