Tag Archives: vermont

Another state moves forward on expanded role for dental hygienists

Photo: John Twohig via Flickr

In a three-sentence brief, WCAX-Burlington, Vt., got out the big news:

“Gov. Peter Shumlin, D-Vermont, signed a law meant to expand dental care in Vermont. It creates the position of dental therapist, who is not a full dentist is able to do more than a hygienist.

“Advocates say the law will help address a shortage of basic dental care, especially in rural areas and for lower income people.”

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Vermont co-op plan suffers surprising setback


Image by redjar via flickr.

We’ve written several times about the role of co-ops in the states (here and here) and posted a lot of resources  for those of you in states with this option. But here’s a story from The Associated Press that surprised me – Vermont just rejected the Vermont Health Co-op, saying it was going to cost too much and was probably too optimistic about enrollment. (Regulators also raised questions about its solvency, which was less surprising if you’ve been following co-ops.)

The co-op is hoping to get that decision reversed so it may not be over.  But this is noteworthy because it’s occurring in a small state that doesn’t have a lot of insurance participation in the exchange – something that backers of co-ops had hoped these nonprofit entities would address.

Vermont is a liberal state that backs health reform, and has created a framework for moving to a state version of a single-payer system a few years from now.  And so far it has only two health plans set to offer coverage in its exchange next year.  It’s the kind of state that – at least from the outside – one would have expected to work hard to find a space for the co-option. I welcome insight from anyone who knows Vermont well and has a different  take.

Paper seeks redacted details from Vt. medical board

Burlington Free Press reporter Adam Silverman writes that his newspaper is seeking the release of certain details redacted from a medical board inquiry into what he calls “allegations that a Vermont doctor engaged in conduct that might have exposed the public to harm” related to a lawsuit filed by a former board director alleging that he was forced to resign his post in 2010 after authorizing two inquiries despite objections from state health officials.

The missing information includes the exact nature of two doctors’ “official” positions with the State of Vermont, as well as the dates of the cases in question. Silverman found that the attorney who filed the suit blacked out the information from the public version because he “didn’t want to risk improperly disclosing details of Medical Practice Board cases before the state became involved in defending the lawsuit.”

In court Monday, Assistant Attorney General David Groff told Toor that judges often have to balance the public’s right to know against competing private interests — in this case, that of doctors whose good names could be besmirched by “spurious” accusations. For the Wargo lawsuit, though, Groff added, state lawmakers already have charted the course: Information about Medical Practice Board inquiries becomes public only if an investigation results in formal accusations. Here, the investigation is ongoing, he said.

No one argued for releasing the records at Monday’s hearing, but the Free Press has written in letters to the court that the material should be unsealed because “there is an inherent public interest” in learning about a possible threat of harm to the public.

News coverage should reflect that Vermont
has long road ahead to single-payer system

You may have seen a lot of breathless coverage about how Vermont is poised to become the first state to have a single-payer health care system. Don’t get too out of breath.

Vermont did pass legislation, signed by Gov. Peter Shumlin today, laying out a pathway toward – perhaps – getting to a single-payer system in 2017. And by all accounts, Shumlin, who ran on a single-payer platform, truly wants to get there, as do many of his supporters in and out of Vermont government. So this post isn’t meant to be cynical about their intentions or sincerity. It’s just that Vermont’s path toward its single-payer system, Green Mountain Care, is way longer and far more unpredictable path than a lot of the overexcited news coverage suggests.

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The Burlington (Vt.) Free Press published a 15-step timeline – and even that wasn’t complete despite a lot of contingencies and unknowns and maybes. Among other things, Vermont’s state legislature  hasn’t determined how to pay for the single-payer plan (probably it will propose some kind of tax that people and or businesses would pay, but they would no longer have to pay insurance premiums). They aren’t even going to recommend the payment system until January 2013, and then they still have to get it through the legislature in the winter of 2016.

Who knows who will be governor of Vermont, or U.S. president or secretary of HHS by then. Or how businesses in Vermont – IBM is the one that gets mentioned most in the coverag­e  – will respond to a new tax proposal, particularly if they don’t want their employees in the state system (or their employees don’t want to be in the state system) and they have to keep paying the costs of their workers health plan plus a new state tax or surcharge for everybody else’s.

That’s not to mention the doctors. Sure some are for a single-payer system; it’s a progressive state and maybe a lot of the physicians are pro-single-payer. But you can be sure not all of the doctors, hospitals and clinics want to be part of a state-run plan where rates are set and they may have less bargaining power or ways to cost-shift. It’s probably a safe bet that the insurance industry will object to a state plan that largely or completely displaces them,  even though Vermont is not exactly the nation’s most gigantic market.

At this stage,  Vermont is still at work on setting up its health exchange (and a few states are actually farther along, although not that many).  Vermont is a liberal state with a history of health care innovation so it’s no surprise that it is doing an exchange, unlike some more conservative states that are threatening to sit it out and let the federal government do it.

Some officials in Vermont call it the “single exchange” but that’s not the same thing as single-payer.  The exchange will have a lot of power to set the rules for health coverage and cost containment in the state, it won’t just be an electronic bulletin board or listings. They are trying to design the state exchange, administratively, in a way that can serve as a foundation, or transition point, to an eventual single-payer plan, as well as some consumer protections so that people know what benefits they are buying – and will get them.

The federal money that will become available in 2014 under federal health reform will go into a payment pot within the new state exchange, and Vermont will try to bring into the exchange  the newly insured, small business employees, and people who have been buying insurance on the individual market  (some of whom will be getting federal subsidies to get covered in the exchange) .

Vermont also wants to bring in the state’s public employees and, at some point, Medicaid recipients. The Medicaid piece will depend on getting federal waivers. It’s not clear to me how much of that happens in 2014, or which groups are phased in later. In theory they also want to bring Medicare recipients in when they go full single-payer in 2017, but that would require even more waivers and rule-bending. Plus there’s workers comp to deal with in some capacity and ERISA (the federal law which governs multi-state health plans, like that covering an IBM worker and dependents).

So could Vermont have a single payer system by 2017? Yes. Has the state approved a plan how to get there? Sort of. There are lots of gaps in the plan – and the coverage.

How hysterectomies spurred Dartmouth Atlas’ birth

In the first of a three-part series on health care costs in America, NPR’s Alix Spiegel tells the story of the birth of the Dartmouth Atlas, how some of its founder’s earliest research changed the health care delivery system in Maine and what it tells us about health and money. Spiegel unspools the story as a series of questions, the answer to each of which pushed researchers and physicians closer to an understanding of what drives health care costs in America.

The story kicks off in the mid ’60s when John Wennberg, now famous (among health reporters, at least) as the father of the Dartmouth Atlas, got a grant to study the best way to expand health technology to rural Vermont. To answer that question, Wennberg asked what health care was actually delivered in the state. From there, he discovers massive geographical differences in the frequency of procedures such as hysterectomies, and the questions and answers tumble neatly into line like so many dominoes.

Part two of the series, focusing on how active patient participation drives up costs, will air next week on NPR’s Morning Edition. In the third installment, Spiegel will examine the cost impact of direct-to-consumer advertising of prescription drugs.