At present, the cost to fund "single payer" has been pegged at anywhere from $1.6 to $2.2 billion. Although a more definitive estimate really can't be arrived at until the benefit plan is designed by the Green Mountain Care Board (GMCB), it's a pretty safe bet the number will be bigger than big and the funding effort an exceptional lift; nothing like state government has ever attempted. Thanks to Sen. Mullin (Rutland), however, the law that set this whole process in motion (Act 48) includes a series of thoughtful conditions that the GMCB must affirmatively address, before the Board can implement any new health care system (single payer or other). These conditions require that any new plan must be fiscally sustainable, contain health care costs and not result in a deleterious impact on the state's economy.
Although the Mullin conditions give some comfort about what we might be getting ourselves into, they also pose a chicken and egg dilemma concerning who does what when. For instance, GMCB can't sign off on the economic impact condition until the Board knows what the funding plan will be. But, the legislature (I gotta believe) can't pass the funding plan without knowing that such a plan will not result in an economic train wreck. So, I think what we are going to see play out, is that the legislature, through its Joint Fiscal Office, will be compelled to bring on some hired guns at a hefty price tag to help answer the questions raised by the Mullin conditions, before a financing plan will be considered next session. (note to self - advise grandkids to become health care consultants).
Although the current timeline contemplates that "single payer" will be up and running in 2017, it may prove more prudent to slow things down to make sure we get this one (a very big one) right. FY 14 Budget Adjustment: On Friday (1/24), the House, by a 110 to 33 vote (Wilson voting with the majority), passed legislation making adjustments to the FY 14 budget plan adopted in the Õ13 session. This year's midyear correction was pretty straightforward and resulted in a net General Fund spending increase of $12.6 million. Most of the new spending ($7.3 million) occurred due to a growing Medicaid caseload.
Other notable changes entailed $2.9 million to address a deficit at the Vermont Veterans Home in Bennington and $3.2 million for additional emergency housing assistance. FY 15 Budget: And speaking of budgets, I have to confess that I did a fairly abysmal job of trying to read the FY 15 budget tea leaves in my last column a couple of weeks back. With a $70 million budget gap, a no new tax pledge and uncertain Federal assistance, I thought for sure that Governor Shumlin would have present a budget plan that included general fund-related program cuts. Boy, was I wrong. The Administration's talented budget team was able to construct a spending blueprint that not only avoided program cuts, but one that increased funding in a number of targeted areas. I heard almost no bellyaching on any of what the Governor proposed; seems almost too good to be true.
Jeff Wilson represents Manchester, Arlington, Sunderland and Sandgate in the state legislature along with Rep. Cynthia Browning. He can be reached at jeffwilsonvtrep.com.
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