Category Archives: Health Care

Capitol Beat with the Governor 2-20-15


Gov. Peter Shumlin and Vermont Press Bureau chief Neal P. Goswami discuss his effort to obtain an “all-payer waiver,” efforts to find savings in labor cuts and the Vermont Veterans Home.

New poll touts support for removing philosophical exemption

MONTPELIER — A new poll commissioned by a pro-vaccine group shows that 68 percent of Vermonters do not believe parents should be able to opt out of vaccinating their children through the philosophical exemption in state law.

The poll, commissioned by Every Child By Two, a national nonprofit group that advocates for vaccinations, also found that 73 percent of Vermonters support efforts to change the law. The poll of 880 Vermonters was conducted by Gravis Marketing on Feb. 9 and 10. It has a 3 percent margin of error.

Every Child By Two Executive Director Amy Pisani said the results of the poll “are a clear indication that Vermont needs to take swift action to ensure that all of its kids are protected from dangerous and preventable diseases.”

“When nearly three-fourths of the residents in a state believe there should not be a philosophical exemption for vaccines, it’s time to change the law,” she said.image015

The poll could spur action on legislation introduced by Republican Sen. Kevin Mullin of Rutland, which seeks to remove the philosophical exemption. The state also allows for medical and religious exemptions, but the philosophical exemption accounts for most of the exemptions in Vermont.

Mullin proposed similar legislation in 2012. It cleared the Senate but the House, faced with strong opposition from a coalition of people advocating for parents’ rights, did not advance the measure.

Data from the Vermont Department of Health has shown that the percentage of unvaccinated children has risen in recent years.

image018Gov. Peter Shumlin has said he believes all Vermont children should be vaccinated, but he does not favor changing the state’s exemption law to eliminate the philosophical exemption. The poll found that 70 percent of Vermonters do not favor the governor’s position.

The Vermont Coalition for Vaccine Choice and other anti-vaccine groups are again expected to wage a strong campaign against Mullin’s legislation. But this year, the Vermont NEA, the state’s largest union that represents teachers across the state, has decided to come out in favor of the bill.

Read the poll questions and data below:

Big health care change is still in the air

MONTPELIER — The quest for a single-payer health care system was sidelined, at least for now, by Gov. Peter Shumlin, late last year. But another effort to dramatically transform the state’s health care system remains very much alive.

Shumlin, a third-term Democrat, shelved his own long-sought proposal for a publicly financed health care system in December, saying it was too expensive at this time. But he is continuing to push for a parallel goal to change the way health care services are paid for in Vermont.

His administration is seeking an all-payer waiver from the federal government that will eliminate the current fee-for-service payment model that pays providers for each procedure.

In Vermont, like all states except for Maryland, government health programs like Medicaid and Medicare pay vastly different amounts than private insurance does for medical procedures. Shumlin hopes to obtain a waiver from the federal government that will allow the state to set the same rates for all insurance plans within individual health systems.

It’s a monumental undertaking that is at the opening stages.

“We’re at the beginning,” said Lawrence Miller, chief of health care reform. “We’ve had conversations with CMS (the Centers for Medicare and Medicaid Services). We’re really just beginning the formal process.”

Miller said the current health system rewards providers for performing more procedures. But the procedures are not always in line with the best health outcomes for patients.

“They’ve got to have a certain amount of service to get a certain amount of fee. Otherwise they can’t keep the lights on,” Miller said.

“So much of health care, the way we deliver it, is a fixed cost,” he said. “You’ve got a building. You’ve got people in so many hours a week. The fact that you’ve got 35 versus 40 patients in a week doesn’t really change your costs. It has a major impact on your revenue.”

If Vermont obtains the waiver from the CMS, all insurance plans will pay the same amount and providers will be have an incentive to work collectively to have the best health outcome that is not paid for based on the number of tests and procedures performed, Miller said.

“They’ve got a real combined interest to drive to best outcomes for people and avoidance of acute care, because then, overall, it does save money,” he said.

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Capitol Beat with Peter Shumlin, Feb. 13, 2015


Gov. Peter Shumlin stands behind his payroll tax proposal and expresses hope that state workers will negotiate with his administration to find $10 million in labor savings in the weekly podcast with Vermont Press Bureau chief Neal Goswami.

Gov. Peter Shumlin inside his ceremonial office on Friday, Feb. 13.

