Still not known is how pathologists and clinical laboratories will be paid for medical lab tests

In classic cart-before-the-horse thinking, Vermont enacted a law to institute a single-payer universal-coverage healthcare system within the state, starting in 2017. However, this law does not specify how the new healthcare system will be funded. That is the next challenge for the Vermont legislature.

Dark Daily suspects that anatomic pathology groups and clinical laboratories in the Green Mountain State will have a keen interest in learning how this new healthcare system will be funded—and how pathology services and medical laboratory tests will be reimbursed.

Vermont’s governor—Peter Shumlin—signed H.202 on May, 26, 2011. It is a bit surprising that this news has not gotten much coverage by national news outlets. After all, this is a major innovation at the state level that will definitely re-shape healthcare services in the Green Mountain State.

Governor Peter Shumlin on the state capitol steps after signing the new single-payer healthcare bill into law. (Photo by Toby Talbot / AP)

Vermont’s newly enacted healthcare program is not another attempt at an “individual mandate” scheme similar to that enacted in Massachusetts in 2006, which is having troubling problems paying for itself. Perhaps, Vermont’s state legislators wanted to put in place state legislation that would supersede expected federal law that will mirror Massachusetts’ failing healthcare system.

Either way, Vermont is now the first state in the Union to model its healthcare system after Canada’s single-payer system. But that system is struggling under its own financial weight, and is turning to privatization to save itself, under the direction of its original designer—Claude Castonguay.

Reducing the Cost of Healthcare is a Primary Goal

With the passage of H.202, Vermont hopes to provide near universal coverage of its residents, while lowering the cost of healthcare. It wants to accomplish this by removing the duplicative administrative costs inherent in the current multi-payer system. The new system also will control expenditures for individual healthcare consumers.

“We gather here today to launch the first single-payer healthcare system in America, to do in Vermont what has taken too long—have a healthcare system that is the best in the world, that treats healthcare as a right and not a privilege, where healthcare follows the individual, isn’t required by an employer—that’s a huge jobs creator,” said Governor Shumlin in a speech before signing the bill.

In order to enact the new legislation, Vermont must first obtain waivers from the Obama administration. These will release Vermont’s citizens from participating in Obamacare.

Vermont’s new publicly funded healthcare system will be called Green Mountain Care after the state’s original program to cover uninsured citizens with low-cost and no-cost health programs. It will be administered by a five-member board appointed by the Governor.

A nominating committee chaired by Elizabeth Bankowski is currently excepting applications from qualified individuals who wish to serve on the Green Mountain Care board, which will be in place by October 1. To be considered, applicants must complete the online forms at http://humanresources.vermont.gov/GMCB_Search before July 11, 2011.

The board’s first task will be to determine how providers will get reimbursed for their services. Another task will be to set up a health insurance exchange, according to federal law under Obamacare. The latter, however, will simply be a bridge to the state funded single-payer system.

“We are the first state that is affirming that we are going to implement a single-payer healthcare system,” said Shumlin in Bloomberg News. “The measure asserts that healthcare is a basic human right for all,” he said. “This is a really significant step.”

Health Coverage for Everyone in Vermont—Almost

According to the Bloomberg article, of the state’s 625,700 citizens, 50,000 have no health coverage, and 150,000 are insufficiently covered. Under the new single-payer plan, all those who live and work in Vermont will have some form of coverage, determined by income and size of family. All except illegal immigrants, that is.

A last minute State Senate decision to bar non-citizens from receiving coverage inflamed supporters of the bill who consider it a human “right” to have healthcare coverage.

“When we say healthcare is a human right, we mean for everybody who lives and works in Vermont regardless of legal status,” said the Vermont Workers’ Center in a statement reported in a Fox News article. “We will not tolerate racial profiling and accept the unjust immigration and foreign policies of the federal government. We can do better than that.”

However, Vermont state senators who support H.202 do not necessarily agree that everyone should receive coverage, especially illegal aliens.

“We wouldn’t provide membership in Green Mountain Care to someone from Iowa who was here temporarily, so why would we do so for someone here illegally, who by definition is here temporarily?” said Sen. Randy Brock, R-Franklin, one of the amendment’s sponsors in the Fox News article.

“We passed a bill to provide Vermonters with universal health care,” he continued. “Not to have Vermonters provide the universe with healthcare.”

Giving a Boost to Clinical Laboratory Testing

Dark Daily observes that one of the strengths of the United States is the ability of individual states to try different approaches. Viewed from that perspective, the upcoming experiment in healthcare reform that will commence in the Green Mountain State in 2017 will be closely studied. Its successes and setbacks will be studied and will guide policymakers in other states as they make their own decisions about how to provide healthcare for the citizens of their states.

Meanwhile, it would be timely for pathologists and clinical laboratory managers in Vermont to step forward and begin educating state legislators, Vermont bureaucrats, and health policymakers in the Green Mountain State about the value of medical laboratory testing. Decision makers should understand the best way to spend the three cents on the healthcare dollar that typically goes to pay for clinical laboratory testing.

Nevertheless, Governor Shumlin signed the bill, which is now on its way to becoming law.

—Michael McBride

Related Information:

Vermont’s Shumlin Uses Obama Health Law to Build Bridge to State-Run Care

Vermont Final Bill H.202

Vermont’s Single-Payer Health Care Bill Ignites Debate Over Covering Illegal Immigrants

State Representative George Till’s Website

First Universal Health Care Bill in U.S. Marks Success of Vermont’s Human Rights Movement (Huffington Post)