Vermont Single Payer System Implementation Going Smoothly

Vermont’s implementation of a single payer health care system under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) is progressing smoothly, according to an article by Dr. Laura Grubb in the New England Journal of Medicine. Dr. Grubb attributed the success of the project to: (1) stakeholder involvement; (2) frequent, transparent communication with the public; (3) the centralization of responsibility for cost containment and quality assurance in one board; and (4) the cost savings to the state.

Stakeholder Involvement

After signing the state’s single-payer legislation in 2011, Governor Peter Shumlin engaged health care professionals in the development of Green Mountain Care (GMC) by forming the Professional Technical Advisory Group; its 68 members included physicians, physical and occupational therapists, dentists, pharmacists, and naturopathic doctors. In addition, 24 mental health professionals comprised a Mental Health and Substance Abuse Advisory Group.

The administration established a website which includes information on all aspects of the development of GMC, from benefits to health information technology (HIT), and the effects on small business owners. Public listening sessions on financing and benefits are held frequently throughout the state. The state also has made its financial

Unified Regulation

There is one unified health care budget. The GMC Board has the authority for decision making about premiums, rate-setting, payment reform, hospital budgeting, allocation of resources and workforce, regulation of insurance carriers, the prescription drug formulary, and a statewide quality assurance program. The Board also is overseeing the development of two accountable care organizations.

The Health Insurance Exchange

Vermont has used the PPACA health insurance exchange as the foundation and infrastructure for its single-payer system. The exchange will offer three tiers of coverage from two carriers. The exchange will be supported by tax revenue. Although the costs of claims will rise, the state expects to save $122 million in administrative costs by 2017.

Leveraging Federal Funds

The state has received $250 million to develop its exchange. The IT system built to support the unified enrollment process for Medicaid, the Children’s Health Insurance Program, and the health insurance exchange will be used for premium collection and claims processing as well.

By implementing the Medicaid expansion, Vermont will receive $249 million. A demonstration project waiver is expected to generate another $267 million.