Gov. Peter Shumlin inside his ceremonial office on Friday, Feb. 13.

Administration analysis aims to boost payroll tax proposal

MONTPELIER — Gov. Peter Shumlin on Monday continued a media offensive aimed at building support for his proposed payroll tax, releasing data that he says shows the tax will actually be beneficial to school districts and municipalities.

Shumlin said Monday that Vermont schools could see a savings of $3 million per year, and municipalities could see a savings of $900,000, if the proposed 0.7 percent payroll tax is passed by lawmakers.

The payroll tax Shumlin pitched in his budget address last month to reduce the so-called cost shift has garnered little support from Legislative leaders or rank-and-file members. But Shumlin has been pushing his plan to media outlets, and by extension, to the public, arguing it will help boost Medicaid reimbursement rates and pay for the expansion of the Medicaid program under the federal Affordable Care Act.

Shumlin’s plan would use the $90 million generated from Vermont businesses and $100 million in matching federal funds to boost Medicaid reimbursement rates to Medicare levels — about 80 percent of the actual cost of care. Boosting Medicaid rates means providers would not have to charge private insurance plans as much to make up costs, according to the administration.

Most Vermont businesses would pay less than $1,000 per year if the payroll tax is enacted, Shumlin said.

The administration’s proposal calls for using $140 million of the combined state-federal money raised through the payroll tax to boost Medicaid reimbursements. Doing so, according to the administration, “is expected” to reduce private insurance premium costs for businesses and individuals by 5 percent. While those premium are likely to still rise, it would be 5 percent lower.

The administration says most businesses will see a greater return from the premium savings than they will pay out as a result of the payroll tax. Schools and municipalities are among the groups expected to see significant savings, Shumlin said.

“Schools and municipalities spend a lot of money to insure their employees,” he said. “Under our plan, they will be asked to pay a small payroll tax but will see that amount and more returned to them in reduced private insurance costs. That will save schools and municipalities money, helping to ease the burden of rising property taxes on Vermonters and allowing municipal governments to use money they would have spent on health care costs to make their cities and towns even better.”

The administration released data Monday from the Vermont Department of Labor, Tax Department and the Agency of Education, as well as from a private consulting firm, to try and bolster its case.

According to the administration’s analysis, schools in Vermont are expected to pay $931.8 million in salaries next year and spend $190.3 million on health care costs. Under the governor’s proposal, schools would pay out about $6.5 million if the payroll tax is exacted. However, they would save $9.5 million if they reach the 5 percent premium reduction predicted — a net savings of $3 million.

Municipalities, meanwhile, have an expected payroll of $309.4 million. They are expected to spend $61.3 million in health care costs next year, according to the administration’s analysis. The 0.7 percent payroll tax would hit municipalities to the tune of $2.2 million, but a 5 percent reduction in premiums would result in a reduction of $3.1 million — a $900,000 savings.

Shumlin spokesman Scott Coriell said applying $140 million in higher Medicaid payments to providers against the $1.6 billion in private insurance premiums paid, would result in about an 8 percent savings in private insurance premiums. That assumes that each additional dollar paid into Medicaid would result in a corresponding dollar in private premiums, however.

The administration went with a more conservative estimate of 5 percent savings because not every dollar applied to cost shift reduction will result in the lowering of premiums by an equal amount, Coriell said.

According to the data provided by the administration, both schools and municipalities see a net savings if the reduction in private premiums is at least 4 percent. However, if the reduction only amounts to 3 percent, schools would see a net loss of $813,000, while municipalities would see a net loss of $327,000.

Speaker of the House Shap Smith was unavailable to comment Monday, according to his aid, Dylan Giambatista. He said Smith would ask the Legislature’s Joint Fiscal Office to review the administration’s data.

“We really haven’t had a chance … to take a look at the numbers,” he said.

Additional analysis is expected to be completed to gauge the impact on the state’s payroll, Coriell said.

See the administration’s analysis below:

Shumlin taps former Rhode Island health official for DVHA

MONTPELIER — Gov. Peter Shumlin on Monday announced the appointment of Steven Costantino, former secretary of Rhode Island’s Executive Office of Health and Human Services, as the next commissioner of the Department of Vermont Health Access.

Costantino will replace outgoing Commissioner Mark Larson, who said in January he would be stepping down in March following a tumultuous several hears at the helm of DVHA.

