In a rare move, a Democratic senator held the floor for much of the Senate Republicans' caucus Thursday.
"I know that I'm in a forum of skeptics and I want to emphasize that I am a supporter. I introduced a financing bill because I believe in it but I also think it's important to have an honest discussion about what this is going to cost and how to do it," said Sen. Peter Galbraith, D-Windham County.
Act 48 required Gov. Peter Shumlin to explain how to pay for a single-payer system last January. He cited implementation delay for only providing a vague outline instead. Galbraith says the governor's proposal will look like his.
"There's really only one way to pay for it in broad terms and that is by an employer-- a payroll tax imposed on employers," Galbraith said.
Galbraith proposes an 11 percent tax on employer payroll and a 2 percent rate for employees. Self-employed would pay both ends and the self-insured would not be exempted; federal employees would keep their current government coverage. Galbraith concedes his tax structure may need tweaking to accommodate plan costs-- current estimates suggest between $1.6 billion and $2 billion-- and legislators' tastes.
A separate hearing on the House side also focused on the future of health care.
"We want to have the highest quality, the best access, but just be a little less expensive than the United States," said Al Gobeille, the chair of the Green Mountain Care Board.
Gobeille told legislators financing and plan creation can't be done separately. However, that package still needs to be imagined.
"Financing not defined, and the word sustainable, not defined, so the words I feel good about are 'for' and 'is,'" Gobeille said.
Board members have not even defined the term benefits yet. Before it can sign off on single-payer, members must be convinced:
Vermonters will be offered strong plans
The move would not have a net negative impact on the economy
Financing is sustainable
The system shows better value than the 2011 market did
Cost containment will not reduce access
A sufficient reimbursement rate for health providers
"These are the things that make your knees buckle," Gobeille said.
After setting dates for further discussion, the board turned its attention to current reform. As administrators for Vermont's exchange sought changes to approved plans for 2015 in order to comply with federal standards. Regardless of what the state does, single-payer won't move forward unless the federal government signs off on re-purposing exchange funds to run it.
The Senate Finance Committee will review Galbraith's plan Friday. Administration officials are also expected to be there, but it's not clear if they will provide any plans of their own.
Friday, April 18 2014 10:13 PM EDT2014-04-19 02:13:23 GMT
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