Feb. 8 looks to be the next big day in the health-care debate. That’s when the Shumlin Administration plans to deliver its single-payer bill to lawmakers, according to some of the governor’s advisors.
Shumlin’s legislation will finally put some teeth behind what has so far been a more academic discussion about the merits of a single-payer design.
The bill won’t have all the answers, but it will include a design for the so-called “health-care exchange” through which the single-payer system would be run.
“It will establish a multi-year plan for making that exchange as close to a single-payer as it can be,” Anya Rader Wallack said Thursday.
It’ll be hard though she said to create what she calls “real single-payer” without an exemption from federal “ERISA” rules. The Employee Retirement Income Security Act exempts self-insured companies from state insurance regulations. Rader Wallack said the administration wants to pass single-payer “architecture” this year so that it can make a better case for an ERISA exemption in Washington, D.C., later this year.
Rader Wallack and Kimbell have been busy meeting with various “stakeholders” –Statehouse-speak for people with vested interests (often financial) in proposed legislation. On Thursday, Bea Grause from the Vermont Association of Hospitals and Health Systems could be seen heading into Rader Wallack’s Pavilion office. Joel Cook, with the Vermont teachers union, was on deck for a meeting with the health-care czar.
“Depending on the group, we’re talking about the concerns highest on their list and getting input from them on areas where we think it might be helpful,” Rader Wallack said.
Consultants to the Legislature on Vermont Yankee issues, Maggie and Arnie Gunderson, testified before a House committee Wednesday and called for a new study to look into the decommissioning of the nuclear plant in Vernon.
The last study was done in 2007, they told the House Committee on Natural Resources and Energy, and has a host of problems, including that it was performed by a company owned by Entergy, which also owns Vermont Yankee.
"Our basic recommendation is that this 2007 survey should not be used for making policy decisions about what to do about Vermont Yankee," said Arnie Gunderson, a nuclear expert who believes the plant should be shut down in 2012 when its license expires.
The Gunderson's think the cost of decommissioning could be cheaper than what is outlined in the 2007 report, which means it could be done sooner.
Check out the details of the Shumlin budget proposal at http://finance.vermont.gov/state_budget/rec
Gov. Peter Shumlin proposes increasing investments in broadband and wireless infrastructure, despite calling for budget cuts in other areas of state government on Tuesday.
Shumlin proposes spending $13 million from the capital bill for telecommunications investment, which would also help leverage $40 million in unused bonding capacity at the Vermont Telecommunications Authority.
"These investments will expedite the build out of fiber optics lines and wireless networks across our state, including the most rural areas that for economic reasons are least likely to attract private providers," Shumlin said in his budget address.
Last January, Vermont was supposedly staring down at a $120 million shortfall in the fiscal-year 2012 general fund. By summer, administration officials and legislative accountants revised the number downward to $112 million. In the fall, the gap suddenly widened to $150 million. And after the latest revenue forecast earlier this month, the number was recalculated at $111 million.
Shumlin’s people though say the real shortfall in next year’s general fund amounts to $176 million. And Shumlin says lack of success with Challenges for Change is one major reason for the new number.
The fiscal-year 2012 budget had previously assumed $26 million in savings called for in the Challenges for Change legislation.
“While Challenges for Change was a well-intentioned initiative, we simply cannot budget $26 million in savings that may not be realized, and I won’t,” Shumlin said in his budget address.
Shumlin’s budget uses cuts at the Agency of Human Services – $110 million in all – to close that lion’s share of the gap. His budget also uses $12 million in labor savings, a $23 million reduction in the genera-fund transfer to the education fund, and $26 million in unexpected revenue from fiscal year 2011 to help balance the budget.
Peter Shumlin has long said that Vermont can’t talk about solving its budget problems without talking about health-care reform. With his budget proposal Tuesday, he has ensured those conversations will be one and the same.
Administration officials cite rapidly rising health-care costs as one of the chief reasons for the $176 million shortfall in next year’s general fund. And they say hospitals, doctors and other health-care providers will have to help close it.
Shumlin’s budget proposal uses new taxes – the administration uses the term “revenue enhancements” – on hospitals, doctors, dentists, nursing homes and private insurers to solve about $36 million of the $176 million problem.
Secretary of Human Services says the emphasis on health care in Shumlin’s budget reflects its impact on general-fund spending.
“It’s an acknowledgment that health-care costs are going up at unsustainable rates,” Racine said. “We cannot continue business as usual in health care, so yes, providers are going to be taking hit in this budget.”