Steven Constantino

Steven Constantino

“We’re excited to welcome Steven to the team and to Vermont,” Shumlin said in a release. “I have known Steven since our days serving in our respective state legislatures and understand him to be a dynamic, hands-on leader. His experience in both the executive and legislative branches of government will serve him and Vermonters well in this position.”

Agency of Human Services Secretary Hal Cohen, whom Costantino will serve under, touted Costantino’s prior experience.

“Steven Costantino’s experience with Medicaid and healthcare reform will be critical as we move toward providing affordable healthcare coverage for all Vermonters,” Cohen said.

Costantino most recently served as secretary of the Rhode Island’s Executive Office of Health and Human Services, the umbrella agency that administers the state’s Medicaid program as well as the state’s main health and human services agencies. According to the Shumlin administration, Costantino was involved in implementing Rhode Island’s Medicaid expansion and health insurance marketplace.

Prior to that, Costantino served eight consecutive terms in the Rhode Island House of Representatives and, including a stint as Finance Committee Chairman.

“Vermont is known nationally for its leadership, innovation and creative approach to Medicaid. I am so excited and honored to serve as the Commissioner of the Department of Vermont Health Access,” Costantino said in a statement released by Shumlin’s office. “I look forward to drawing upon my successful experience in Rhode Island to help Vermont develop its healthcare reform efforts.”

DVHA oversees the state’s Medicaid program, as well as Vermont Health Connect, the state’s online health insurance marketplace.

Larson has had a rocky tenure as commissioner since taking the post in January 2011, which included overseeing the botched rollout of Vermont Health Connect.

The former state representative from Burlington and chairman of the House Health Care Committee, was eventually stripped of his oversight of the exchange in September of last year by Shumlin. The site was taken offline by the state after the federal government raised concerns over its security and threatened to disconnect the state from a federal data hub.

Larson’s oversight role was taken over by Chief of Health Care Reform Lawrence Miller, Shumlin’s former Commerce secretary, who was first brought on in January 2014 to help the Shumlin administration right the ship after the botched exchange rollout in October 2013.

Larson was also chastised last year by Shumlin and legislative leaders after he offered misleading statements concerning an exchange security breach to the House Health Care Committee.

Shumlin decries VITL media campaign

MONTPELIER — Gov. Peter Shumlin is criticizing a decision by Vermont Information Technology Leaders to purchase advertising time during this year’s Super Bowl, saying the money could be better spent on improving care for Vermonters.

VITL, a nonprofit organization that looks to advance health care reform through information technology, has been designated by the state to operate the Vermont Health Information Exchange. It is not, however, a part of state government, and has its own board of directors and staff. The group is largely funded through grants.

VITL helps health care providers adopt and use IT systems, with the goal of improving the quality of care delivered and boosting patient safety while reducing costs.

According to VITL, allowing providers to exchange health information means they have the ability to see a more comprehensive, accurate and current medical histories of patients. That means better care by avoiding duplicate tests and errors in prescribing medicines.

“Many Vermonters joined me in being disappointed that state and federal funds were being used for an advertising buy during the Super Bowl. This should highlight the need for the Green Mountain Care Board to regulated VITL’s expenditures,” Shumlin said Sunday.

Gov. Peter Shumlin proposed in his budget address last month that VITL and the health information exchange it operates be put under the authority of the Green Mountain Care Board, which regulates health care in Vermont. That would mean the GMCB would have oversight of VITL’s budget.

Gov. Peter Shumlin

Gov. Peter Shumlin

The organization recently announced an awareness campaign to boost its exposure. A public survey the group conducted revealed that Vermonters have a high level of awareness of electronic medical records but a much lower awareness of VITL.

VTDigger reported last week that VITL spent $13,000 of a $30,000 ad buy for a commercial to air on local affiliates during the Super Bowl. According to the VTDigger report, that is part of the $195,000 marketing campaign the group has planned.

Shumlin said VITL should be working with health care providers to boost participation in the Vermont Health Information Exchange, not appealing directly to patients.

“VITL’s doing great work and they’re helping electronic records contain health care costs, but the providers using the service should be educated to encourage their patients to sign consent forms. The notion that you go direct to the patients seems misguided. It just seems like an inappropriate expenditure of $200,000,” he said.

