Act 48: Vermont`s New Health Care: How did we get here?

How did we get here? What does it do?
What needs to happen next?
Ellen Oxfeld
PNHP Annual Meeting
October 29, 2011
Two decades of activism – just a few
Rallies for over ten years
Meetings, forums (in the hundreds)
Town Meeting Day resolutions passed in
many towns in 2005
Huge effort by single payer supporters
during Democratic primary in 2010 (Peter
Shumlin won by only 200 votes)!
Work to get business groups, public citizen
groups, unions , and health professional
groups to coalesce around the concept.
This is still ongoing!
“Inside/Outside” strategy
A strong statement of intent that includes reference to health care as a
public good that should be publicly financed and should cover all
Vermonters in a seamless manner.
A timetable that requires the state to seek a waiver “as soon as allowed
under federal law” to allow the suspension of the health benefit exchange
and the transition to Green Mountain Care, utilizing federal monies.
A “road map” to universal care that envisions a transition from the federal
health benefit exchange to Green Mountain Care, a publicly funded universal
Cost containment by reducing administrative expense, and by health system
planning and budgeting.
Ongoing evaluation of “payment reform pilots” to guard against adverse
effects on patients.
Green Mountain Care will not include ERISA
Medicare and Medicaid recipients will not be
folded into Green Mountain Care
The legislation does not include global budgets
The package will not be comprehensive
Legislature must still approve two additional pieces
of legislation:
• A financing act (tax)
• Appropriations
First precondition to implementation is waiver of
ACA. If ACA is overturned by Supreme Court,
amendment of Act 48 needed.
Legislature still has to establish rules for Exchange
(which can ironically impact single payer).
There is a large population of involved people in
the state, and we need to keep this going.
Shumlin administration is genuinely committed
to single payer, and some members of the new
Board are absolutely true blue single payer
The process has been and continues to be open.
Exchange has many problems and public could confuse
this with “single payer.”
Act 48 was the “easy” part. We will have to mobilize
people to get behind the financing package (but
emphasize that these new taxes will replace premiums).
Need to keep our eyes on all things at once – benefit
package must stay comprehensive, financing must be
progressive – this means keeping the public involved!
Governor Shumlin needs to be re-elected, and legislature
needs to stay committed (which means public support
must continue to be organized).
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