MEDISCARE: As the election nears, Vermont seniors are trying to figure out what the future holds for Medicare under Vermont’s single-payer system.
By Bruce Parker | Vermont Watchdog
It’s OK for Gov. Peter Shumlin to talk with feds about a possible state takeover of Medicare in Vermont, but it’s “a scare tactic” if the public talks about those talks.
That’s the insinuation by supporters of single-payer health care as a hot debate rages over the governor’s recent meeting with the Centers for Medicare and Medicaid to discuss the future of Medicare in Vermont.
The discussion began Oct. 7, when Libertarian gubernatorial candidate Dan Feliciano held a news conference drawing attention to the governor’s Medicare meeting with feds in Washington, D.C., as detailed in an Oct. 1 VTDigger article.
As reported, Shumlin met with the Centers for Medicare and Medicaid to inquire about waivers that would transfer financial management of Medicare to Green Mountain Care, with the assumption Vermont would provide the same benefits seniors have come to expect from the federal program. The takeover of Medicare money would help Vermont finance its single-payer health care system, estimated to cost between $1.8 billion and $2.2 billion annually.
While supporters of single-payer admit that Shumlin’s Medicare meeting occurred, they have blasted public discussion of the meeting.
In response to Feliciano’s news conference, Shumlin campaign manager Scott Coriell issued a statement saying, “Vermonters deserve better than a scare tactic from their gubernatorial candidates.”
The “scare tactic” mantra surfaced again last week when state Rep. Sarah Buxton, D-Tunbridge, said a Republican Senate candidate’s signs about Medicare being administered under single-payer were “flat out wrong.” VTDigger health-care reporter Morgan True countered the signs were “factually correct,” but he added the implications of a possible waver were unclear.
VTDigger publisher Anne Galloway jumped into that debate Sunday, opining that Buxton “is correct that Republican Senate Candidate Bob Frenier’s campaign signs claiming the state wants to administer Medicare as part of single-payer are inaccurate.”
Also over the weekend, AARP state director Greg Marchildon told the Burlington Free Press it was “easy to try to freak people out.” He said seniors “have no reason to think there will be any changes at all.”
But Ethan Allen Institute’s Rob Roper, in a commentary published in the Times Argus, showed that Shumlin’s meeting with Centers for Medicaid and Medicare is mandated by Act 48, which states “Green Mountain Care shall assume responsibility for the benefits and services paid for by … Medicare.” — Sec. 2(a)(6)
Roper further showed the statute requires the agency to “seek permission from the Centers for Medicare and Medicaid Services to be the administrator for the Medicare program in Vermont.” — 18 VSA 1827
VTDigger’s Galloway on Sunday wrote Vermont statute 18 VSA 1827 no longer says the agency must seek to be the administrator for the Medicare program in Vermont, and she reported that “state officials have said they are no longer seeking to administer Medicare as part of Green Mountain Care, and the law reflects that change.”
But Shumlin’s meeting at the Centers for Medicare and Medicaid last month represents the most recent and concrete intention of the Shumlin administration regarding Medicare and single-payer to date. Moreover, in 2013, Shumlin told Physicians for a National Health Program he would seek the waivers required to get everybody in the single-payer health care pool, including Medicare beneficiaries.
In light of those developments, the current scare seems as much related to the governor’s meeting with Centers for Medicare and Medicaid as to subsequent discussions about it.
Observers have expressed multiple concerns about a state takeover of Medicare.
First, the Shumlin administration’s failed rollout of Vermont Health Connect has shaken the confidence of even the most ardent supporters of single-payer. The online exchange establishes a track record of administrative failure that seniors fear could spread to Medicare.
Next, many seniors worry about what would happen to their supplemental coverage. Since Medicare and Green Mountain Care provide only limited essential benefits, all beneficiaries will have to buy supplemental insurance plans — a rarely discussed issue that will add millions of dollars to current Green Mountain Care cost estimates. Seniors who now use Medigap to fill in “gaps” in services can only guess how they will obtain supplementary coverage once they are no longer on Medicare.
If Medicare is administered by the state, seniors may see changes to care. Since decisions about health services will be made by doctors and hospitals under guidance of the Green Mountain Care Board, it’s unclear current Medicare benefits will be maintained. Moreover, seniors who can receive care in any state using their current Medicare plans can’t be sure how they will get care while visiting or living part-time in other states.
Finally, under Green Mountain Care, seniors will likely pay new taxes for their health care. It is unclear whether seniors would be taxed on pensions, Social Security interest income, capital gains or part-time income. Yet without absorbing Medicare revenue streams, Vermont stands little chance of coming up with the funds to finance Green Mountain Care — apart from obscenely high payroll or sales taxes.
While health-care officials in the Shumlin administration say their meeting with Centers for Medicare and Medicaid revealed impracticalities of a state takeover of Medicare, seniors heading to the polls Nov. 4 will get their say about the uncertain future of Medicare coverage in Vermont.
Contact Bruce Parker at firstname.lastname@example.org