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Green Mountain Board’s Community Engagement Series may have predetermined ‘All-Payer’ outcome
By Michael Bielawski
The Green Mountain Care Board (GMCB) wants the public’s input on a state-mandated overhaul to how Vermonters pay for healthcare. Despite what locals may ask for, there are some predetermined outcomes via recently passed state law.
That’s because the legislation passed in 2022 – Act 167 – states that a mandated “All-Payer Model Agreement” must be adopted.
It states, “The Director of Health Care Reform in the Agency of Human Services, in collaboration with the Green Mountain Care Board, shall develop a proposal for a subsequent agreement with the Center for Medicare and Medicaid Innovation to secure Medicare’s sustained participation in multi-payer alternative payment models in Vermont.”
Non-economically feasible
An “All-Payer” model for healthcare may sound familiar to Vermonters. That’s because it was examined over a decade ago in a broad public debate during the years of Democrat Governor Peter Shumlin. Shumlin formally gave up all efforts from his office by the end of 2014.
Meg Hansen, the former director of Vermonters for Healthcare Freedom wrote in 2022, “The Shumlin Administration failed at implementing single payer because the model’s cost growth exceeded Vermont’s annual GDP growth, which proved prohibitive.”
She further explained the All-Payer model (speaking about the Shumlin plan) also sacrificed Vermonters’ health.
She wrote, “However, the All-Payer model’s cost containment is taking place at the expense of the health of Vermonters. Data from DVHA’s (Department of Vermont Health Access) Blueprint for Health shows that primary care physician rates declined across Vermont from 2013-16, as did the overall healthy rate [of citizens].”
The 27-page document made for the public by the GMCB does not mention the term ‘All-Payer.’ It is referenced once as the “Subsequent APM Agreement.” Similar to Shumlin’s plan for cost containment, this one is touted as an effort to “Reduce Operational Costs.”
Harder to avoid high premiums?
There will be a push to get Vermonters off of a pay-per-visit model in favor of the All-Payer system. That means Vermonters living free of healthcare premiums could see more obstacles. The average premium for Vermont’s “Average Lowcost Silver Premium” plan is currently $948 per month.
The act states that “the Green Mountain Care Board shall in collaboration with the Agency of Human Services and using the stakeholder process described in subsection (a) of this section, build on successful healthcare delivery system reform efforts by developing value-based payments, including global payments, from all payers to Vermont hospitals or accountable care organizations, or both…”
It continues, including to, “help move the hospitals away from a fee-for-service model.”
The next part states that they want to “provide hospitals with predictable, sustainable funding that is aligned across multiple payers, consistent with the principles set forth in 18 V.S.A. § 9371, and sufficient to enable the hospitals to deliver high-quality, affordable health care services to patients.”
More ‘equity’
The term equity shows up in the act and the board’s material. The act states, “To promote engagement with diverse stakeholders and ensure the prioritization of health equity, the process may utilize existing local and regional forums, including those supported by the Agency of Human Services.”
Another section states that these new policies must “meaningfully impact health equity and address inequities in terms of access, quality, and health outcomes.”
Where to go to participate
There are 15 dates including 14 in-person meetings around the state and one online only at the end. By now there will have been five such meetings, the next being July 29 at the University of Vermont Medical Center. The whole schedule can be seen here.
The author is a writer for the Vermont Daily Chronicle as well as Keep Vermont Safe
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Categories: Health Care
It’s difficult to imagine the “health care” system getting any worse than it is already considering a friend’s recent experience after a trip to the ER. Having to wait weeks to see a specialist, and months for testing that should be done before seeing the specialist, it seems “follow up care” has become an oxymoron.
Cathy, New Hampshire’s moto “Live Free or Die” can be compared to Vermont’s moto “Not Enough of What We Need”
Clearly Vermont is doing something wrong. The more the government tries to help , the worse it gets. I went to the informational meeting in St. Albans and the information was very grim. We have an unsustainable health care system. I realized all the problems the hospitals are having are real and they need more money but the general public does not have the money needed. The day after the informational meeting , it was reported that health insurance wants double digit increases. We already have the highest costs. One Care Vermont and the All Payer Waiver may have helped the hospitals but they are a failure at controlling costs for the people and the availability of care has decreased. We pay too much for too little. At the informational meeting it was acknowledged that the GMCB knows our system is unsustainable.