Newsletter – August 10, 2012

by Vermonters for Health Care Freedom

Vermont Selects “Benchmark” Health Benefits Plan for Exchange

In what may be the least surprising announcement in the history of health care reform, the Vermont Department of Health Access announced the selection of Blue Cross Blue Shield as the benchmark “essential health benefits” plan for the federally-mandated Vermont Health Benefits Exchange. In their public announcement of this selection, administration officials emphasized that there will be multiple insurers offering similar plans through the exchange. The reassurance that Vermonters will continue to have some choice in these products appears to be an important talking point. Notably absent from the administration’s talking points was the fact that within 3 years of the establishment of the exchange all insurer choice will be outlawed and everyone who was forced into the exchange will be herded into the single payer government monopoly plan.

The exchange is the system through which individuals and small businesses will purchase health insurance starting in 2014, and is required by the federal Affordable Care Act. One of the first steps in creating the exchange is to select an existing benefits package from private or public insurance plans currently available to individuals and small groups in the state to serve as the benchmark, or minimum set of benefits. Starting in 2014, any plan offered by any insurer must substantially match the benchmark benefits. The DVHA selection is actually a recommendation to the Green Mountain Care Board, who will have the final say.

What makes this announcement less than surprising is the fact that all plans currently in use by these groups in Vermont (BCBS, MVP and even CIGNA) cover almost exactly the same benefits. So regardless of which existing plan was selected the benchmark health benefits would be the same. This is because the Vermont Legislature has mandated a great many health benefits over the years; so many that all currently operating plans are essentially the same. This is also a major reason why Vermont health insurance premiums are high compared with other states.


WCAX Confuses Commissioner Larson – and the Rest of Us

Viewers watching the WCAX’s Thursday evening interview with Department of Vermont Health Access Commissioner Mark Larson on the selection of the benchmark plan for the health benefits exchange might have noticed his confusion when asked to respond to VHCF’s Jeff Wennberg’s pre-recorded comments. He was right to be confused. WCAX took Wennberg’s comments on the Single Payer plan and ran them as though they were in reference to the selection of a benchmark plan for the health benefits exchange (see above). While the two are related, they are not the same. In the recorded interview Mr. Wennberg offered VHCF’s comments on camera regarding the selection of the benchmark plan, essentially as given above. We do not know why WCAX chose to use the single payer comments instead.

The confusing WCAX coverage is available here:


Vermont Exchange Unique in the Nation 

National media are starting to get the message that Vermont is doing something very different with the Affordable Care Act. Heartlander ran a piece titled “Vermont Health Insurance Exchange Is Bridge to Single Payer,” pointing out that in this state the Exchange is a very temporary feature of reform.

“According to John McClaughry, vice president of the Ethan Allen Institute, the health insurance exchange is not important in and of itself. For Vermont, its importance lies in the federal money it will bring to the state, which is necessary for Vermont to implement its proposed single-payer health care system, Green Mountain Care, in 2017.

“The whole point of the Shumlin exchange is to corral as much in tax credits as possible, and then in 2017 get HHS to allow Vermont to grab all the tax credit dollars, put them into the pot to finance single-payer Green Mountain Care, and abolish the exchange since there won’t be any insurance companies in existence,” said McClaughry.”

The full Heartlander piece is here:


Britain’s National Health Service Enjoys High Support but gets Low Marks

An op-ed in the Los Angeles Times examined the disconnection between the poor measured quality of the UK’s centralized National Health Service and public perception of quality.

“In a centralized system, the setting of targets can lead to organized deception as well as distortion of effort. For example, when the British government decreed that every patient arriving in the emergency room should be admitted to a hospital ward within four hours if admission was necessary (and that hospitals would face fines if they failed to achieve this goal), traffic jams of ambulances formed outside one hospital, with patients prevented from entering the emergency room until the hospital could comply with the directive. Other hospitals designated corridors as wards so they could claim that patients on stretchers had been admitted in time.”

The full LA Times op-ed is available here:,0,7412265.story


Affordable Care Act Expected to Fail to Achieve Universal Coverage reports that a new Congressional Budget Office (CBO) estimate projects that while the ACA is expected to reduce the number of US uninsured by up to 30 million over the next 10 years, this is still 30 million short of the goal of universal coverage.

The brief article is here:

The CBO report is here:


Shumlin’s 2008 Comments Telegraph ERISA Strategy?

Activity on the VHCF Facebook page turned up some interesting video from the 2008 Democratic National Convention in which then Senate President Pro-Tem Peter Shumlin addressed the critical need to strip ERISA employers of their federal protections to make single payer work. The status of these federally-protected self-insured companies remains an unresolved issue as Green Mountain Care races toward implementation. Vermont estimates that about 17% of this state’s population is covered by ERISA protected employer self-insurance plans.

Ever since then-BISCHA Commissioner Steve Kimbell briefed the legislature in March of 2011, it has been assumed that a waiver from ERISA is not possible without unlikely Congressional approval. Shumlin’s 2008 comments were in defense of Sen. Bernie Sanders’ efforts to secure exactly that Congressional approval. Sanders was unsuccessful, and Kimbell’s comments appear to be an admission that that avenue was no longer available. But Shumlin’s disdain for the ERISA protection and acknowledgement of the critical need to capture these lives under single payer could not be clearer:

“Bernie Sanders could give Vermont the best opportunity to actually implement the single payer health care plan by the simple fact that if we can elect Obama President of the United States and get Bernie’s bill passed which says that 6 or 7 states shall be exempted from the ERISA requirement that basically lets wealthy companies protect themselves and their own health care pool so that they would be basically exempt from any state plan. If we can get everyone in one pool in a number of states we can pass universal coverage state by state . . . let’s get the job done, it’s gonna happen state by state, we need the ERISA waiver . . .”

So if Governor Shumlin continues to see the critical need to capture ERISA enrollees under single payer, how would he do it? Here is the speculation of Jeannie Keller, arguably the single best informed expert on these matters in Vermont, from her 2011 blog, responding to reader posts and referring to the report of Dr. William Hsaio which served as the basis for Act 48:

“. . . Note that he [Hsaio] doesn’t say anywhere the state can ORDER a self-insured or insured employer to drop their plan in lieu of the single payer. The technique used, to attempt to skirt ERISA, is to impose a tax that makes the employer’s own plan redundant. Absent an ERISA waiver from Congress, that is all a state apparently can do, according to Hsiao, and even that likely would result in a court challenge, and as his expert Butler says, the outcome of that cannot be predicted.”

ERISA employers should watch the proposed single payer financing plans very carefully (if we ever actually see one) to find out whether ‘wealthy companies’ can continue to ‘protect themselves and their own health care pool.’

Shumlin’s 2008 video comments are here:

Keller’s 2011 Blog post is here:


Taiwan Nurses Protest Working Conditions

Here is another report from Taiwan, the island-nation that, like Vermont, turned to Dr. William Hsaio to design their single payer national health system. Under funding of the government monopoly single payer program has resulted in low pay, long hours and abysmal working conditions for doctors and nurses. According to this report from Focus Taiwan News Channel, 200 nurses protested in front of the national Department of Health to draw attention to their plight.

“Although there are 230,000 individuals who hold nursing licenses in Taiwan, only about 40 percent of them are in the work force, according to statistics compiled by health officials.

According to statistics from the DOH, the turnover rate for nurses reached 20 percent last year, which was 3 to 4 percentage points higher than in previous years. About 17,800 people left the profession in 2011.”

The Focus Taiwan report is here: