But the entire proposal hinges on whether Congress will approve a bipartisan proposal to allow states to opt-out of the federal health reform law starting in 2014 if they meet a slew of benchmarks.
“I think Vermont's strategy is to put together a detailed business plan and think big and see how far we can go with the belief that the federal government is becoming more amenable to state innovations,” said Bea Grause, president and CEO of the Vermont Association of Hospitals and Health Systems, which has not taken a formal position on the legislation.
The bill would establish a new independent five-member panel, called the Green Mountain Care Board, to draft a proposal to move the state to a universal healthcare system.
Vermont's single-payer system would be called Green Mountain Care and would be available to all Vermont residents. The bill does not include a financing scheme, but instead directs the new board to develop one by January 2013.
Essentially, Green Mountain Care would take all federal, state and private healthcare dollars into one bucket and pay it out for coverage and care for Vermonters. As a first step, the bill mandates that a state-run health insurance exchange begin enrolling individuals and employees of small firms by Nov. 1, 2013.
The Patient Protection and Affordable Care Act requires that states have health insurance exchanges operational by January 2014, or HHS will operate them.
The Vermont Medical Society likes that the bill sets up the insurance exchange consistent with federal law, and also seeks to lower the administrative burdens on providers.
But the society is concerned about the power and scope of the proposed Green Mountain Care Board, said Paul Harrington, executive vice president of the Vermont Medical Society.
“It seems top-heavy to us,” Harrington said.
The board would have a budget of about $1.1 million in 2012, mostly for salaries, according to the Legislature's Health Reform Task Force. Harrington said that budget is too high.
Members would be appointed by the governor and serve six-year terms. According to the House bill, the board would, along with figuring out a single-payer system, review and approve insurance rates, hospital budgets and certificate of need proposals. It would also come up with alternative provider payment models such as global payments and establish strategies for health information technology and the healthcare workforce, among other duties. Four out of the five board members would be part-time only.
Grause said the board may have too large of an agenda. “It's very, very broad in scope in terms of what they are supposed to do,” she said.
Near-term federal approval for Vermont's single-payer system hinges on a bill in Congress sponsored by Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.). Their Waiver for State Innovation bill would allow states to opt-out of the individual mandate and other major provisions of the Affordable Care Act starting in 2014 instead of 2017, as allowed under the federal reform law. President Barack Obama has come out in support of the Wyden-Brown bill, but its approval in Congress is by no means assured.
Back in Vermont, lawmakers would have to approve a financing plan for Green Mountain Care beyond the myriad federal approvals required.
“It arguably would be the largest tax package in state history,” Harrington said.
Whatever the outcome, local providers say this latest plan reflects the state's independent streak and its enthusiasm in moving the needle on healthcare innovation.