Key local lawmakers give high marks to Hsiao report

MONTPELIER — Two Addison County lawmakers who will play prominent roles in the state’s health care reform debate this biennium are praising a recently released study advocating for a single-payer insurance system for Vermont.
The study was undertaken last year by Dr. William Hsiao, the Harvard School of Public Health professor who was retained by the Vermont Health Care Reform Commission to outline three insurance coverage options for the state.Hsiao is widely regarded as an expert in the field, having designed and implemented a single-payer system in Taiwan and assisted in health care reform efforts in eight other countries.
Hsiao on Jan. 19 issued his preliminary report to the Legislature, in which he recommended the state pursue a public-private, single-payer health insurance program that has a public governance structure and preserves a limited role for one private insurer.
Such a program, according to Hsiao, could reduce health care costs by $500 million in the first year while providing universal coverage — including some vision and dental coverage — for Vermonters. He stated such a plan — which would feature a payroll tax — could actually reduce overall employer payments for health care, decouple health insurance from employment and create as many as 4,000-5,000 new jobs in Vermont.
Hsiao and his team told lawmakers he believes a single-payer system could save the state $2.1 billion by 2024. The savings, he said, are primarily derived from channeling medical health care payments through a single pipeline, “with uniform payment rates and common claim processes and adjudication procedures.”
“This is a system that could work to significantly reduce costs, cover everyone and control health cost escalation with minimum disruption,” Hsiao said.
Gov. Peter Shumlin last week urged lawmakers to use Hsiao’s report as the foundation for major health care reform that he would like to see drafted this session. At the forefront of that effort will be Sen. Claire Ayer, D-Weybridge, and Rep. Mike Fisher, D-Lincoln. Ayer and Fisher are chairwoman and vice chairman, respectively, of the Senate and House Health Care Committees.
Both lawmakers said they were impressed with the thoroughness of Hsiao’s report and will spend the coming days, with their colleagues, deciding which elements of the Hsiao report will be reviewed by Senate Health Care and which will be fielded by the House panel. Those committees will be very busy, as they must also ready Vermont for implementation of the federal health care reform during the coming years — barring Congressional repeal.
“We’ll be talking about (the Hsaio recommendations) all year long,” Ayer said.
Ayer and Fisher have been receptive to the notion of a single-payer system, though they believe many details would need to be worked out. They said the Hsiao report has left them optimistic about the viability of a single-payer plan.
“The idea here is that most people would end up paying less,” Ayer said. “People would spend less and have better health care — that’s the plan.”
Fisher said he was impressed by the tone of Hsiao’s report.
“It was pretty impressive to have an international expert… sit before us and not talk gloom-and-doom, but say ‘you can do this,’” Fisher said.
That said, Hsiao also warned that Vermont could not afford to do nothing — a consequence that could result in the financial collapse of the current system within around five years, Ayer said.
“He made it abundantly clear that we have to take action to bend the curve on inflation,” Fisher said.
“It was pretty compelling,” Ayer said of Hsiao’s argument for reform. “This wasn’t a pie-in-the-ski moral treatise. He was very practical and his conclusions were backed up by data.”
A draft of the Hsiao report and other related documents can be found at
Vermonters have until Feb. 3 to weigh in with their comments about the Hsiao report. They can do so at [email protected].
Once the comments are gathered and processed, Hsiao will issue a final report.
“It is an exciting time, but it is just the beginning,” Fisher said.
Reporter John Flowers is at [email protected].

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