Listen: Capital Beat Podcast with Gov. Peter Shumlin
MONTPELIER — With just three months left in office, Democratic Gov. Peter Shumlin says he plans to push hard to complete a handful of projects before his successor is sworn into office in early January — including an overhaul of how the state pays for health care services.
Shumlin, who is not seeking re-election after his third term expires, reflected in an interview about his time in office and pledged to continue his work until his final day as governor.
“This is the best job that anyone can ask for, being governor of Vermont. It’s been an extraordinary privilege. One thing that governors do every day is focus on what they were elected to do, which is to grow prosperity, grow jobs, make sure our state remains the best place to live and work and raise a family. I’m working just as hard as I was on day one,” the governor told the Vermont Press Bureau.
Among Shumlin’s top three goals for his final months in office is completing negotiations with the federal government on an all-payer model for health care payments. Under such a system, the state would reimburse health care providers based out health outcomes rather on the number of procedures they perform.
Shumlin said Vermont’s economy has improved during his tenure, with wages rising and 17,000 jobs created. But he acknowledged health care costs continue to weigh on the economy.
“I think Vermonters agree that we’re headed in there right direction, but there’s still frustration that we’re not doing better. One of the reasons for that is the health care system takes money out of our pockets, even if we can’t see it being taken out, faster than we can earn it. What I mean by that is health care costs, not just in Vermont but across the nation, grow faster than our incomes and it’s a killer,” Shumlin said.
Vermont and the rest of the country are spending too much on health care and “we don’t have the best results or the best outcomes,” according to the governor.
“Other countries do better than we do and are spending a lot less,” Shumlin said.
Shumlin, who met with U.S. Health and Human Services Secretary Sylvia Burwell on Wednesday to help aid negotiations over an all-payer model, said he expects to know in the next two or three weeks if the state and federal government can agree on a deal.
“It’s certainly on the top two or three list,” he said. “If we can do it we’ll be the first state that is able to accomplish this.”
An all-payer model would allow the state over a five-year period to bring Medicaid, Medicare and private insurance into a more balanced payment system, Shumlin said. The Shumlin administration is trying finalize how much federal support the state will receive under such a system.
“Our problem is that in a fee-for-service system where particularly, primary care providers — doctors, nurses, chiropractors — get paid for every service they do and their reimbursements vary depending on who they serve. Medicaid, Medicare and private pay all pay different rates for the same service,” Shumlin said. “The perverse thing about our health care system right now is it rewards quantity, lots and lots of service, and if we can move to a system where you get paid for keeping someone healthy it’ll make our health care system for Vermonters. They’ll have better outcomes for less money.”
Even if the state fails to secure an agreement with the federal government, Shumlin said he would still give his administration “a very high grade” for health care reform.
“I will be the governor that brought universal health care coverage to Vermont. That’s what we did. You now have a 2.7 percent uninsured rate. That’s a huge accomplishment. If we can also be the state that moves to a more sensible payment system, that grows jobs and improves quality, I think that will be a great legacy,” Shumlin said. “Now, do I wish that we could have gotten a publicly financed universal access single payer? Absolutely. Did I know it was a huge lift? I did. I said as many times as people would listen, ‘We’re going to go out and do the hard work and see if this will work or not.’”
The governor said he also plans to continue the effort to address heroin and opiate addiction in Vermont. Shumlin famously devoted his entire 2014 State of the State address to the issue. Since then, the issue has ballooned across the country. He said he wants to implement new rules for opiate prescription before leaving office.
Other states ran into opposition when trying to limit prescriptions for opiates, Shumlin said, because “big pharma” came in and convinced lawmakers that such painkillers were needed, even for minor procedures.
“Ten days of Oxycontin, that’s enough to make you an addict,” he said. “We looked at the problems that these governors were having getting any reasonable limits in the legislatures. We got permission from the [Vermont] Legislature to have our health commissioner, by a rule, set reasonable limits. I want to get that done and I want it to be low limits. I don’t think that you should be able to pass out a bunch of incredibly addictive opiate pills for procedures that get Vermonters addicted to those pills and then to heroin.”
Shumlin said Health Commissioner Harry Chen and the Health Department are working on a new rule now.
“I’m not a doctor so i’m letting my commissioner do the work on that, but three days of oxycontin for a minor procured, getting your molars out, that’s plenty,” he said.
A new treatment facility should also open before Shumlin leaves office.
“We want to build out more treatment centers. We’re working on one up in Saint Albans to get rid of the wait lists because as we get more and more people addicted we’ve got to make sure that we’re moving them into treatment, not jail, and we’ve done a good job of that,” the governor said.
Crafting a 2018 fiscal year state budget that his successor will take over his Shumlin’s last big priority. He said the budget his administration creates for the new governor will be balanced and not look to increase broad-based taxes.
“I’m incredibly proud of the fact that in tough economic times we balanced six consecutive budgets without raising broad-based tax rates on Vermonters. I keep reading from the opposition, ‘Oh the Shumlin administration raised all these taxes. Listen, that’s malarkey. We’ve raised fees. Every governor does that. They keep up with inflation,” he said. “We’ve raised some very minor taxes, but I have refused to raise income tax rates, sales tax rates, rooms and meals tax rates, because they’re already high enough.”
Vermont’s previous governor, Republican James Douglas, raised the sales tax, Shumlin said.
“I want to point out it was the last governor who raised the sales tax from 5 percent to 6 percent,” he said. “If you do the math on that that’s $680 million that Vermonters have paid in sales taxes since it was raised from 5 percent to 6 percent.”
Shumlin said he expects the country will miss President Barack Obama, who is also leaving office in January. Will Vermonters will miss Shumlin? Eventually, the governor said.
“It might take longer to miss a governor, and that’s nothing new,” Shumlin said. “Governors come in, they get a honeymoon. They start making decisions, and you make hundreds of them a day, and you make lots of people mad. You leave and they forget what you did and they start to like you.”