May 28,2013
In reading the article about Oversight of
the Health Care System in Sunday’s Herald, I find it inconceivable that
the same Legislature that voted for the system, now feels they need
additional millions of dollars for another layer of oversight. To quote
representative Paul Poirier, “And frankly, I don’t trust the government
any more than I trust the insurance companies we have today.”
Was the Legislature that mistrusting of what they did under Act 48? If so, why were they so quick to set up a system that they have little or no control over, nor have they shown any significant interest in establishing costs and more importantly how to fund it?
I do believe that there should be some government oversight to the autonomous Green Mountain Care Board; however, based on the article, it looks like they are looking to set up a well-funded bureaucratic organization to provide “oversight” of another bureaucratic organization, the “GMCB,” sanctioned by the Legislature, again with no definitive idea of costs or funding.
MARTY POST
Killington
Was the Legislature that mistrusting of what they did under Act 48? If so, why were they so quick to set up a system that they have little or no control over, nor have they shown any significant interest in establishing costs and more importantly how to fund it?
I do believe that there should be some government oversight to the autonomous Green Mountain Care Board; however, based on the article, it looks like they are looking to set up a well-funded bureaucratic organization to provide “oversight” of another bureaucratic organization, the “GMCB,” sanctioned by the Legislature, again with no definitive idea of costs or funding.
MARTY POST
Killington
Article Below
Oversight of health care system considered
MONTPELIER — As lawmakers embark on a
health care reform initiative that will endow state bureaucrats with
unprecedented influence over the medical industry, they’re also beefing
up independent oversight of the government agents now regulating
everything from insurance rates to hospital budgets.
But while the Legislature this year
OK’d modest funding increases for the Vermont Office of the Consumer
Advocate, watchdogs say that as Vermont progresses toward single-payer
health care, lawmakers will need to more closely guard the public
interest.
“If we stay on this path we’re on
now, then the state will become everyone’s new health insurance
company,” says Rep. Paul Poirier, a Barre City independent. “And
frankly, I don’t trust government any more than I trust the insurance
companies we have today.”
Poirier this year led the charge to
install new checks on the Green Mountain Care Board, a five-person panel
endowed by lawmakers in 2011 with the power to approve or deny
insurance rates and hospital budgets, and set costs for various medical
procedures.
The board will also be responsible
for deciding what services Vermont’s single-payer health plan covers,
and what kinds of out-of-pocket expenses residents will have to absorb.
Vermont has had an Office of Health
Care Ombudsman since 1998 to help wronged consumers navigate for
solutions in a Byzantine health care industry. A name change this year
to the Office of the Consumer Advocate reflects the expanded duties
lawmakers have added to the organization’s role.
Rep. Michael Fisher, a Lincoln
Democrat and chairman of the House Committee on Health Care, says the
office will oversee “pretty much everything going on” at the Green
Mountain Care Board.
“As we’re contemplating next steps, I
think there is even more of a need
to have a well-financed public advocate who is speaking out for
Vermonters around these major decisions that have an impact on their
pocket books,” Fisher says.
As the Green Mountain Care Board
evolves into its new role, Fisher says, it will become increasingly
difficult for individual residents to influence the process.
“As we contemplate moving toward a
system that is much more publicly financed, I think that individual
Vermonters would have a hard time sitting at the table and speaking out
for themselves and their individual interests,” Fisher said.
Trinka Kerr, director of the Vermont
Office of the Consumer Advocate, says that if her organization is going
to be able to fulfill its statutory role, then it will need a larger
budget than it’s had in the past. A patchwork of state and federal
funding accounts for the approximately $900,000 budget this year at the
10-person operation.
The state uses an RFP process to
select a nonprofit organization to perform the duties of the Office of
the Consumer Advocate. Vermont Legal Aid has always submitted the
successful bid.
“In terms of speaking for the public for hospital budgets and all the cost-control efforts that the (GMCB) wants
to do, along with pilot projects and certificates of need and all sorts
of other things, we just didn’t have the resources to really jump in on
those,” Kerr says.
Lawmakers considered a number of
funding mechanisms before deciding on a “bill-back” provision that will
put insurance companies, hospitals and other entities regulated by the GMCB on the hook for oversight-related costs incurred by the Consumer Advocate.
“And this funding this year
hopefully is going to help us beef up our staff to be able to carry out
those responsibilities,” Kerr says.
Poirier says the funding mechanism is a faulty one. Ultimate bill-back authority lies
in the hands of the GMCB — the same entity over which the Consumer Advocate is supposed to be watching.
“You can’t be giving the financial control to a board that might not like what the Consumer Advocate is doing,” Poirier says.
Poirier says the money needs to come from residents in the form of either a tax or fee.
“This is about protecting the
consumer interests, and the only way that’s going to happen is if
consumers are the ones paying for the office,” Poirier says.
Poirier also says the office needs
far more than $1.5 million. He says that as single-payer ramps up, he
envisions something akin to the Department of Public Service, except for
health care.
“We’re talking about a $5 billion
industry here,” Poirier says. “We need a serious, well-staffed,
well-funded department that makes sure consumers interests’ are always
the first consideration.”
A provision in legislation passed
this year creates a study to evaluate longer-term funding sources for
what Fisher says will be a growing arm of public advocacy.
Kerr says the devotion of new
resources is the only way to ensure that her organization will be able
to keep pace with the rapid rollout of health care reform in Vermont.
“In the past our expertise has been
with individual consumers, and state policy that is related to state
programs,” Kerr says. “And as we’re developing the expertise to deal
with this more system-wide oversight, we need to hire people with the
experience and skills to really be able to have an impact on what the
Green Mountain Care Board does.”
Kerr says that as the Legislature
ponders various models for what that oversight looks like, they should
preserve a model that keeps the Consumer Advocate a nonprofit
organization operating outside of state government.
“When we talk to consumers, a lot of
times they appreciate we’re not part of state government — it gives
them some confidence,” Kerr says. “There’s a lot of people that don’t
trust the government.”