Vermont Approves Single-Payer Health Care: ‘Everybody in, nobody out’

[ProSense]

96. As state legislatures permit,

more states could soon take the VT route. Fortunately, VT was ahead of the game.

Study: States Can Learn From Vermont’s Health Care Reform

Kirk Carapezza

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A study published this week in the New England Journal of Medicine says other states can learn some lessons from Vermont in rolling out health exchanges that are essential to the federal Affordable Care Act.

Doctor Laura Grubb at the University of Texas wrote the report. In a phone interview Wednesday, she said other states should follow Vermont administrators' lead and take matters into their own hands.

"As opposed to having a mandate from above pushing it at you, instead, they decided to take their own initiative and go with what was best for the people of Vermont," Grubb said

In her study, Grubb points out that Vermont created the Green Mountain Care Board to slow the rising cost of health care. She says administrators have worked to reduce redundancy and improve transparency, while developing a state-exchange that will be 100 percent federally funded...The state has been awarded more than $250 million in federal funding for its state health exchange...

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http://www.vpr.net/news_detail/98021/study-states-learn-from-vermonts-health-care-refor/

Single Payer movement in the era of Obamacare

by Shockwave

If you believe that healthcare is a basic human right and understand why Single Payer IS the final destination of healthcare reform and you want to get it done as soon as possible, read on.

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If you are involved in the Single Payer movement in California this diary may help you understand what we face and whet we can do to get things done.

I am one of those Single Payer activists who understands that Obamacare will benefit many and it is truly amazing that this effort, that President Obama should get full credit for, is the best that could come from a dysfunctional and extremely polarized DC.

And I support those who keep up the fight to prevent its sabotage by all the Republicans in red states and in DC.

I consider the ACA a giant first step towards an America where healthcare is recognized as a basic human right and there is a system that allows ALL who live here to have access to affordable medical attention without the fear of going bankrupt.

And I understand that California is leading the country in the implementation of Obamacare. But it's not about being better than other states like Texas and Georgia where Obamacare is being sabotaged or ignored. It's about joining Vermont to help lead the country to a place where ALL are covered, where the private insurance blood suckers are gone, where medical results and costs are in line with other developed nations, where if you need to see a doctor (or a dentist) you make an appointment and you don't worry whether you will be able to pay the rent (given that 76% of all Americans live paycheck to paycheck).

So how do we get it done? <...>

Bill Zimmerman has just published an article that sets the tone;

Why California can lead the way to Single Payer in the U.S.

Recently Public Citizen, a member of California’s AllCare Alliance, released a report entitled, “A Roadmap to Single-Payer: How States Can Escape the Clutches of the Private Health Insurance Industry.” “We’re looking for a few pioneering states with the courage and fortitude to let common sense prevail over the insanity of our current patchwork system, “said Lisa Gilbert, director of Public Citizen’s Congress Watch division. “Once they succeed, we expect most opposition to single-payer and our reliance on privately insured health care to become historical relics.”

By the time California votes to move to a single payer system – the earliest date possible is 2017 when the Affordable Care Act allows states to set up their own systems – Congress will have gone through two more election cycles. Voters will be less white, and probably less conservative, and the changing composition of the House of Representatives may allow for passage of single-payer waiver legislation for states, perhaps even with “state’s rights” support from a few Republicans.

California, Vermont and possibly other states moving to single-payer will put increasing pressure on Congress to grant other state waivers. Once subject to such pressure, Congress could theoretically pass a federal bill to give (improved) Medicare to all, but it is politically far more likely that they will simply let the states set up their own systems, which can then become models for a larger federal program. California, once again, could be the engine driving national change.

One of the features of Obamacare is the "waiver". The idea is that states can apply for this "waiver" and implement their own plan starting 2017 if this new plan covers more people and is affordable.

So lets take a look at what the ACA says about the "innovation waiver";

SEC. 1332 ø42 U.S.C. 18052¿. WAIVER FOR STATE INNOVATION.
(a) APPLICATION.—
(1) IN GENERAL.—A State may apply to the Secretary for the waiver of all or any requirements described in paragraph
(2) with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2017. Such application shall—
(A) be filed at such time and in such manner as the Secretary may require;
(B) contain such information as the Secretary may require, including—
(i) a comprehensive description of the State legislation and program to implement a plan meeting the requirements for a waiver under this section; and
(ii) a 10-year budget plan for such plan that is budget neutral for the Federal Government; and
(C) provide an assurance that the State has enacted the law described in
subsection (b)(2).

So this is the milestone that any state has to go through. The Vermont single payer activists lead the way. Even Vermont will apply for the "innivation waiver" to get federal funds starting in 2017 to help pay for their Single Payer system.

Here in California the Single Payer organizations (linked logos below) will announce soon the plan to achieve the "waiver" milestone by January 1st 2017. The Single Payer plan that will be proposed will be based mostly on SB 810, which was approved by SEnate and Assembly twice and vetoed twice by Arnold Schwarzenegger and in 2012 it was stopped by 6 blue dogs in the Senate before it could get to Jerry Brown's desk.

In California, one of the key issues is that Obamacare will leave out over 3,000,000 undocumented workers. These 3,000,000 are an integral part of our society and mostly but not all are Latinos. And as Joan McCarter pointed out, Latino organizations worry about funding for Obamacare outreach efforts;

Hispanic health centers and community organizations say they don’t have the funding or resources to carry out the complicated sign up process for the 10 million Latinos who will be eligible for new public and subsidized health coverage options.

