by Hamilton E. Davis
For close watchers of health care reform in Vermont, there is a technical but important issue left over from the recent election. That is the late-campaign claim by Republicans that Gov. Peter Shumlin is trying to “take over” Medicare in order to fund his single payer initiative. If he succeeds, these critics say, it could cost Vermont seniors their health care benefits and their access to doctors.
I have written about this issue previously, but it is worth labeling this claim again for what it is: a total fabrication. Federal law does not allow anyone to deny Medicare recipients their coverage and all that comes with it, including the right to choose their own physicians.
It is true that Shumlin’s planners will seek to shift the way that health care providers are paid by federal Medicare officials. That effort involves standardizing the wildly variable payment patterns now in effect, as well as encouraging cost containment and higher quality. None of that implies denying care to seniors. Improving the efficiency of care delivery is the central goal of all reform efforts, including Obamacare. In fact, federal officials have already approved such a shift in Maryland.
When the legislature wrote Act 48, the health reform statute, drafters thought it might be desirable to ask that Vermont become its own Medicare claims administrator, using either the state’s Medicaid machinery or an administrator such as Vermont Blue Cross.
Subsequently, however, research by Shumlin’s planners showed no such step was possible. Vermont is part of a larger Medicare administration district that includes New York state. If Vermont administered Medicare claims, it would have to do so for the whole region. Given this landscape, it became obvious that the language in Act 48 was moot, so it was removed from the law.
What remains, however, is critical to health care reform -- shifting the way doctors and hospitals are paid for services to seniors. Acting on its mandate from Act 48, the Green Mountain Care Board has been working for the last three years to design such a new payment structure.
That work is not yet complete, but when it is the Shumlin administration will apply for something called an “all-payer waiver” that would work as follows: If Vermont can show the feds that the state’s new payment mechanism will save the federal government money, as well as improve the quality of care, then they (the feds) can adopt it for Vermont doctors and hospitals.
Such a new payment methodology would, in practical if not legal terms, have to be acceptable to both doctors and hospitals. If it wasn’t there is little chance that the feds would have anything to do with it.
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