State keeps eye on health reform

MIDDLEBURY — Vermont officials said they’re pleased federal officials are cobbling together a national health care reform plan, but want to make sure new federal legislation does not undo reforms the Green Mountain state has enacted on its own during the past three years.
“Vermont should not be penalized for being ahead of the nation,” Vermont Senate President Pro Tem Peter Shumlin and Vermont House Speaker Shap Smith said in a July 23 letter to U.S. Sen. Patrick Leahy, D-Vt. “If federal health care reform does not allow for flexibility for states in the forefront (of health care reform), Vermonters could be in jeopardy of having fewer or less comprehensive options than they have now.”
That sentiment was echoed by Rep. Steve Maier, D-Middlebury, who is chairman of the House Health Care Committee.
“My main message for the past eight months has been, ‘We have done some really great work, broader than perhaps any other state, and we’ve done about as much as we can do without help from the federal government,’” Maier said in an interview with the Independent last Thursday. “We need to really pay attention to what is going on in Washington and make sure that as it comes out, we can make more progress in this state and not be penalized in any way.”
Maier said approximately 94 percent of Vermonters now have basic health care coverage, either through private insurance or a litany of state and federal programs like Medicare, Medicaid, Catamount Health and Dr. Dynasaur. Vermont has been able to extend coverage to the working poor through a variety of mechanisms, including asking employers and workers to pay some of the premiums for the state health care plan, Catamount Health. But the state has also been able to expand its offerings through federal Medicaid program waivers, through which Vermont has been able to tap into federal dollars to extend benefits to people who might not qualify for the Medicaid program, but who don’t make enough to pay for private insurance.
State officials are concerned about new federal program trumping Vermont’s nascent system and suddenly changing the flexible manner by which it can access Medicaid dollars.
“Vermont’s fundamental restructuring of the delivery system focuses on health maintenance, prevention, control of chronic disease and integration of public health with care delivery,” Shumlin and Smith’s letter states. “These efforts cannot be sustained or expanded without the participation of the federal government.”
Congressional leaders are currently working on an “America’s Affordable Health Choices Act” that in a draft presented to the House of Representatives proposes, among other things:
• The option of a federal health insurance plan.
• That insurers no longer have the right to deny coverage to clients with pre-existing health conditions.
• New funds to support community health centers, and maintains the current requirement that these rural areas receive special consideration for distribution of funds.
• Training for primary care providers for rural areas.
• Incentive payments to physicians practicing in areas that are identified as being the most cost-efficient areas of the country, many of which are in rural America.
• $15 billion over five years on grants to deliver community preventive services to fight things like diabetes, obesity, tobacco use, and substance abuse.
While the plan continues to change by the day, supporters hope to fund a portion of it through a surtax on the nation’s highest wage earners.
Rep. Peter Welch, D-Vt., said he anticipates a vote on the bill this year.
“In my opinion, it is more important to get it done right than get it quick,” Welch said during a phone interview on Friday.
He also pledged to work with state lawmakers to ensure that provisions of the bill don’t dismantle Vermont’s current health care programs.
“We want to make sure Vermonters do better under the federal health care legislation,” Welch said. “Vermont has been a leader … and we want to make sure it continues to get rewarded.”
Welch added he believes a “strong” national public health care option will provide more competition — and therefore more affordable premium rates — throughout the industry.
Maier supports a public health care option, but stressed “if that’s all we end up with, I’m really afraid we will have missed this critical opportunity to do a broader and more complete set of health care initiatives.”
Without other initiatives that focus on such things as cost-containment, preventative care, managing chronic diseases and streamlining the medical records system, Maier is concerned that a national health care plan will not be sustainable in the long term.
“In our current system, providers get paid for ‘sick care,’” Maier said. “They get paid for treating you when you’re sick. There is no financial incentive built into the system at all for keeping you healthy.”
Maier and other state officials have made occasional trips to Washington, D.C., in recent months to share Vermont’s health care reform experiences. They hope such interaction helps preserve the best features of Vermont’s program while providing some fodder for a national plan.
“It’s about time,” Maier said of the prospect of seeing national health care reforms. “I’m hopeful that this time around, it will happen.”

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