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Vermont takes another step towards single payer

As expected, Vermont’s House passed, by a vote of 94-49, a bill that points the state towards a single payer health care system that will cover all of its residents. Governor Peter Shumlin, who campaigned on single payer health care, will sign the legislation later this month.

The bill won’t create a new health care system overnight— instead it sets up a planning process to create a “single payment” system called Green Mountain Care (GMC). The general framework is to bring as many health care payers into one system as possible:

  • State municipal employees and everyone in the exchanges set up by the Affordable Care Act (individuals and small businesses) will definitely be covered, since those are directly regulated by the state.
  • For Medicare and Medicaid, Vermont will ask the Obama administration for waivers, so that the federal money from those programs would be sent to GMC, who would then cover Medicaid and Medicare patients.
  • Large employers are also shielded from state law somewhat, thanks to a federal health care law called ERISA. Vermont can’t force large employers to join GMC, but employers could participate voluntarily. So Vermont is considering a “pay whether or not you play” tax- all employers would be taxed to pay for GMC, whether or not they join. The hope is that most employers wouldn’t want to pay for health insurance they’re not using, so they’d just move their employees in GMC voluntarily. The danger though is that employers would choose to leave the state entirely, rather than pay the tax.

Also, the bill doesn’t spell out some of the most important details: how it will be paid for, what benefits will be covered, and what copays and deductibles will be included. Instead, those questions will be answered by a five-member board, in consultation with the governor and the state legislature.

For more on the Vermont bill, Boston University professor of health law Kevin Outterson is your guy. He has a five part series on the excellent health care blog, The Incidental Economist, explaining the bill here, and a great interview with The Washington Post’s Ezra Klein here.

Speaking of single payer…

The Senate’s Bernie Sanders (I-Verm.) and the House’s Jim McDermott (D-Wash.) have introduced bills that would give states guidelines and establish minimum standards to establish single-payer health care programs.

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