Vermont Gov. Peter Shumlin (D) and members of his administration travelled to Washington, DC to meet with U.S. Secretary of Health and Human Services Sylvia Burwell and other federal health care officials in late September, where they asked for control of Medicare funds spent in the state. The request was made as part of the governor’s effort to launch a single-payer health care system in Vermont, in which the state would directly pay for all covered medical services provided to all residents.
The request became a political football when it was revealed by VTDigger.org, a local independent news bureau, and Libertarian candidate for governor Dan Feliciano held a press conference denouncing Shumlin’s attempt to “take control” of Medicare in the state.
State officials tried to deflect the charge with a statement from Robin Lunge, director of Health Care Reform for the Shumlin administration, stating, “Medicare benefits are protected by federal law, and it’s never been our intention to take away or reduce people’s Medicare benefits.”
Not everybody is buying the Shumlin administration’s denials, and the prospect of the state running Medicare has Darcie Johnston, head of Vermonters for Health Care Freedom, concerned. “Control under the Green Mountain Care Board has the potential to lead to rationing when demand exceeds the global budget,” she told Health Care News.
Johnston also said enacting single-payer in Vermont would make health care “a lot more expensive, and Vermont will be unable to attract new businesses.”
Shumlin Proposed Medicare Takeover
Shumlin has in the past suggested the state should take over Medicare. During a question-and-answer period at a meeting of Physicians for a National Health Plan in November 2013, questioners challenged the governor about whether his plan could be considered real single-payer because Medicare and Tricare (the military’s medical plan for current and retired personnel) would remain outside it.
“But I’m going to try to get the waivers to get everybody [in Vermont] in the pool—everybody. I want everybody in the pool,” Shumlin responded. When it was pointed out this would require congressional action, Shumlin said, “If you help me get rid of those Tea Party nuts in 2014, I’ll get it done.”
The law authorizing Vermont to pursue a single-payer health care system, Act 48, also specifies the state would seek control of the state’s Medicare program: “Green Mountain Care shall assume responsibility for the benefits and services previously paid for by … Medicare,” and “The agency shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont.”
“Yes, the proponents of single-payer do desire to take over Medicare,” said Rob Roper, president of the Ethan Allen Institute, in a commentary posted on VTDigger.org shortly after the controversy became public and the Shumlin administration denied their interest taking over Medicare. “They want to take over the Medicare revenue that currently flows into Vermont and put it into Green Mountain Care, and to take over responsibility for administering health care benefits to Vermont seniors.”
Despite this evidence, the Shumlin administration and its allies have repeatedly denounced the claim they want to run Medicare for Vermont’s seniors.
Waiver Backup Plan
The argument over Vermont’s single-payer system running Medicare in the state appears to be moot for the moment, because it would require a change in federal law that is unlikely to occur, at least for several years. But the Shumlin administration is exploring a different sort of waiver that could still have a serious impact on Vermonters’ Medicare.
Known as an ‘all-payer’ waiver, it would allow the state to establish the rates Medicare reimburses doctors, hospitals, and other providers for providing treatment. Currently only the state of Maryland has such a waiver for Medicare, granted in 1977 in order to bring the program into Maryland’s larger rate-setting regime, in which the state sets hospital reimbursement rates for all third-party payers, including private insurers and Medicaid.
Sean Parnell ([email protected]) is managing editor of Health Care News.