Kudos for Vermont from New England Journal of Medicine

Friday April 5, 2013

MONTPELIER -- An article in the prestigious New England Journal of Medicine is praising Vermont's efforts to redesign its health care system, saying Vermont can serve as a model for other states.

"Vermont is progressive," said the article's author, Dr. Laura Grubb, also a fellow in adolescent medicine at the University of Texas Medical School. "They didn't wait until each step of the Affordable Care Act had to be implemented. They voted on their own state-based reform system."

Much of the energy behind Vermont's efforts to implement the 2010 federal law actually has been directed at a more ambitious goal. Gov. Peter Shumlin and his fellow Democrats who control the Legislature have put Vermont on a path to move as close as it can to a Canadian-style, single-payer health care system by 2017.

The federal law calls for states to set up regulated health insurance marketplaces, called exchanges. Vermont has been eagerly setting up its exchange, in hopes of using it as a springboard for the single-payer system. State lawmakers passed legislation in 2011 to set itself on a two-stop journey to set up the exchange in 2014 and the single-payer system in 2017.

Shumlin, who has championed the changes to Vermont's health care system, said the state should be "proud to be a leader" in implementing the federal law.

"We are pleased to gain recognition of our path to single payer health care and our Vermont-style solutions in the New England Journal of Medicine," he said.

Darcie Johnston, founder of the group Vermonters for Health Care Freedom, a group opposed to the state's health care plans, said Grubb is a member of Physicians for a National Health Program, which supports single-payer health care nationwide.

In a phone interview, Grubb said she was an "inactive" member. "I haven't paid dues in a couple of years."

Grubb, a medical doctor pursuing a master's degree in public health policy, highlighted four areas in which states would do well to follow Vermont's example. She noted:

--The creation of a centralized board -- the Green Mountain Care Board -- to coordinate efforts to retool the state's health care system and set up what will be called the Green Mountain Care system by 2017.

--The inclusion of people, called stakeholders, who will be affected by health policy in its development.

--An aggressive approach to setting up the exchange, getting started even before last year's Supreme Court decision upholding the law and before President Barack Obama's re-election, which helped ensure the continuity of the federal effort.

--Attracting federal funds to help the state effort to implement the changes. The second-smallest state by population, Vermont ranks fifth in the country in attracting federal funds to support health care efforts.

The Green Mountain Care Board set up a 64-member advisory group of physicians, dentists, physical and occupational therapists and naturopathic doctors. It also set up a 24-member advisory group of mental health and substance abuse professionals to help guide its work.

"The engagement of such stakeholders has facilitated a smoother transition to large-scale reform," Grubb wrote.


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