On March 24, the Vermont House passed H.202, the Health Care Bill. Many residents have contacted me with concerns about the steps toward reform outlined in H.202. To address this, I have asked two experts on the bill to come to Shelburne to speak with us. Anya Rader Wallack, Special Assistant to the Governor for Health Reform, and Mark Larson, Chair of the House Health Care Committee will be at the Shelburne Town Offices on Tuesday, April 5th from 6:30-8:30 to help explain the House-passed version of the bill and answer your questions.
Although there is much angst about H.202, one thing that seems to bring universal agreement is this: our current system is unsustainable. We currently spend $5 billion per year on health care in Vermont and these costs are expected to grow at a rate that far exceeds personal income growth, state revenues and the ability of many businesses to pay these costs.
This is not to say that there are not many wonderful things about our current system, and much testimony pointed to concerns about losing the good things that we have. The problem, however, is the way we deliver and pay for this system is so complex and chaotic, without broad reform, we won’t have the potential to find the savings that we must find and are likely to lose these good things in the process.
H.202 has three reform components that are implemented over a 5-7 year period with checks along the way. First, it establishes a board whose charge will be to design a more sensible way to pay for health care. The bill allows for multiple opportunities for public participation in the process. While the Governor had wanted his office to appoint the board with Senate confirmation, the House felt this gave too much power to that office. The House version thus mimics the process for the appointment of judges and Public Service Board members.
Second, it sets up an exchange system. Federal health reform requires every state to either create a “health benefit exchange” or fall back to the federal exchange. The exchange is similar to websites that allow travelers to compare services and costs for airline travel, however here, purchasers can compare insurance company benefits and costs for one-stop shopping. Exchanges act as engines for health care reform by implementing and simplifying administration and payment.
Third, it sets the stage for Green Mountain Care, a universal access to essential health care benefits. If things go according to plan, this would be in place sometime between 2015 and 2017.
During the two days of debate last week on this bill, the primary division seemed to be whether we should start with the concept and then build in the details as H.202 did, or start with the details and then build the system as the opposition preferred.
I came to see that this bill is not a complete system but a first step to address health care delivery and cost containment. Similar to starting a business, designing a house or marketing an invention, design usually comes first with financing later. The newly created board would be responsible for developing the financing plan once the direction is more firmly established. The coming months and years would likely indicate that further analysis would be required and adjustments made.
There are some answers we cannot know at this time. That is the nature of pioneering work and it is easy to sew angst to try to derail it.
What is known is the current dollars being spent cannot continue. Certainly there is a more efficient use of these dollars that could be used to help us get well and stay well which could ultimately bend that curve on spending.