Lawmakers Set New Deadline For Single-Payer Financing

Apr 23, 2014

Legislative leaders are ramping up the pressure on Gov. Peter Shumlin to provide answers on how he plans to finance his single-payer health plan.

The pressure includes detailed questions about how the plan could affect the economy, and a proposed deadline for the financing plan to be delivered.

It’s been three years since legislators passed Act 48, the law that set Vermont on a path toward single-payer health care. But the number of unanswered questions seems to have grown, not shrunk, since then. And on Tuesday, a legislative consultant tried to help lawmakers understand the scope of the work ahead.

"If we're not going to have finance plan next year, then there have to be some consequences to not getting a finance plan. So basically we're saying, 'hey, if you don't get a finance plan to us, let's call a complete timeout on what we're doing.'" - House Speaker Shap Smith

  “Basically what this is is to provide some type of framework or structure for thinking through the key design issues associated with implementing Act 48,” policy analyst Ken Thorpe told the House Committee on Ways and Means.  

Thorpe was referring to a handout that includes 44 questions that lawmakers will want answered before they give the go-ahead to a publicly funded, universal health care system.

The questions include items like: What is the total cost? How would alternative financing models affect the state’s ability to attract and retain businesses and jobs? And does the plan address recruitment, training and retention of the health care workforce?

Calais Rep. Janet Ancel is the Democratic chairwoman of Ways and Means. Her committee wants to use a pending health care bill – called S.252 – to make sure that legislators can obtain answers to those kinds of questions. And Ancel says lawmakers need to be sure they don’t have to rely on the Shumlin Administration to get them.

“The governor’s going to make a proposal. We’re not going to rubber stamp that proposal,” Ancel said. “We’re going to look at it independently, with our own experts and our own questions before we make a decision about moving forward. And that’s really what this bill reflects.”

The bill requires the Shumlin Administration to deliver a financing plan to the Legislature by Feb. 3 of next year. And it cuts off funding for Shumlin’s health care reform process if the deadline goes unmet.

Shumlin has postponed twice now the unveiling of which taxes he’d use to fund single payer. House Speaker Shap Smith says he understands that factors beyond the governor’s control contributed to those delays. But Smith says time is running short.

“But if we’re not going to have finance plan next year, then there have to be some consequences to not getting a finance plan,” Smith said. “So basically we’re saying, ‘hey, if you don’t get a finance plan to us, let’s call a complete timeout on what we’re doing.’”

Thorpe, an Emory University professor hired in January to provide policy expertise to the Legislature, told lawmakers that they’ll need to compile a body of research before they’re ready to evaluate the merits of whatever proposal Shumlin puts forward.

“Because you know you can’t really evaluate alternative proposals unless you have a  baseline spending distribution to look at how much people are paying now, how much businesses are paying now, both in terms of premiums, out of pocket, and so on,” Thorpe said.

Tuesday marked Thorpe’s first public appearance before a legislative committee since the surfacing of a confidential memo last week in which Thorpe outlines a possible alternative concept to the single-payer plan touted so heavily by Shumlin.

The memo described a system that would continue to rely on the premium-based model in place currently. The plan in the memo wouldn’t force self-insured companies to buy into the plan, and envisions a state insurance plan that covers only about half of residents in the state.

Dorset Republican Rep. Patti Komline asked Thorpe about that memo, and whether he could elaborate on the ideas it contained. But Thorpe said he couldn’t comment on it. An analyst from the Joint Fiscal Office said confidentiality issues prevent Thorpe from discussing work he’s doing on behalf of individual legislators.

While Shumlin has indicated he wants lawmakers to pass a financing plan in 2015, Ancel says the Legislature won’t rush the process.

“We will take whatever time we need. I don’t know how much time that will be,” Ancel said. “But if it takes more than a session, it’ll take more than a session.”

Smith has approved funding for the House Committee on Health Care to hold four meetings during the off-session to work on the health care reform issues. He said he’s also considering the formation of a new legislative oversight committee to keep tabs on the health care reform process after lawmakers adjourn.