Green Mountain Care details prompt questions

In May 2011, Vermont passed what appeared to be groundbreaking health care reform, going beyond the federally mandated changes that are beginning to take place across the country.

The Affordable Care Act (ACA), commonly referred to as ObamaCare, includes an expansion of Medicaid eligibility, a requirement for all individuals to secure coverage and health care exchanges, where individuals and smaller companies can purchase insurance at lower rates than they could on the open market.

While the ACA introduces many changes and updates to the current system, it falls short of the sweeping reform that some believe is needed.

Along with the creation of the mandated exchange and an overhaul of Vermont’s health care infrastructure, the state legislature approved a plan to create a single-payer, publicly financed, universal health care system.

“I think Vermonters were greatly concerned about the way that health care works today. It is not really a system. It’s an amalgam of a bunch of free agents and it results in a lot of inefficiency,” says Robin Lunge, Vermont’s director of health care reform. “We spend twice as much as every other country and our outcomes are far worse. It is hard to make an argument that our health care system is in any way better.”

The plan, labeled as Green Mountain Care, will eventually replace private insurance in the state tied to employment with a comprehensive system that provides basic care for all residents. It does not, according to the GMC’s Web site “require Vermonters to drop existing private coverage, nor does it prohibit Vermonters from purchasing supplemental coverage if desired.”

The drive for universal health care has been building in Vermont since the early 1990s, when individuals first collaborated to address what they felt was a broken system where small business owners, farmers and others without insurance paid exorbitant rates for care.

After many failures, they found a champion in now-Governor Peter Shumlin, who promised to work for a single-payer plan. Using a study by William Hsiao, Ph.D., a professor of economics at the Harvard School of Public Health and an internationally recognized expert on health care systems, to back up the push, advocates got the idea approved by the state legislature in 2011.

“We actually had three health care studies that looked at reform and they all found that the single payer plan was the best way to make sure all are covered, all contribute and reduce waste,” says Lunge.

What remains to be seen, of course, is exactly how it will work. If health care is no longer tied to employment, will it be funded by a replacement tax to individuals and corporations? Will larger employers leave the state rather than pay the increased tax even if it reduces their health care costs? How will private insurers be involved in the plan if they are allowed to bid for the right to deliver some of the administrative services? And, how will this affect health care professionals?

Before the plan’s implementation, hurdles must be overcome. The details and funding mechanism must be determined and the state will also require a waiver from the federal government because it will replace the mandated health insurance exchange.

The administration hopes to get the plan online in 2017.

Within psychology, there are many concerns about how this will affect private practice. One question brought up on the Vermont Psychological Association’s Listservice is whether professionals will no longer be allowed to work directly with insurance companies to negotiate deals.

“But I don’t think you’ll find many providers making their own deals with insurance companies now,” says Lunge. “Insurance companies dictate the rates for smaller providers.”

Another concern is that reimbursements are too low. According to Lunge, this concern is being taken very seriously because they know that the success of the system rests on keeping providers in Vermont to offer services.

“Right now, we are a fairly well paying Medicaid state,” she says. “We are paying at 80 percent of Medicare, which is better than most other states. We also recently voted to increase rates along with inflation rates. We are committed to working with our providers.”

The only way to combat this feeling of unease about the parts of the plan that have not been finalized or publicly announced, says Rick Barnett, Psy.D., LADC and president of the Vermont Psychological Association, is for professionals to participate in the process.

“As a global construct, single payer is a positive step forward. But with the finer details, it’s a lot less clear how positive this movement will be. We have to be active at the table and contribute to how it is shaped. To that end, the VPA are trying to be more and more involved as health care reform evolves.”