by Hamilton E. Davis
In my last post, I raised the question whether Gov. Phil Scott’s administration could be maneuvering to somehow get rid of the Green Mountain Care Board, whose job is to recast the Vermont health care delivery system. I think the answer to that is no; the administration knows that it cannot do that without causing a politically dangerous mess. I think what it is doing is cutting the bone and muscle of the Board to the extent that the Board can’t accomplish what it was designed to do. And Scott wants to do that without suffering any political damage.
Scott’s budget team has told the Green Mountain Care Board that it needs to cut its roughly $8 million budget by about $250,000. Budgets get cut all the time, of course, but it is striking how short sighted this effort is. The first thing to understand is that only 27 percent of the Board’s budget comes from the General Fund, which is about $1.8 billion. That means that the quarter million dollar cut to the Board’s budget will save only about $75,000 for the General Fund. In other words, an 11 percent cut in the Board’s already small staff will generate a savings to the General Fund of just four one thousandths of one percent.
It gets worse. The way the rules operate, the only way the Board can make the Scott-ordered cuts is to lay off staff members. Moreover, the rules dictate that staff members who are on a sort of temporary employment have to go first. In the current case, the three employees slated to lose their jobs aren’t some minor leaguers operating on the fringe of the staff operations; they are highly skilled people who will absolutely be needed to meet the huge challenges facing the Board as it shepherds the country’s leading health care reform project through uncharted waters.
For example, when Susan Barrett, the chief of staff, and Kevin Mullin, the chair of the Board, testified in the Legislature about the cuts, Barrett said in answer to a question that two of the members on the chopping block had done the major part of the staff work on the Board’s survey of primary care doctor attitudes in the state about reform. This survey resolved some of the most contentious issues surrounding the role of primary care in the state. In fact, the survey blew up a thoroughly malignant effort in the Vermont Senate to drive the Board in a direction it clearly didn’t want to go.
The survey was conceived and designed by Jessica Holmes, a Board member whose day-job is as professor of economics at Middlebury College. Important elements of the work, however, were carried out by the staff, and that kind of thing will become more important as the health care delivery system enters a fully elaborated reform phase.
There is yet another dimension to this issue. When asked about the whole cut issue, the chair, Kevin Mullin, replied:
It’s no big deal. We will be able to do the work we need to do with the staff we have left, and we will have been stewards of the taxpayer’s dollars.
That response ran pretty high on the obtuse meter. An 11 percent cut in an elite, but very small staff is in fact a very big deal, both in the staff’s ability to perform its particularly difficult mission, and in the morale and esprit de corps that animate such a team.
The morale problem doesn’t lie so much with the staff members who are gone, but with those who are left. The Green Mountain Care Board badly needs the staff experts that it has recruited and trained to a high level; and if they conclude Mullin won’t have their back under pressure then they could just leave—many of them for multiples of the salaries they get today.
It isn’t clear yet how all this will play out. There is already a bill in the House that would reverse the cuts ordered by the Scotties to the Green Mountain Care Board, and to some other elements in state government . I have no idea yet whether that bill will have legs; far more bills are written in the House than get a hearing, let alone passed. So perhaps the Legislature will step into this issue.
What is now perfectly clear is that Scott is prepared to make very damaging cuts to a very small body that is managing not just an industry that spends far more than the state budget itself, but produces 20 percent of the whole state economy. The term “false economy” was coined precisely for situations like this.