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Exchange seen as step to single-payer

MIDDLEBURY — At the Ilsley Library on Sept. 13, Vermont Commissioner for Department of Vermont Health Access Mark Larson described the workings of the Vermont Health Benefit Exchange that will by 2014 will serve as the central purchasing point for all the state’s insurance plans — and touched on how the Exchange will help Vermont transition into a single-payer health care system by 2017.
This past spring, the Legislature passed Act 48, which created not only the Exchange, something mandated by the federal Affordable Care Act, but also the Green Mountain Care Board and the framework for Vermont’s transition to a single-payer system.
According to the health access department website, “Vermont’s Exchange will become the platform for Vermont’s single-payer system” that will “replace private insurance tied to employment with universal coverage that encourages efficiency, lowers overhead costs, and incentivizes health outcomes.”
Specifically, Larson said the technological infrastructure that the $104 million federal grant awarded to Vermont last week will be designed to support the single-payer system, to be administered by the Agency of Human Services, in which the Exchange can still play a role.
“We are trying to make sure everything we build in this phase is usable and valuable in that phase,” Larson said.
According to the website, although state officials “are planning ahead in accordance with Act 48 to implement Vermont’s single-payer health care system,” there are hurdles.
“The single-payer system will not go into effect until a number of milestones are achieved, including obtaining a waiver from the federal government and approval by the Vermont Legislature of a financing plan that meets the requirements of Act 48,” it reads.
The Green Mountain Care Board must “oversee certain financial aspects of the system,” according to the website, while  “Act 48 establishes a Green Mountain Care fund within the state treasury to serve as the (single-payer) program’s single funding source.”
Although the Shumlin Administration has said that it is still working on a plan to pay for single-payer and won’t release a funding plan until next year, the website does provide some broad parameters. It says revenue sources for that Green Mountain Care fund will include:
•  “State appropriations authorized by the general assembly.”
•  “Federal funds received for Medicare and Medicaid.”
•  “Federal funds received through the health insurance Exchange waiver.”
•  “Grants, donations, and other revenue sources.”
Health officials also believe the system will contain costs because it will “simplify and streamline administrative and claims processes to reduce overhead and enhance efficiency.”
They also hope an emphasis on wellness and better primary care, as well as set payments for particular health needs, will encourage cost containment, according to the websites.
The law does not require Vermonters to drop existing private coverage, or prohibit them from purchasing supplemental coverage, according to the online information.

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