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Conflicting statements by politicians and bureaucrats has led to some confusion surrounding language in Act 48 that requires the state government to seek waivers from the federal government that would allow Green Mountain Care (single payer) to control the dollars and administer the benefits for Medicare recipients. What exactly is the intent of the the law and legislators who passed the law.
What the Law Says
Act 48 says as passed in 2011:
(6) The director, in collaboration with the agency of human services, shall obtain waivers, exemptions, agreements, legislation, or a combination thereof to ensure that, to the extent possible under federal law, all federal payments provided within the state for health services are paid directly to Green Mountain Care. Green Mountain Care shall assume responsibility for the benefits and services previously paid for by the federal programs, including Medicaid, Medicare, and, after implementation, the Vermont health benefit exchange. In obtaining the waivers, exemptions, agreements, legislation, or combination thereof, the secretary shall negotiate with the federal government a federal contribution for health care services in Vermont that reflects medical inflation, the state gross domestic product, the size and age of the population, the number of residents living below the poverty level, the number of Medicare-eligible individuals, and other factors that may be advantageous to Vermont and that do not decrease in relation to the federal contribution to other states as a result of the waivers, exemptions, agreements, or savings from implementation of Green Mountain Care. (Act 48, Page 12)
(e) The agency shall seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont. If the agency is unsuccessful in obtaining such permission, Green Mountain Care shall be the secondary payer with respect to any health service that may be covered in whole or in part by Title XVIII of the Social Security Act (Medicare). (Act 48, page 85)
Who Voted For This Language?
Click HERE to see the final House roll call vote for H.202 (Act 48), passed 94-49, May 5, 2011.
Click HERE to see the final Senate roll call vote for H.202 (Act 48), passed 21-9, May 3, 2011
The Act 48 language in statute was amended in 2014 via Act 144, deleting section (e) and adding:
(f) Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military, or to federal employees.
(As of this writing (10/26/14) the online statue has not been updated to reflect this, leading to a great deal of confusion.)
The Shumlin Administration and legislators who voted for Act 48 are now claiming that these changes absolve them from any original desire to “take over” Medicare.
However, Act 144 also states:
(b) The Green Mountain Care Board may take such steps as are necessary to include all payers in the global hospital budget pilot projects, including negotiating with the federal Center for Medicare & Medicaid Innovation to involve Medicare and Medicaid.
Although this language is certainly less onerous, it is more of a recognition that demanding the whole cake will not fly, so it’s better to politely ask for just one slice… to start.