Lawmaker Pushes Alternative To Single-Payer System

May 8, 2014

Lawmakers won’t see a plan to finance single-payer health care until 2015. But even as the Legislature tries to speed toward a Saturday adjournment, the issue of health care funding continues to loom large. And some lawmakers are ramping up efforts to create an alternative to single-payer.

At the beginning of the year, a group of mostly Republican lawmakers went to a legislative analyst and posed a question: Is there a way for Vermont to abandon single-payer, but still achieve all the health care benefits that Governor Peter Shumlin has promised to deliver to residents of the state?

“Which include universal coverage, access to quality care, and cost containment,” Arlington Rep. Cynthia Browning says. “And we wanted to be able to achieve those goals. But we thought it might be possible to make progress without going all the way to public financing.”

Browning, the lone Democrat in the group, says work with the analyst has yielded an attractive alternative. The plan would, at a broad level, maintain the private insurance market, allow for plans to be sold outside of the new online exchange, and ramp up state subsidies to low- and middle-income Vermonters who otherwise might not be able to afford insurance.

Browning says the proposal comes with an annual cost of about $30 million.

“It doesn’t require redoing how insurance is provided, or how it’s financed,” Browning says. “It doesn’t require redoing our tax code. It doesn’t require raising $2 billion or even $250 million.”

House Minority Leader Don Turner says the document should not be viewed as a proposal from the Republican caucus. And he says there’s plenty in the plan that his members might find troublesome, like the tax on health benefits that would be used to fund the new expenditures. But Turner says that while it’s up to Shumlin to deliver a plan, the GOP is contemplating other approaches to health care reform.

“We felt that since the Legislature had hired this expert that had worked with the state of Vermont in the past, that we would try to work in a bipartisan manner to try to achieve the goals that were laid out in Act 48, understanding that we fully believe that a more robust marketplace is where we want to go,” Turner says.

Gov. Peter Shumlin says he isn’t ready to show Vermonters how he’ll pay for single-payer. But Windham Sen. Peter Galbraith raised some eyebrows last Friday when he told his colleagues that not only is the governor’s financing plan nearly complete, but that he’s gotten a look at it.

“It comes to me from a source that is not in the administration, but I have a great deal of confidence that this does in fact reflect the thinking of those in the administration,” says Galbraith, a Democrat who earlier this year proposed using an 11 percent payroll tax to fund single-payer.

As was reported first by VTDigger.org, Galbraith says the Shumlin plan would use a combination of a 5-percent payroll tax, a 2-percent tax on fuel gross receipts, and a mandatory premium that would be equivalent to a 9-percent income tax on people making $50,000 per year and above, with a maximum cap.

Administration Secretary Jeb Spaulding wouldn’t comment Wednesday on whether any aspects of Galbraith’s assertions are based in fact. But he said he can “state quite certainly that some of the pieces that Galbraith says the governor is thinking about, he is not anywhere near thinking about doing those.”

Browning says her plan doesn’t ensure health insurance as a right of Vermont residency, something Shumlin has insisted is an essential component of any health care reform initiative. But she says that according to the administration’s own projections, the number of uninsured Vermonters will soon drop below 15,000, thanks in large part to increased Medicaid eligibility as a result of the federal Affordable Care Act. And she says it doesn’t make sense to upend a system that works for many Vermonters when policy makers could take a more surgical approach to finding and enrolling the uninsured.

“To my mind this is a modest reliable alternative path for health reform that builds upon what we’ve already got and uses what’s already going right,” Browning says.