WCAX.COM Local Vermont News, Weather and Sports-YCQM - Robin Lunge - June 26, 2011

YCQM - Robin Lunge - June 26, 2011

June 26, 2011 -- Robin Lunge, the director of health care reform, joins Kristin Carlson and Darren Perron to discuss designing Vermont's new single-payer system.

TRANSCRIPT:

From Vermont's most trusted news source, wcax brings you your newsmakers, your neighbors. This is "you can quote me."

>> Good morning, everyone. I'm Darren Perron and I'm Kristin Carlson. Our news maker this Sunday morning robin lunge. She's the director of healthcare reform in Vermont. We're going to get a progress report on the design of the state's new single pair system.

>> And your neighbors in the news. The greener, the better. In Middlebury, students in a housing competition there. Also, meet the were you ins biggest fan, an angler makes the catch of a lifetime in Keagan Harsha tries to surf.

>> But first our news maker is robin lunge. She's been assigned this new task as the director of healthcare reform in Vermont. She is someone who grew up in Brattleboro and served as legislative counsel with legal advice so lawmakers. Thanks so much for being here. First of all, why do you think you got the job? What qualifies you to take on this role?

>> well a as i think you know i work at the legislative council for a number of years prior to accepting this position and in that job, my focus was on health and human service's so i had to become an expert in the broad area of healthcare and healthcare reform issues. So i think it's my technical expertise and my background.

>> What do you see as your role? Because this is a new position that Governor Shumlin has sort of -- Shumlin has said is needed to oversee everything, but what do you see as your role?

>> I see my role as helping to coordinate the state government efforts around healthcare reform. As you know, healthcare spans a number of different state agencies and each of those agencies will have a key role and important research and other functions to play in implementing healthcare reform, but we thought it made sense to have someone who can really make sure that the left hand and the right hand were both making sure we were moving in the right direction, and to coordinate the activities.

>> So that sounds like a big job, robin.

>> Nah!

>> It is.

>> are you sure that the left hand knows what the right hand is doing?

>> we have a lot of really good, great competent people in state government and so it's really a matter of setting up systems, and making sure that the communication is good and that really the communication flow happens routinely and regularly and frequently.

>> let's talk about the steps because it seems like there's a lot of steps in this process with the ultimate goal of a single payer system potentially in 2017, maybe a few years sooner if we get a federal waiver, but this is a multi-year process.

>> It is.

>> What are you focused on now? Again, you were just appointed to this position a few weeks ago. What have you focused on so far?

>> The position actually starts July 1st, but I'm already jumping in. What we're focused on right now is organizing the studies that were contained in h 202 or act 48, the legislation that just passed this session, and in that legislation, the general assembly really focused on laying out a step-by-step plan for moving from where we are today to the single payer system, so the task immediately is getting those studies up and running, making sure we had work plans for each of them. There's about a dozen, but making sure each has a team lead, each has the right team of internal people, organizing how to get external feedback and setting up a work plan, essentially, between now and January when the reports are due.

>> How much chance will be there for public feedback in this process?

>> My expectation is that we want to work with all the interested parties and make sure that we have public feedback from all sources, interested folks. This is, you know, it's a new and exciting endeavor, but we need everybody's help to work together with us.

>> now, one of the things that's going on right now is this healthcare nominating board is trying to look at this five-member panel who is going to help work on the single payer system. Are you involve in that process at all?

>> I was a bit involved in setting up the materials for the nominating committee. I was present in the legislature for all of the testimony and the discussions around the nominating committee, so in terms of providing information and feedback and what is this piece of the bill mean, I'll probably play that kind of support role.

>> So once this five-member board is set up, they're going to be in charge of a lot of things. They're going to be looking at how to control costs and maybe what certain things should cost Vermonters. When they're up and running, how will you work with them?

