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May 2011 St@teside

Vermont Single Payer Legislation Includes Creation of Insurance Exchange

Today Vermont Governor Peter Shumlin signed into law H. 202 that lays out three major tasks aimed at reforming that state’s health care system. The bill creates the Green Mountain Care Board charged with undertaking immediate efforts to control health care costs, creates a Health Insurance Exchange, and supports work for detailed planning to implement a single payer health financing system.

According to the law, the state’s health benefit exchange shall begin enrolling individuals and small employers no later than November 1, 2013 for coverage beginning January 1, 2014. Governor Shumlin’s vision has been to build the health insurance exchange as a platform for a single-payer infrastructure, and the foundation for Green Mountain Care.1 According to the bill, “The purpose of Green Mountain Care is to provide, as a public good, comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless and equitable manner regardless of income, assets, health status, or availability of other health coverage.”

The newly-created Green Mountain Care Board will have the authority to control the rate of growth in both health insurance premiums and health care provider payments.  The independent board will set rates for providers and medical manufacturers, establish minimum benefits, develop global payment methodologies, and run payment reform pilot projects. In addition, the Board will recommend the benefits package to be provided under a single payer if the legislature votes to implement such a system and a federal waiver is approved.

A single-payer financing plan is not outlined in the law. Consequently, the Green Mountain Care Board must present a viable plan to the legislature by January 2013. If approved by the legislature, the state will need to receive waiver approval from Medicare and Medicaid provider-payment rules and the Affordable Care Act’s (ACA) individual mandate and subsidy rules to be able to implement the program and still meet the goals of the ACA. Currently, states can apply for waivers starting in 2017.  Should the Wyden-Brown bill pass, Vermont could apply for waivers in 2014.

1NEJM Hsiao, W. state based single payer health care – a solution for the United States march 31, 2011. 364;13