When Governor Shumlin signed Act 48 (“An act relating to a universal and unified health system”) into law in June, 2011, Vermont started on the path to a single payer system. One critical aspect of a revised system is developing a financing plan that assures a single payer system will cost less than the current system. 33 V.S.A. §1822 (a) (5) Although the question of how Vermont’s single payer plan will be paid for will remain open until 2013, the groundwork for developing a financing proposal is underway. The Agency of Administration is conducting a statewide listening tour that focuses on financing issues. The tour is designed to engage health care providers, employers of all sizes, and members of the public in the development and design of the financing structure that the Secretary of Administration is to present to the Vermont Legislature in the 2013 session. See Act 48, Sec. 9 (c)
The first three sessions of the tour have already been held in Brattleboro, Rutland and Williston. The final session is scheduled for January 12, 2012 in St. Johnsbury. Each session is structured the same way. Attendees are presented with information about the escalating costs of the current system; how these costs are expected to increase in the near future; the consequences of the increased costs to employers, individuals and families, and the medical system; the available sources for funding health care reform (providers, employers, individuals, and government); and a snapshot of the mechanics of state and federal revenue streams. The attendees provide input by expressing their preferences, through small group exercises, on the principles that should underlay financing a health care system, and the potential funding sources.
Act 48, which identifies a number of guiding principles for Vermont’s health care reform in section 1a, specifies that “the financing of health care in Vermont must be sufficient, fair, predictable, transparent, sustainable and shared equitably.” Sec. 1a (11) The first small group exercise is designed to capture the participants’ ranking as to which of these principles they find most important, which they find less important, and why. Similarly, in the small group exercise devoted to potential funding sources, participants are asked to state which funding source or mix of sources identified in the educational presentations best reflects the principles they selected earlier, and which funding source(s) cause them the most concern as an individual/provider/employer.
Finally, after the small group discussions, each participant is given $1000 in $100 denominations and asked to allocate the money among boxes representing the various state and provider funding sources identified in the presentation. The Agency of Administration will aggregate the information it receives at each of the listening sessions and use it as a basis for developing its financing proposal next year. Act 48 is quite explicit that “the state must ensure public participation in the design, implementation, evaluation and accountability mechanisms of the health care system.” Sec. 1a (3) This listening tour and the information it elicits from the public is an important step in meeting the public input mandate in designing the financing system.
For more information about the status of Vermont’s health care reform efforts, including the language of Act 48 and information about the listening tour and presentations, please go to http://hcr.vermont.gov/.