>> sort of the role -- part of the role that's outlined in the statute for the director of healthcare reform is to be a liaison with the board, so it will be also my job to make sure that the executive branch agencies and the board are really working together and talking to each other about what they want to pursue in the policies, but it's a liaison role.

>> do you see it happening potentially that the administration wants to jag left and someone else wants to jag right and how do you make the difference, again, when you're talking about such massive changes?

>> Well, i think, you know, is it theoretically possible? Absolutely, but i think that in setting up the board, the board members will be forward-looking, smart, really knowledgeable folks and i expect that because we are creating a new system, we're all going to be learning together and we'll work through issues like that that come up.

>> So what do you see as the timeline for when the next change Vermonters may feel? Because again, this is a multi-step process, but when will Vermonters start to feel and see a change potentially?

>> in terms of when Vermonters will see and feel a change in their actual insurance coverage, some of that has started already under the federal reform, the federal affordable care act, so many people may have noticed that in their insurance policies, they now have the option of, for example, covering their kids up to age 26. So there will be smaller insurance-related reforms under the federal reform that will be the fist things that people notice.

>> And as far as state reform?

>> In terms of state reform, i think again it's going to be an evolution over time. I think the first major impact will be felt probably in 2014 when the exchange is up and running. In the meantime, though, we are still working over things like the blueprint for health, which is establishing patient-centered medical homes in those pilot communities, patients are already seeing those changes.

>> So what are you really going to focus on, robin? Because there are so many different things moving. You mentioned this blueprint for health which is a long-standing state initiative to try to control chronic disease and better treat people and save costs in the long run and then you have the healthcare exchange which is a federally mandated program which we can talk more about, and then you have the goal of everyone covered under some form of a single-payer system, so where is your focus?

>> I'm focused on all of them.

>> okay.

>> As you know, each of these initiatives have lead folks already in place, so for example, Dr. Craig Jones is the director of the blueprint. So it's not like i have to do it all by myself. We have a great team of state agency folks. It's really my role to work with the existing people we have in place and make sure that communication and feedback loop is in place.

>> How do you make sure it doesn't get too bureaucratic and nothing gets done?

>> That's a good question. I think one of the strengths of governor Shumlin is that he is really interested in seeing agencies work together and to cut down on that kind of silo bureaucratic evident, so i think that takes leadership from the top and he is providing that leadership.

>> So he's going to be the spur saying get it going, robin?

>> we're all saying get it going, and i think everyone feels that because -- even though it is a planning process, there is lots of time between now and 2014. We need to start immediately in terms of doing the research, looking at different models and starting to dig into the work.

>> Let's talk about this healthcare exchange because that might be the first step that Vermonters really will see a difference. It's federally mandated. Some people have explained it to me, it's like expedia, you go and shop around for air fair, but you can go around and shop for your healthcare. Is that a true comparison because Vermont doesn't have as many health insurance providers.

>> it's through we only have three major insurance companies, so something like an exchange? Vermont will have a slightly different kind of presence than perhaps another larger state where there are 25 or 30 insurance companies. But each insurance company offers a number of different plans and usually when people need to go out and shop for insurance, they're facing a wide array of different plans, which have different deductible many and different co-payments and different coverage and it's really different to make an apples-to-apples comparison. So one of the major consumer-oriented changes with the exchange is to provide that apples-to-apples comparison, so that Vermonters truly can look at, okay, here are my however many choices, six choices, let's say, for example. This one has this deductible, this one has that copay, these are the premiums, and really make the best choices for their needs.

>> and would those be for Vermonters who are looking for healthcare coverage and like if you're at a job and you're happy with your coverage k you just stay where you are and not go to the exchange?

