by Hamilton E. Davis
Over the last few months, I have put up a series of short posts on the status of Vermont’s healthcare reform project, which has been underway since 2012. For the most part, it has been a litany of failures by all the major players—the Governor, his staff, the hospital industry itself, and most importantly, the Green Mountain Care Board.
Does that mean there is nothing left but to write the epitaph of what was once the most promising initiative in the country? Not quite, not yet, but a rescue mission will have to be mounted in the Legislature by mid-January. It will be a very heavy lift. Still, the coming legislative session will be very interesting, indeed.
At least part of what the lawmakers will confront will be an effort to radically recast the Green Mountain Care Board, stepping it down from any role in what amounts to health policy planning, and limiting it to enforcing policy decisions that would be made by the executive branch. Such a step would transfer political accountability for arguably the state’s most important social institution to the Governor, who is directly responsible to the voters of the state.
Over the last few years, a movement in that direction has been stirring under the surface. A handful of experienced players have been discussing a plan advanced by Gretchen Morse, a former legislator and Agency of Human Services Secretary, who has been at the center of the healthcare reform effort for 50 years.
In the early 1980s, as a member of the Vermont House, she worked closely with former Gov. Richard Snelling to develop the Vermont Hospital Data Council, the first effort to corral out-of-control healthcare costs. She later served as then-Gov. Madeleine Kunin’s Secretary of Human Services; her duties there included serving on the Data Council and administering the Doctor Dynasaur program, a landmark Kunin achievement. After retiring she spent several years on the board of UVM’s health care system.
In the last year or two, she has pressed an initiative she calls “Back to the Future,” which I have described above. In letters to Governor Scott and the Green Mountain Care Board and pretty much anyone who would listen, Morse has laid out the case for returning health planning to the Vermont Health Department, where it originated in the 1970s. She argues essentially that the current version of the Green Mountain Care Board has departed from the original legislative intent of Act 48 (Title 18 in Vermont law) which was drafted as the vehicle for former Gov. Peter Shumlin’s Single Payer initiative; Single Payer collapsed in 2014.
Following is a lightly edited version of the Morse case.
Vermont law requires the Department of Health in the state Agency of Human Services to conduct studies, develop state plans, and administer programs and state plans for hospital surveys and construction, hospital operations and maintenance, medical care and treatment of substance abuse…
Today, more than 10 years, later there is no comprehensive State Health Care Plan for hospital services. There is no big picture. Testimony at GMCB appears to me as opponents versus proponents,“he said, she said.” There is no objective independent analysis that goes beyond the financial “bottom line" and considers the impact on how and where care should be delivered…
It is not unreasonable for the Legislature in its next session to expect the Scott Administration to organize resources for the distribution of the largest expense in Vermont's budget more efficiently with transparency, community involvement, and accountability. Vermont has done it with the utilities. The Public Service Department does this for utility planning and policy distinct from the Public Service Board’s role of regulating budgets and rate setting.
Vermont has a long history of health reform and strong institutions, public and private, which have collaborated to achieve outcomes that contribute to making Vermont a healthy place to live. What keeps me up at night, is a premonition that Vermont’s health care system is at a tipping point. It is time to turn it in a better direction toward a healthier future for Vermonters.
The question going forward is how the Legislature will deal with the issue. The key players will be Lori Houghten, the Essex Democrat who chairs the House Health Care Committee; Sen. Ginny Lyons, a Chittenden County Democrat; Jill Krowinski, the House Speaker; and Phil Baruth, the Chittenden County Democrat, who is President Pro Tem of the Senate. Add in Jane Kitchel, the Democrat from Danville, who chairs Senate Appropriations, and who The Vermont Journal considers the strongest single player in the Vermont state house.
No one knows what, if anything, will come of all of this. I expect to see bills from both Houghton and Lyons, which will be different from one another and which are probably being drafted now by Legislative Counsel.
On a broader reach, there is an interesting state political backstory at work. Governor Phil Scott, a Republican, is now in his fourth two-year term and is expected to seek a fifth next November. As far as I know, however, no one has asked him, so anything is possible. Meanwhile, two prominent Democrats—Lt. Gov. David Zuckerman, and State Treasurer Mike Pieciak—have been unofficially auditioning for a gubernatorial run when Scott steps down. Neither has shown any inclination to challenge Scott in 2024…although there is now a wild card in the game: Burlington Mayor Miro Weinberger, a Democrat, is walking away from City Hall, and is clearly interested in the top state job. There might be enough gravitas in the healthcare reform space to turn the 2024 gubernatorial election into something other than a stroll to a fourth term for Phil Scott.
Finally, there is an historically unprecedented project afoot in the Legislature itself that could provide a framework for a full reexamination of the healthcare reform project. In the last session, both House and Senate signed onto a project they called “Accountability,” aimed at exploring the body’s fundamental role in state policy. What is each policy committee actually doing? What issues should each be focusing on, and in what direction should it head?
The director chosen to steer that effort was Rep. Jessica Brumsted, a Democrat whose district is Shelburne-St. George. Over the fall, Brumsted’s group of senators and representatives met three times to discuss the issues. The results of that effort will be on the agenda when the Legislature convenes on Jan. 3 of the new year.
The health reform issue is certain to be part of that, somehow.