The governor said he believes his feelings have been conveyed to VITL officials, who could not be reached for comment on Sunday. And he hopes lawmakers will also see this as a reason to bring VITL under the GMCB’s authority.

“I’m sure that they’ve heard about my disappointment. I think that the answer is that the Green Mountain Care Board does a great job of regulating costs and asking tough questions about debatable expenditures. Let’s make sure that the Green Mountain Care Board has the same authority over VITL,” Shumlin said.

Video: Vermont This Week on Vermont PBS

Bureau chief Neal Goswami joins Alicia Freese of Seven Days, Taylor Dobbs of Vermont Public Radio and moderator Stewart Ledbetter on this week’s show.

Capitol Beat with the Governor 2-6-15


Gov. Peter Shumlin and bureau chief Neal Goswami discuss Medicaid and vaccinations. And the governor takes a tough stance — choosing puppies over kittens as his favorite animal. He also explains why the Tax Department has temporarily halted refunds. Have a listen…

Vermont pushes to end philosophical exemptions to vaccines

MONTPELIER, Vt. (AP) — A group of Vermont lawmakers and health professionals are trying again to eliminate the philosophical exemption parents can use to avoid having their children vaccinated.

But a parents’ rights group is vowing to refight a battle it largely won three years ago.

Vaccine supporters say Vermont is among the top states in the country for parents taking the exemption, and that the rate has gone up since lawmakers declined to eliminate the exemption three years ago.

They say the current national measles outbreak points to the importance of getting as close as possible to universal vaccination.

Jennifer Stella of the group Vermont Coalition for Vaccine Choice says vaccines are riskier and less effective than advertised. She says parents should decide whether their kids get them.

Podcast: Capitol Beat 2-2-15


Vermont Press Bureau reporter Josh O’Gorman and bureau chief Neal Goswami talk education, health care and exfoliating.

Capitol Beat with the Governor 1-30-15


Gov. Peter Shumlin sits down Vermont Press Bureau chief Neal Goswami to defend his payroll tax plan and discuss the needs of millennials in Vermont. He also predicts a Super Bowl victory for the New England Patriots on Sunday.

Gov. Peter Shumlin records Capitol Beat with the Governor.

Gov. Peter Shumlin records Capitol Beat with the Governor. (Photo by Jeb Wallace-Brodeur)

House advances annual budget adjustment

MONTPELIER — The Vermont House gave preliminary approval by voice vote Thursday to the annual budget adjustment bill, which will lower state spending in the current fiscal year by $12 million.

The reduction in spending is needed following a revenue forecast delivered by state economists last week that projects lower revenues than initially thought. In fact, the current, 2015 fiscal year budget is has seen a downgrade of more than $41 million since January 2014 — a 2.8 percent reduction in funds available to support government operations.

The budget adjustment, unanimously approved by the House Appropriations Committee Monday, uses $10 million in spending reductions to cover the downgrade and sets aside $2 million for use in balancing the 2016 fiscal year budget. It brings available revenue in line with spending, and sets 2015 fiscal year spending less than 1.5 percent more than the previous year, said House Appropriations Committee Chairwoman Mitzi Johnson, D-South Hero.

“This budget brings general fund growth to under what average growth in the economy is,” she said.

Rep. Mitzi Johnson

Rep. Mitzi Johnson

The plan approved by the Appropriations Committee covers increased costs for Vermont Health Connect, the state’s online health insurance marketplace. Overall spending on the exchange is rising by $28.3 million, including $14.6 million in state funds, according to Finance Commissioner James Reardon. It is the first time state funds are being used for operations related to the exchange.

The budget adjustment also includes $2.15 million in additional funds for the Vermont Veterans Home in Bennington. And, it funds 110 new opiate treatment slots in Bennington County, which will free up space in Rutland County.

“Though overall spending is down, we were able to make some investments,” Johnson said.

There are several large reductions, too, including $ 1 million in the Low-Income Home Energy Assistance Program, $437,000 in mental health housing vouchers and $224,000 in cuts to the Judiciary, which is expected to decrease the availability of judges.

Johnson said a plan to cut $500,000 from the Judiciary presented by Gov. Peter Shumlin was scaled back. Instead, the committee sent a letter to the Judiciary asking officials to find ways to cut costs without diminishing services or slowing justice.

