Editorial: Confident Man; Gov. Shumlin on Single-Payer
Gov. Peter Shumlin says his administration has work to do to restore public confidence in Vermont’s “ability to get health care right” after the sputtering rollout of the state’s online health-insurance exchange. Even so, he’s determined to press on with an ambitious plan to establish by 2017 a single-payer reimbursement system that would abolish most forms of private health insurance in the state.
“The confusion, the disappointment and struggle created by the website woes have caused some to suggest that perhaps I should be deterred from my promise to move Vermont beyond the exchange to the first sensible, universal, affordable, publicly financed health-care system in this country. Let me assure you that I am not so easily deterred,” he told a group of legislators last week.
Critics, however, point to the technical problems with Vermont Health Connect as evidence that the Shumlin administration isn’t ready to execute a bold, first-in-the-nation experiment in health-care finance within the next several years.
Shumlin and his critics both have a point, but both overstate the effect of the website’s failings. The lack of public confidence may have less to do with that than with Shumlin’s failure to explain exactly how the state intends to make the transition from a health-care system largely reliant on private insurance to one dependent on public financing. For all his determination to offer universal health coverage, Shumlin has yet to provide important details.
This is not to say that the state’s oversight of the exchange is irrelevant. For months before the October launch, officials assured press and public alike that the website was ready for business. But it turned out to have some of the same glitches as the federally operated Healthcare.gov site. Many residents were unable to access information, complete applications or, in the case of small businesses, use the site at all. So far, the state has fallen well short of its goal to enroll 100,000 people.
However consequential, the website’s flaws amount to a technical problem that officials expect to fix. The larger problem is strategic. How will the state get from here to a publicly financed system? The administration intends to use the exchange website as a steppingstone to the kind of single-payer scheme envisioned in Act 48, which the Legislature passed in 2011. But it’s not clear how it will do so, though obviously major modifications would be required to a site now designed to help consumers buy affordable private insurance.
Furthermore, there are high political, legal and financial hurdles to jump before the state can switch to a single-payer system. For example, Vermont would need several federal waivers in order to: receive in one lump sum the federal funds now paid as subsidies to individuals and small businesses who use the exchange; include Medicare and Medicaid patients into its single-payer system; and get around the law allowing companies to self-insure their employees. Such waivers aren’t assured, particularly if Republicans occupy the White House after 2016.
And since federal funds alone won’t begin to cover the estimated $6 billion Vermonters currently spend on health care, state funds must be identified to help pay for the benefits residents would receive. In his remarks last week, Shumlin told lawmakers that money now spent on insurance premiums would go toward funding a publicly financed system — revenue presumably collected through a payroll tax split between employers and employees, as a legislative report recommended. But he added, “I don’t know all of the answers. And everything is on the table. Everything is fair game.”
If Shumlin’s sense of urgency about moving to public financing for universal health coverage isn’t matched by his sense of urgency in supplying answers to the most basic questions, then credibility can’t be restored.