April 17, 2014

 Vermont Digger

Press reports about a supposed “Plan B” that would replace Gov. Peter Shumlin’s universal health care proposal has stirred controversy again this week in the Statehouse.

But a memo from a legislative consultant outlining a watered down version of single-payer doesn’t appear to have backing from lawmakers – or at least not publicly.

The Legislature hired consultant Ken Thorpe to help lawmakers sort through the complexities of developing a universal health care system. Thorpe has consulted for Vermont in the past and helped design its Blueprint for Health and the Catamount Health Plan.

Thorpe declined to comment for this report, and would not provide any context for the memo or who might have received it.

The memo was obtained by VPR, which reported it as evidence that “some lawmakers are already considering alternatives” to the governor’s forthcoming single-payer financing proposal.

That’s not a radical notion given many Republicans oppose single-payer in any form and are undoubtedly looking for alternatives. But the VPR report does not mention which lawmakers received the memo, or who is considering the plan it outlines as an alternative.

House Minority Leader Don Turner, R-Milton, has worked throughout the session with Thorpe and the Joint Fiscal Office developing a single-payer alternative, he said, and while some aspects of Thorpe’s memo are “familiar,” it doesn’t pertain to directly to their work.

The Republican plan will be unveiled in the coming weeks, but Turner and others are still working to iron out the details, he said.

Under Thorpe’s proposal, Vermonters would continue to pay for health insurance primarily through premiums, while a smaller tax hike would allow the state to expand subsidies to higher income levels.

Though it has not released precise details, the Shumlin administration has talked about the reverse – using a much larger tax hike to eliminate or greatly reduce premiums.

Thorpe’s alternative would make Green Mountain Care a standard health plan for all Vermonters with private insurance or Medicaid, while allowing the privately insured to buy supplemental coverage through Vermont Health Connect.

Thorpe also carves out certain populations that would get their primary coverage from Medicare or Tricare (for military and federal employees). These groups could purchase supplemental insurance through the exchange.

The administration has talked about making supplemental coverage automatic for those populations.

Lawmakers on the House Health Care Committee said they had no knowledge of the memo.

Rep. Mike Fisher, D-Lincoln, chair of House Health Care, said the idea of expanding subsidies has long been on the table, but his committee had discussed it mostly as an interim step, not an alternative to a more robust single-payer system.

Sen. Claire Ayer, D-Addisison, who chairs the Senate Health and Welfare Committee, said she’s not familiar with the memo. Its contents may have come up when he spoke before her committee, but she said she’d had little or no interaction with Thorpe outside of committee.

Senate Finance chair Sen. Tim Ashe, D/P-Chittenden, who is quoted in the VPR report, said he’s familiar with the memo and Thorpe had outlined its contents in testimony before his committee. They have also discussed it informally and in private, Ashe said.

However, Ashe would not say if he considered Thorpe’s proposal a viable option.

“I think it’s way premature for the Legislature to consider that when we don’t even have the administration’s proposal,” Ashe said.

“I would resist the notion that a hired consultant putting ideas forward in turn becomes part of a possible narrative that this is a reaction to the administration or that it’s a formal proposal,” he added.

When asked about the memo from Thorpe at a Wednesday press conference, Gov. Peter Shumlin said he expects there will be numerous alternatives proposed en route to a single-payer system.

“It shouldn’t surprise us that some folks have taken some old ideas and tuned them up, and put them back on the table,” Shumlin said.

“My own view is, middle class Vermonters do not have any more money to subsidize other people’s health care and then get asked to pay the health care premiums that they’ve always had to pay.”

His administration considered Thorpe’s proposal, which Shumlin described as “Catamount on steroids,” and concluded that it didn’t go far enough, he said.

Shumlin rejected the notion that he’s in conflict with legislative leadership over how to proceed, and said while he anticipates debate, he is confident that lawmakers will ultimately go with the plan his administration presents next year.

Health care reform advocate Deb Richter, a longtime opponent of Thorpe’s ideas on single-payer, said the memo is a rehash of ideas he presented as consultant several years ago.

“This is so completely predictable,” she said. “The problem is that we have new legislators since 2006, and they’re looking for an easier option and he comes through telling them that they have one.”

Richter said she understands the appeal of a smaller tax hike, but expanding subsidies won’t achieve universal affordable coverage.

“There’s not enough money in the economic pie to do that, you still leave tremendous out-of-pocket costs for people,” she said. Vermonters with diabetes, cancer or other serious illnesses could still go bankrupt paying for care, she added.

“It basically staves off some of the problem and lets it fester and come back later,” Richter said.