1. Pushing the Envelope Vermont’s quest to implement publicly financed universal health care

2. The First Try In 1994 Governor Howard Dean spearheaded efforts to move Vermont to a publicly financed universal health care system. After efforts failed, Vermont implemented more modest reforms including Medicaid the expansion projects Catamount Health and Vermont Health Assistance Program.

3. 2010-2011 Peter Shumlin is Elected Governor on the promise to bring universal publicly financed Universal Health Care to Vermont. Dr. William Hsaio delivers his analysis of how Vermont can transition to universal health care. The Vermont Legislature passes Act 48 setting the state on the course to implement “Green Mountain Care” in 2017.

4. The Green Mountain Care Board Act 48 created the Green Mountain Care Board to regulate health care in the state and oversee reform efforts. Responsibilities under Green Mountain Care Determining a uniform benefits package for Green Mountain Care Determination that the administration’s financing and implementation plan meets the triggers in Act 48 Areas of regulation Hospital budgets Rate review Certificates of need Vermont’s ACA marketplace “Vermont Health Connect”

5. The Shumlin Administration Tasked with developing a financing plan to support Green Mountain Care. 2013 Umass Wakley report found that Vermont would need to raise $1.6 billion in new public funds to support “Green Mountain Care”. 2014 The administration works with the joint fiscal office and provider stakeholders to reach a consensus estimate of $1.7-2.2 billion needed in new public funds. Responsible for applying the necessary ACA waivers that would allow implementation of Green Mountain Care in 2017.

6. The Big Announcement On December 17 th 2014 the Governor announces that “Now is not the right time to move forward with Universal Health care.” The Governor then laid out what his recommendations would have been if the state were to move forward. 94% AV plan for all Vermonters except those on Medicare and Tricare. Coverage for all “commuters” who live out of state, but do not work for Vermont businesses. What would it cost? $2.58 billion in funding for the first year of Green Mountain Care A 11.5% payroll tax for all VT businesses (no exceptions) and a 9.5% personal premium on income for everyone paying VT income tax.

7. Why Pull the Plug? The Administration cited a number of components that influenced their decision not to move forward with Green Mountain Care Federal and State funding estimates for Green Mountain Care are less than expected Critical policy choices not included in previous reports cost more money Vermont’s economy is growing more slowly than expected. Easing the transition for thousands of small Vermont business to Green Mountain Care is necessary but extremely expensive. For the full administration presentation on their recommendations for Green Mountain Care visit http://bit.ly/GMCpresent

8. What’s Next? In the Governor’s budget address he laid out five key policy initiatives to reform Vermont’s health care system. Cost containment: move way for fee for service and seek a all payer waiver that could be paired with global budgets. Strengthen the regulatory oversight of the Green Mountain Care Board. Greater investments in the state’s medical home pilot program the “Blueprint for Health”. Increase Medicaid reimbursement rates: Use a 0.7% statewide payroll tax to cut the current cost shift in half (approx. $80million). $2 million to increase state subsidies for Vermonters on the state’s exchange.

9. Questions ? Falko Schilling, Esq. Consumer Protection Advocate Vermont Public Interest Research Group 802-223-5221 x.26 Falko@vpirg.org