>> The exchange? 2014 will be -- exchange in 2014 will be open to individuals who don't have employer sponsored insurance. So either their employer doesn't offer it or their employer -- or they don't have an employer like some folks, especially between age 55 and 65 that aren't eligible for medicare yet, but they may have retired early and don't have access to a retire coverage, so folks like that that don't have access to an employer plan, they will be eligible to buy in the exchange and also small employers. The mom and pop stores and even some of the larger businesses that are still on the small side, they will have the exchange as an option for making their comparison for their employees and one of the cool things about the exchange is you can actually design it so that if i have -- let's say i have two part-time jobs and i don't quite work enough hours at either employer to get their insurance. The employer -- both employers could choose to chip in together and i could buy my insurance through the exchange, so that will really increase access for seasonal or part-time workers to insurance.

>> What's to say that some businesses might say the exchange is up and running, I'm going to drop insurance coverage now for my workers?

>> It's certainly possible that they could do that. For some employees, that anyway be a better option because in the exchange, there will be federal subsidies through a tax system, actually a tax credit that you get every month in your check to help pay for insurance, and it may be that with that tax credit, that that makes insurance possible for people. But that's only available if your employer doesn't offer insurance. However, there are some penalties built into the federal law for larger employers, over 50 employees or more, who drop insurance. So if you're a larger employer, there is this federal dis disincentive.

>> Let's talk about the single-payer system. A lot's been made of what to call it. What do you call it?

>> I call it green mountain care.

>> And what does that mean?

>> green mountain care is the name that the legislature chose for the single payer system that's set up in the act 48 in the legislation that just passed, and it's structured to provide coverage for all Vermonters by virtue of residency, so you get green mountain care because you're a Vermonter.

>> and under that scenario, again, if you have a place of business where you like your insurance, can you keep that or is everyone then tried to funnel into one system so there's more savings?

>> the way the legislation structured the green mountain care was to allow employers to continue to do whatever they chose to do, so if you had employer-sponsored insurance and you like that insurance, you could stick with that. You will still have access to green mountain care to wrap around that coverage if you needed that.

>> So is that really a true single-payer system then?

>> there are ways to accomplish a lot of administrative savings, which is one of the major advantages of a single-payer system is it cuts down on a lot of the paperwork that providers have to do in terms of billing and there are ways to funnel over insurance through the same administrative system. It gets kind of wonky, which I'd be happy to get into because I'm an it with of a wonk -- a bit of a wonk, but i think we can achieve a lot of those administrative savings through what's called a single pipe and that will basically replicate a single payer in the advantages.

>> credit tixz of this plan -- critics of this plan say, of course, we don't know how much it's going to cost and who's going to pay for it. Do you think it was a mistake that lawmakers delayed that decision for a year or two?

>> i don't because when you have a program that's not starting right away, it makes more sense to take your time, really look at all the financing mechanisms available, figure out what makes the most sense for Vermont, what makes the most sense for Vermonters and i think that's a better idea than rushing into a financing mechanism years before you actually need it to kick in.

>> If Vermont does take this step, it would be the first state to do this. Can it work on such a small economy of scale?

>> yes, i think in some ways, being small, it's an advantage for Vermont because we really can sit down and talk with each other and work through the challenges and issues as a community and achieve the goal. I think it's actually getting much more complicated in a much larger setting.

>> if you have a scenario where -- you know, 2017 is a long way out, we don't know who the governor will be, we don't know if you will still be in this position, maybe you will still want to do this, where you look at the numbers and there's contentions that this doesn't add up and lets not do this or do you think we're on the train and it's left the station?

>> I think we've set it as a goal. We have a series of planning processes, but there are a number of places to check in to make sure it's the right path. The legislature did, in particular, include a series of triggers that the green mountain care board would look at to make sure that we really were on the right track, so the train has not left the station. We want to make sure that the route is fully planned out before we really, you know, can't turn back.

>> And you're signed o I'm sure, for a few years then?

>> Yes, definitely. I think it's going to be fun.

>> Well, we'll leave it there. Robin lunge, the new state director of healthcare reform. Thank you so much for the progress report and again, you haven't even started your job, right?

>> Not yet, but that's okay.

>> July 1.

>> Yes.

>> Robin, thank you very much.

>> Thanks for having me.