West Addison, Vermont - February 23, 2011
Dawn Scoville is one of the hundreds of people from New York who work in Vermont. She worries what Vermont's proposed single-payer health care system will mean for her and her family.
"Everything is a concern with insurance," Scoville said. "You can't really single out what it's going to be. It is just a concern. It's just a big concern that everybody needs to deal with."
Scoville makes frequent trips from her home in Schroon Lake, N.Y., to the Vermont's Children Hospital in Burlington because her daughter requires special treatment for intestinal issues.
"I'm very nervous, I'm very nervous about it," she said. "You never where you are going to have to go if you can't use your insurance at a certain place. That's the big concern."
At Fletcher Allen Health Care about 15 percent of the 1.1 million patients who visited the hospital last year came from New York. Hospital officials do not expect patient care to be impacted by a switch to single-payer in Vermont.
"Based on our analysis, based on the models that have been discussed, it would not have any impact on the state level or national reform that would affect those patients from coming out of state," said Todd Moore, the vice president of revenue at Fletcher Allen Health Care.
But at Champlain Valley Physicians Hospital in Plattsburgh, they see some potential problems; like what if a person who lives in New York and works in Vermont is enrolled in the single-payer health care system, but needs medical treatment when at home?
"Depending on what kind of payment arrangement they are offering to neighboring states and contracting arrangements, they may or may not be able to secure the network of providers which would then require the employee to get their care in Vermont," said Kathy Peterson, the director of patient accounting at Champlain Valley Physicians Hospital.
Another worry for CVPH-- a Vermont resident who requires care in New York.
"We would never deny anyone care no matter what. If someone is injured here and is from Vermont we would see that patient," Peterson said. "The question becomes how do we get paid for that service that we rendering to that patient that is from Vermont?"
"There's a lot of details still to be worked out," said Anya Rader Wallack, a special assistant to the governor for health care.
Wallack is the Shumlin Administration point person on health care. She says one of the most important details is how to pay for a single-payer program. A consultant's report advised using a payroll tax. But analysts say that could cause problems with bordering states. For example, under that payroll tax payment system a Vermont resident who works in New York would potentially receive free health care because they wouldn't be paying the payroll tax. Under the Shumlin administration plan all Vermonters would be covered, but federal law prohibits Vermont from charging a payroll tax outside the state.
"The residents of the state of Vermont, that work in Vermont, they would be paying for your health insurance for you; a great deal," said Craig Fuller, a health care consultant.
And this could potentially give an advantage to businesses along the border.
"I would try and get a Vermont resident to be my employee because he already has health insurance through the state of Vermont. That would allow me, if I wish, to give him a higher salary, which would mean New York businesses would become more attractive employers for employees," Fuller said.
Sticking with the theory of a payroll tax system, someone who lives in New York but works in Vermont could potentially end up paying for a benefit they can't use, since right now the single-payer system would be strictly for Vermont residents.
"I think that raises a basic fairness issue if someone should be paying for something they aren't eligible for," Fuller said.
The Shumlin Administration is working on the potential border issues of using a payroll tax.
"Obviously there are details like that at the border that you have to deal with," Wallack said. "Either you have to allow that person not to be part of the tax system and say I have coverage somewhere else and not tax more, or allow that person to buy into the Vermont system."
Again, these are just potential problems. The Shumlin administration says it will be at least another two years before they determine how to pay for it and who would be allowed to join.
Matt Henson - WCAX News