Racine said the proposal will bring providers even closer to the table as the state begins a landmark debate over the merits of a single-payer health-care system.
“We hope the providers taking hits here will see where we’re headed with this, and the possibility to bring costs out of the system and reimburse providers at an acceptable rate,” Racine said. “But we need health-care reform to accomplish that.”
The National Governor's Association has announced the leadership and committee assignments for the coming year, and Gov. Peter Shumlin has been named to the Education, Early Childhood and Workforce Committee. He'll be serving alongside Massachusetts governor Deval Patrick, and Tea Party favorite Nikki Haley of South Carolina.
The NGA calls itself the "collective voice of the nation's governors" and is a powerful lobbying force on behalf of states. According to the NGA press secretary, this committee, like the other three standing committees, "develops policies and provide a forum for governors to address key issues." and "regularly provides governors and their staff members with information on legislative or regulatory actions, status reports, strategic guidance and other assistance related to federal policy activities."
Governors are in a tough position this year, with some states like Illinois considering bankruptcy as a way to solve fiscal a massive fiscal crisis. Vermont's budget gap for the next fiscal year is projected at about $140 million right now. Illinois? A structural deficit of about $13 billion.
As many of you know, we've been looking for reporters for our Press Bureau, after naming Pete Hirschfeld the new chief in December.
We have hired Thatcher Moats, currently the Montpelier reporter for the Barre-Montpelier Times Argus, to be a Vermont Press Bureau reporter. Thatcher has been with the Times Argus since the summer of 2008, when he replaced Pete as the cops and courts and general assignment reporter for the Times Argus. He moved to the Montpelier position last spring, replacing Sue Allen.
He will be moving into his new duties this coming week, while keeping an eye on Montpelier (the city government, not the state) until we can get him replaced. And, the third position will be filled soon…
John Tracy, an aide to Sen. Patrick Leahy, has been tapped to serve as the senior senator’s new state director.
The prestigious slot opened up when Chuck Ross left the post to serve as Peter Shumlin’s secretary of agriculture. Like Ross, Tracy began his political career in the Vermont House of Representatives, where he served as leader of the Democratic caucus during the historic debate over civil unions.
Tracy, who will oversee Leahy’s Vermont staff and spearhead some of the senator’s congressional initiatives, ran for lieutenant governor in 2006 but lost in the Democratic primary to Matt Dunne.
In a written statement, Leahy touted Tracy’s “experience and leadership skills.”
“With health reform topping agendas in both Vermont and the nation, John is perfectly suited to help advance our work in improving health care in Vermont,” Leahy said.
Tracy has spent the last five years working as a field representative for Leahy, traveling the state and helping Vermonters navigate federal programs and agencies.
A Vietnam veteran whose son just returned from a deployment to Afghanistan with the Vermont National Guard, Tracy has also been active on military issues.
“As the father of one of Vermont’s own in Afghanistan, John and his family have been touchstones for us and for others through a difficult and dangerous deployment.” Leahy said.
After running afoul of the Agency of Agriculture’s strict marketing regulations, McDonald’s has agreed to offer pure Vermont maple syrup for the “Fruit and Maple Oatmeal” on the franchise’s breakfast menu.
Turns out MickeyD’s oatmeal isn’t flavored with “maple” at all, but the pulverized bark of a “bush remotely related to maple tree,” Gov. Peter Shumlin told reporters this morning.
The settlement applies to Vermont franchises only, though Shumlin said he intends to push McDonald’s to use some of this state’s signature agriculture product in restaurants nationwide.
It’s unclear exactly how much syrup the franchise will buy, or what sort of windfall it might bring to Vermont sugarers. Shumlin also didn’t know if customers will be charged a premium for the amber gold.
The news comes as Shumlin pushes a health-care reform bill aimed at lowering medical costs in the state. Asked if he wants Vermonters to start frequenting the Golden Arches, he said “if they have Vermont maple syrup in their product, I would certainly hope more people go there, at the expense of other fast-food restaurants.”
Besides, Shumlin said, maple syrup is good for you.
“There’s a health benefit to this,” he said. “Maple syrup is a much healthier product for Vermonters and Americans than is raw sugar. So there a lot of reasons this makes sense.”
The syrup will be available in Vermont franchises beginning Feb. 1. Shumlin said he’ll be there to partake.
“I will go to McDonald’s on Feb. 1 and have oatmeal,” Shumlin said, “if I can get an extra heaping of maple syrup.”
