This article originally appeared on Kaiser Health News, February 27, 2017.
By Steven Findlay
Tiny — and very blue — Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress.
The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for. The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse.
The six-year initiative — an outgrowth of a failed attempt by Vermont a few years ago to adopt a single-payer plan for all residents — could eventually encompass almost all of its 16 hospitals, 1,933 doctors and 70 percent of its population, including workers insured through their jobs and people covered under Medicare and Medicaid.
The Obama administration approved the experiment, but it fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing — possibly even in the short-term before Republicans come to an agreement about the future of the ACA.
Two Republican senators, Bill Cassidy of Louisiana and Susan Collins of Maine, introduced legislation in January that would permit individual states to design their own health reforms and keep provisions of the health law intact.
Coincidentally, the ACA contains a provision that allows states to launch such experiments starting this year, as long as they meet the ACA’s overall goals for coverage expansions and consumer protections. One possible scenario, then, is that the Trump administration and Congress would agree to retain a version of that provision — modified to make it easier for states to experiment, experts say.
“It’s a very reasonable approach, especially if it looks as if Congress can’t agree on an immediate replacement plan,” said Stuart Butler, a senior fellow in economics and health policy at the Brookings Institution in Washington, D.C. “States have long been the laboratories for social change and policy reform, and I think many governors, Republican and Democrat, would welcome this opportunity.”
Chris Jennings, a longtime health policy adviser to Bill and Hillary Clinton and Barack Obama, said Democratic states also may be amenable. “There’s a long way to go on this and there are downsides — for example, what would state legislatures actually do — but it looks like it will be a meaningful debate.”
‘We Want To Simplify How Things Work’
Al Gobeille, Vermont’s secretary of Human Services and a Republican serving under newly elected Republican Gov. Phil Scott, said the hope is that the Trump administration will preserve the state’s initiative.
“We are doing what [the Republicans] seem to be talking about,” said Gobeille, who owns a restaurant company in the state. “We want to simplify how things work, with both coverage and access to care. We want to enhance competition and we want to lower cost growth even as we improve quality.”
Scott and Gobeille this month announced the formal launch of the program’s pilot phase. In 2017, 30,000 of the state’s roughly 190,000 Medicaid patients will get care, under a set budget, through an organization called OneCare Vermont. OneCare’s network of hospitals and doctors already provide care to about 100,000 Vermonters.