Challenges await Vermont after its single-payer leap

The sky over the Vermont capital of Montpelier on May 26 may have been dark, stormy, and threatening, but the feelings below on the steps of the State House seemed upbeat as Gov. Peter Shumlin (D-VT) signed into law legislation (.pdf) that would establish the nation's first statewide publicly funded health system.

Is this the beginning of a new era in the way providing healthcare or a process that won't go the distance to deliver promises of improved healthcare coverage?

"I realize that people have legitimate questions about how a single payer will be financed and operated, and we will answer those questions before the legislature takes the next step," Shumlin said in a statement yesterday.

The single payer system, which is being called "Green Mountain Care," will make Vermont's 620,000 residents eligible for coverage--including 47,000 uninsured and 150,000 underinsured--once it is up and running.

A "few challenges" still ahead for the state, the governor acknowledged at the signing ceremony, will be to achieve its goal of establishing a universal healthcare system that takes "health insurance off the backs of employers."

One of those challenges is getting waivers from the federal government to implement the single-payer component. In addition, the state needs another waiver related to the state-run health insurance exchange. If Vermont secures this waiver, care could begin as early as 2014.

A five-person board will manage the exchange, responsible for setting reimbursement rates for healthcare providers while streamlining administration into a single system. Vermont residents and small businesses will be able to compare rates from the various plans and enroll for coverage they select.

The new board, which is expected to be in place by October, is to work with healthcare providers as the state moves away from paying for care on a fee-for-service basis. Providers are to be rewarded for efficiency and for keeping people healthy.

"This law recognizes an economic and fiscal imperative--that we must control the growth in healthcare costs that are putting families at economic risk and making it harder for small employers to do business," Shumlin said.

Vermont will be entering some unchartered territory to organizing, paying for, and delivering care. While a single-payer system idea did come up in the federal healthcare reform discussion last year, the White House and Congress backed away when opponents complained that it would introduce too much government intervention.

Right now, the outcomes are far from certain. But it's definitely a journey that will bear watching. - Janice