Waiting for the Mandate – MVP Evaluates Vermont’s Health Care

by Kevin Joseph Ryan

Healthcare is changing in Vermont, of that there can be no doubt. Even if the Supreme Court decision concerning the individual mandate had gone a different way Thursday morning, Governor Peter Shumlin (D) has said that he will stand strong by his commitment to make Vermont the first single-payer insurance state in the Nation. With the “Obamacare” case having been decided, with most of the law being found constitutional in the form of a tax, the road is clear for Shumlin to move ahead with his plans, including $300-$400 million in Federal funds for Vermont. MVP Health Care company does not think this is a good idea and to explain the implications of the system Shumlin and the Vermont Democrats have passed, a community meeting was held Thursday morning at Burlington’s Hilton Hotel.

Susan Gretowski, once a actor as Deputy Director for State policy on Health Care and now the Senior Government Affairs Strategist for MVP explained to the capacity crowd of 250 how the Shumlin plan would eventually work. Simply put, she explained that over the next few years, and with changes beginning in 2013 and completing transition by 2017, the Shumlin plan would have private insurance be phased out. Eventually, insurance plans would have to offer their coverage thru an online marketplace and would be required to offer four levels of coverage, based on what percentage of the cost of health services would be covered by the insurance. This would range from Bronze Level, which would cover 60% of the cost of a procedure, to Platinum, which would cover 90% of the cost. An audience member asked if a $500,000 operation, with the best type of insurance plan, would still result in the patient bearing a cost of $50,000 out of pocket, the answer was yes. A loud murmur spread through the crowd.

Gretowski, explained that all decisions about what is covered, who could offer insurance in the marketplace and all other aspects of care, would be decided by the Green Mountain Care Board, a five man panel appointed by Shumlin. The best estimates as to the result of the changes, even with private insurers would be that the cost of individual health plans would increase by 18%, whereas group plans would decrease by 18%. Gretowski added, “We won’t know for sure the details they are released on January 15th, after the upcoming election.

Commissioner Steve Kimball, who heads up the Vermont department tasked with health care oversight, was on hand to defend the Shumlin Plan. He let the audience know that health care costs were estimated to continue to rise over the next few years, but that something had to be done. “We’re not talking about reducing costs.” Kimball Said, “We’re talking about reducing the rate of the increase of the costs.”

MVP had invited a panel of experts as well to further clarify the impacts of future plans for health coverage in Vermont. This included Frank Fanshawe, the VP for MVP Corporate Affairs seemed pessimistic with plans to eliminate private health coverage in Vermont, as could be expected. “The business plans, the employee plans, business is very happy with them. Then Vermont says you are going to have to do something very different.” Fanshawe told the meeting. “We have a single payer plan that’s failed – Medicare.” He Said. Fanshawe noted that the problem with health care is not accessibility at this time, but costs. “Everyone’s covered, but the cost is out of control.” Looking to the future, and realizing that Vermont is not an island, Mr. Fanshawe said “(Vermont) will become a very unattractive place to do business with single payer.”

The panel also included Betsy Bishop, the President of the Vermont Chamber of Commerce and Dr. Dan McCauliffe, a skin care specialist from Rutland. “Having a global budget here presents tremendous risk”, Said Dr. McCauliffe. “if the system under single payer fails, where do you turn?” The Doctor also referenced the Canadian health care system, frequently held up as a model of single payer. “The average waiting time in a Canadian emergency room is thirty minutes….why, as the Canadians are turning away from their own health care system, are we turning toward it?’

As the presentation wound up at 10 AM, a hush went over the crowd as twitter feeds, cell phones and laptops began to fill the room with the breaking news that the Supreme Court had indeed upheld Obamacare. The room emptied very quickly as people rushed back to offices to spread the news and prepare for the aftermath of the decision. The news wasn’t all bad, according to Jeffery Wenneberg, Executive Director of Vermonters for Health Care Freedom. “This tells us three things that are good news. First, it means that the State will have to wait until 2017 to get waivers under Obamacare to create single payer health care, number two, it tells us it matters who’s in the White House setting policy and three, it tells it is very important who is on the Supreme court, perhaps moreso than we thought.”

Immediately following the MVP event, Vermont Senator Randy Brock ( R), a current Candidate for Vermont Governor, held a press conference in the Hilton Hotel. He pointed to a clear difference between himself and current Governor Shumlin on the health care issue, and told the press what he thought we could do differently. “We Vermonters can start asking our political candidates and the news media to look much more closely at much better options.” Brock reported. “Why can’t we choose from lots of different policies offered by many different insurance companies from other states? A “single payer” one-size-fits-all is not a “choice”! And why are we forced to purchase insurance policies with mandated coverage for every service and product that health care lobbyists can wangle into our laws? Why can’t we choose the coverage we think suits us instead of what government tells us we need?”

3 thoughts on “Waiting for the Mandate – MVP Evaluates Vermont’s Health Care

  1. The 18% increase would be for association plans, whereas the 18% decrease would be for individuals. That number was reversed in error.

    The $50,000 co-pay on a $500.000 operation WAS in fact stated from the stage, and the question was in reference to the Platinum level coverage. What motivated that statement, I do not know.

    KJR

  2. I’d like to make two corrections and a comment to this piece:
    1) “The best estimates as to the result of the changes, even with private insurers would be that the cost of individual health plans would increase by 18%, whereas group plans would decrease by 18%.” This statement is incorrect. What should have been stated is that the cost of individual plans will be less for many individuals but businesses that purchase their insurance through associations, such as the Chamber of Commerce, will see their insurance costs go up by approximately 18%.

    2) I never said “The average waiting time in a Canadian emergency room is thirty minutes.” I said that the current median waiting time for patients in Canada to receive treatment from a specialist is nearly 5 months. I also mentioned that Canada is moving away from global budgets that cause rationing, as Vermont’s single payer plan moves to implement global budgets.

    Comment: “An audience member asked if a $500,000 operation, with the best type of insurance plan, would still result in the patient bearing a cost of $50,000 out of pocket, the answer was yes.” The answer in fact is no. There are limits as to what a patient would have to pay. For example, Bronze plans typically have a deductible and are often coupled with a Health Savings Account, that in some instances the Health Savings Account covers most, if not all of the deductible, that is typically $2,000 to $5,000. So a patient with a Bronze Plan that incurred a $500,000 hospital bill would owe only $2,000 to $5,000, and no more. They may have enough in their health savings account to pay for the full amount. So the statement that is someone with a $500,000 hospital bill would end up paying $50,000 is incorrect.

  3. Just a point of clarification. When you quoted Dan McCauliffe, ““The average waiting time in a Canadian emergency room is thirty minutes….why, as the Canadians are turning away from their own health care system, are we turning toward it?’” It should read 30 hours not 30 minutes.

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