Vermont to explore single-payer option

Governor allows into law a bill calling for creation of a commission to look at overhauling the state's health system.

By Chris Silva — Posted June 11, 2010

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A new Vermont health care bill could lead to significant changes in the state's delivery and payment structures, including a possible move toward a single-payer system. Governor Jim Douglas announced May 27 that he would allow the bill to become law without his signature.

Douglas, whose term ends in January 2011, said he chose not to put his signature on the bill because of his apprehension about two particular features -- the exploration of a single-payer model and the requirement that pharmaceutical companies publicly release information on expenses related to free drug samples.

The law will create a health reform commission, which has until Feb. 1, 2011, to propose to the governor and general assembly three design options for creating a single system of health care in the state. It specifies that one of those options will include the design of a government-administered and publicly financed single-payer benefits system.

Douglas called the provision "a wasteful expense of time and scarce resources," especially as Vermont would be prohibited by the federal health reform law from implementing any new system designs until 2017 at the earliest. The governor's office said states could seek a waiver to that rule, but their chances of approval might be limited.

The law also bolsters the state's medical home model by requiring insurance carriers to participate in the statewide expansion of the program, the Vermont Blueprint for Health. Also, hospitals will be required to establish and maintain interoperable connectivity to the state health information exchange network to support the Blueprint's clinical data repository. The move is designed to make laboratory, hospital discharge and other data more readily available to physicians.

The Vermont Medical Society, which was involved in the drafting of the bill, said it is in favor of it, though it has not taken a stance on the single-payer provision.

"Ninety percent of the bill continues reform efforts that the medical society has been involved with, particularly around the patient-centered medical home, the statewide adoption and use of health information technology, and the piloting of different payment reform models," said Paul Harrington, VMS' executive vice president.

Some of the state's physicians said they are excited about Vermont exploring the single-payer model.

"With a qualified consultant and the right governor, this just may get us to a better health care system than what the national health care bill will provide," said family physician Deb Richter, MD, spokeswoman for the citizens group Vermont for Single Payer.

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