Floor action on the bill came to a grinding halt Thursday afternoon when Rep, Mary Morrissey, R-Bennington, sought to introduce an amendment seeking greater transparency in exchange spending. Republicans said the amendment was triggered because of new state spending on the exchange.

House Speaker Shap Smith called for a recess to allow the Appropriations and Health Care Committees to review the amendment and provide time for the parties to caucus.

Rep. Mary Morrissey

Rep. Mary Morrissey

Morrissey’s amendment called for halting the expenditure of funds included in the budget adjustment for VHC unless Lawrence Miller, the governor’s chief of health care reform, provides lawmakers with:

— A full accounting of the state and federal expenditures through 2014 for development and implementation of the exchange
— Projected remaining development and implementation of the exchange through 2015
— Remaining balance of any federal grants awarded to the state for development and implementation of the exchange
— Projected expenditures for fiscal years 2015 and 2016 for the operation of the exchange by funding source and department

House Minority Leader Don Turner, R-Milton, said the amendment will force the administration to become more transparent and will provide information to lawmakers that so far has not been forthcoming.

“I think it’s a very good one if you believe in transparent government,” he said.

The Appropriations Committee substituted its own version of the amendment, essentially stripping Morrissey’s fingerprints from the process. The Democratic version, which was approved by the House on a voice vote, removed the threat of halting spending.

“We’re prepared to take action should we not receive satisfactory information,” Johnson said in an effort to placate discontent among Republicans.

The House later agreed to add the amendment to the budget adjustment on a 135 to 0 roll call vote. Democrats said they have already asked the administration for the data sought in the amendment and have already received most of it.

Morrissey said she is “appreciative” that the Democratic majority choice “to copy” her amendment.

Exchange tax documents in the mail, state says

MONTPELIER — State officials are warning Vermonters who obtained health insurance through Vermont Health Connect to be on the lookout for important tax documents that should arrive in the mail by next week.

More than 25,000 1095-A forms have been mailed to Vermonters. The form has the financial information customers provided when signing up for health insurance coverage on the state’s online marketplace.

But Chief of Health Care Reform Lawrence Miller said some customers may experience problems because not all change of circumstance requests have been processed by the state. Another batch of changes is expected to be processed by Feb. 20, so some customers may received a corrected 1095-A.

“There will be some that get corrections but that doesn’t necessarily slow anybody down in completing their taxes,” Miller told reporters Thursday. “People may find that they’ve got a discrepancy … and need some help.”

State officials brief reporters on required tax documents for Vermont Health Connect customers.

State officials brief reporters on required tax documents for Vermont Health Connect customers.

Customers could also be required to pay back subsidies if their incomes changed during 2014, or could receive payments from the federal government, depending on whether their income went up or down.

Miller said 36 percent of the 37,239 Vermonters on the exchange had no federal subsidy. Ten percent of customers had only a federal subsidy, and 54 percent received a federal subsidy as well as additional premium assistance from the state.

Everyone who receives a 1095-A form in the mail will need to fill out IRS Form 8962. The 1095-A form includes the financial information needed to do so. Even those that didn’t receive tax credits as part of their coverage must complete the form if they purchased a bronze, silver, gold or platinum plan on the exchange, according to officials.

Customers with questions will see a “substantially faster” connection to the VHC call center than the IRS. Miller said the IRS “received inadequate funding to fully staff its’ call center” and wait times of at least 20 minutes are expected.

“That will be a bigger challenge for folks if they need to call the IRS help center,” he said.

Tax preparation software and accountants and tax preparers should be prepared to help complete required tax forms related to health care.

“Those people have been prepared and folks should expect a relatively smooth experience,” Miller said. “My hunch is, while this seems very new and very complicated, for the majority of people as they go through their taxes, it will be smooth.”

State officials said whether or not customers will owe money back for subsidies received or receive subsidies after-the-fact depends on how close their actual income was compared to what they estimated. That information is unclear to the state until forms are completed and filed.

“No way of knowing. This is the first year its’ been done. It’s hard to know what happens to people’s income over the course of a year. You would tend to assume, that if people based their financial information on their income from last year, most people would have seen a slight increase in their income,” Miller said. “It depends on what they estimated.”

Capitol Beat Podcast 1-26-15


Vermont Press Bureau chief Neal Goswami and VPB reporter Josh O’Gorman talk about sugar, beagles, Vermont Health Connect and a dispute between two Penn State graduate students and the state Agency of Education.