We are reading through the Hsiao report today, after getting a preliminary look at it last night. I keep getting questions on how it will affect certain groups or certain people, and the answer is, if the Legislature goes with option 3, the Public-Private Single Payer plan, each group will be impacted differently.
A few key questions that we'll be trying to answer over the next few days: How will it work? Will Medicare remain the same? What about malpractice reform? Can they really reduce administrative costs that much? Who pays? Will we really be able to get waivers for everything from the federal government?
Also, lest you thought we weren't paying attention, a bill that would set up a single payer system (called "Ethan Allen Health") was introduced by Susan Davis today. H.80 would set up what looks like Hsiao's Option 1, but would not be exactly equivalent.
While sitting in the Statehouse for the Hsiao report presentation yesterday, I had a strange realization that my grandfather may have sat in the same seat in 1936 as he reported for the first time on the legislature. I was using a laptop computer; the reporters around me were tweeting and blogging and recording. Video cameras were live-streaming over the Internet. But the seats are the same, and back then the legislature was moving to debate something that may have been just as ground-shaking: the Green Mountain Parkway, which would have created a highway along the ridge of the Green Mountains.
In Vermont media news, the CEO of MediaNews, which owns the Brattleboro Reformer, Bennington Banner and Manchester Journal in Southern Vermont, Dean Singleton, has announced that he will be stepping down. That won't probably have much affect on the Vermont papers, but it comes in the context of rumors that MediaNews might merge with Freedom Communications, another media chain, and perhaps a few others. Both MediaNews and Freedom just emerged from Chapter 11 bankruptcy, which Singleton told the Colorado blog Westword puts him in a good position for expansion.
"After our restructuring, we have a very good balance sheet for expansion," Singleton maintains. "And expansion, if you do it geographically, lets you consolidate a lot of overhead, which makes the businesses more efficient — and that gives the core business a lot more value. But it also gives you more critical mass to create new media platforms. In terms of developing new media strategies, interactive and mobile and social media, the size of the platform does matter, and having a larger platform does offer some opportunity." – From the Westword interview
Expansion, and going into debt to leverage that expansion, is one reason the major newspaper companies got into serious trouble over the last few years. A further merger would put the majority of newspapers nationally in the hands of just a few giant chains – MediaNews/Freedom, Gannett, McClatchy, and a few others. That leads to less diversity of coverage, more intense focus on profits and less responsiveness to the communities we serve.
Businesses, who have watched the cost of health-care benefits for employees rise at double-digit rates in recent years, have a lot at stake in the health-care debate.
William Hsiao says that, on the whole at least, businesses stand to see at least modest decreases in health-care costs under his single-payer plan.
In 2009, according to his study, the health-care premium paid by employers amounted to 11.3 percent of their total payroll. By 2015, he says, that figure is projected to reach 12 percent.
Hsiao’s plan would mark an end to a World War II-era system in which businesses tend to be responsible for their workers’ health-care policies. Under the single-payer model, businesses would instead see a new payroll tax. In 2015, Hisao said, that tax is expected to be 11 percent – one percent less than what businesses would have paid under the old system.
Employees too would be subject to a payroll tax, however Hsiao says they too would save money on the whole.
The current slide (in the power point show) is saying that a payroll contribution (a.k.a. a tax) would replace insurance premiums, with exemption for low-wage workers. This could be crucial to seasonal employers like ski areas.
The following slide talks about the world of providers – that it's so confusing and complex to get paid for being a doctor or nurse practicioner. The reform would make a uniform payment method wil the same rates for all payers.
A new acronym for your vocabulary ACO or Accountable Care Organization. Not exactly clear how these will play into the overall plan, or how they are different from HMOs.
He's saying that the leading option to pay for this health care plan is through a payroll tax – although one parameter is that the plan will not increase spending for employers and workers, but also will not reduce the net payments to hospitals, doctors, and other providers. He's also saying that there will be no change in Medicare benefits.
He's also proposing savings through tort reform – "That's why I have many friends who refuse to return my calls – and these friends are trial lawyers." – which is, in laymen's terms, reforming the liability process for the health care system. This was a flash point in the national debate over health care in 2009.
One part of this report is how comprehensive the insurance coverage should be – should it cover long term care benefits for the elderly? How about additional dental and vision coverage? He's saying that the full boat – comprehensive coverage including all of them – will be too expensive.
Hsiao is projecting health care savings between $330 million and $590 million by 2015, and between $1.3 billion and $2.1 billion by 2024, but said he plans on using some of that savings to expand some kinds of coverage – like medical and dental – and upgrade everyone to a standard essential package.