Latino organization outreach is a key to success.

And we should coordinate the efforts around the country.

So here in California we need to work with Sacramento at all levels. It will be a lot of hard work but there are thousands of committed activists.

One way you can help is by joining one of the Single Payer organizations and help us organize and direct the grassroots movement that will be instrumental in convincing Sacramento to go along.

And this week on Thursday August 1st you can join other activists to watch The Healthcare Movie in Santa Monica at 7:30PM and celebrate the 48th anniversary of Medicare. You can buy tickets here.

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http://www.dailykos.com/story/2013/07/30/1226609/-Single-Payer-movement-in-the-era-of-Obamacare

Note:

Kos Media, LLC Site content may be used for any purpose without explicit permission unless otherwise specified

Remember Section 1332 of the health care law?

State single payer waiver provisions in the Senate healthcare bill - legislative language and fact sheet from Vermont Sen. Bernie Sanders

Why the 1332 Waiver in the Senate Health Reform Bill is the Only Opportunity for State Single Payer Systems Under the Bill

The health care reform bill passed by the Senate requires that all states set up Exchanges through which private insurance companies could sell their plans. Because federal laws preempt state laws, the federal health care reform bill would supplant any state attempt to set up a single payer system in lieu of an Exchange, which by its nature calls for multiple payers to compete. If the Senate bill is enacted, the only opportunity for states to move toward a single payer system is found in Section 1332. This section would allow a state with a plan that meets certain coverage and affordability requirements to waive out of the requirement to set up an Exchange for private insurance companies. Only with such a waiver could a state move in the direction of a single payer system.

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http://www.pnhp.org/news/2010/march/state-single-payer-waiver-provisions-in-the-senate-healthcare-bill-legislative-langu

Release: President Endorses State Waiver Proposal

Vermont Delegation and Gov. Shumlin Hail Obama Endorsement of State Health Reform Waiver Legislation

WASHINGTON, Feb. 28 - The Vermont congressional delegation and Gov. Peter Shumlin today hailed President Obama's endorsement of legislation allowing states to provide better health care at a lower cost starting in 2014.

At a meeting of the National Governors Association Monday morning, Obama announced his support for amending the Affordable Care Act to allow states like Vermont to seek a federal waiver to the new law three years earlier than currently allowed. States would be required to design plans that are at least as comprehensive and affordable as the federal model and cover at least as many people

Last month Sens. Bernie Sanders (I-Vt.) and Patrick Leahy (D-Vt.) introduced in the Senate and Rep. Peter Welch (D-Vt.) introduced in the House legislation that would advance the date waivers would be accepted from 2017 to 2014. The three joined Gov. Shumlin at a Montpelier press conference to announce the legislation, which would provide Vermont the flexibility it needs to adopt reforms Shumlin is pursuing.

Leahy said, "This is a wise decision that keeps in focus the goal of continually improving health care in America. I applaud President Obama and Secretary Sebelius for supporting efforts by Vermont and other states to go above and beyond what the Affordable Care Act requires. They know that the federal government does not have a monopoly on good ideas, and innovations by the states will prove - and improve --- the benefits of health insurance reform, on the ground, and in practice. While some in Washington want to turn the clock back and repeal the new health reform law, Vermont and other states want to move ahead. Vermont has already been working hard to improve the state's system of health care, and passage of the delegation's waiver bill will move our state one step closer to that goal."

Sanders said, "At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all, single-payer approach. I am delighted that President Obama announced today that he will, in fact, support allowing states to innovate with health coverage models sooner rather than later. I worked hard to draft and secure the waiver provision in the health reform law and I am very pleased the president now agrees that we should make it available in 2014 as originally intended. While there is a lot of work to be done, I look forward to working with Sens. Leahy, Wyden, Inouye, Brown and others in the Senate and Rep. Welch and others in the House to get this done as soon as possible."

Welch said, "President Obama's support for allowing states to innovate sooner is a good news for Vermont and all states looking to tailor health care reform to individual states' circumstances. This legislation will give Vermont a green light to lead the nation in providing quality health care at a lower cost. I'm hopeful that Democrats and Republicans alike will support this practical step to give states flexibility to achieve progress their own way."

Shumlin said, "I was excited to learn about this today during a visit to the White House. All along officials from Health and Human Services have expressed a willingness to work with us, as long as we don't compromise standards under the law. I think this is an excellent example of how we can work together to control skyrocketing health care costs and implement meaningful health care reform as soon as possible."

A fact sheet on the delegation's "State Leadership in Healthcare Act" is available here.

http://www.sanders.senate.gov/newsroom/news/?id=44a664de-8e92-43f4-a871-d26e0b5a252d

FACT SHEET

"State Leadership in Healthcare Act‟

Section 1332 of the Patient Protection and Affordable Care Act – the “Waiver for State Innovation” – allows states to waiver out of some of the requirement of federal health reform if they meet certain standards. The provision in the new law was authored by Sens. Bernie Sanders (I-Vt.) and strongly supported by Sen. Patrick Leahy (D-Vt.) and Rep. Peter Welch (D-Vt.).

The Sanders-Leahy-Welch “State Leadership in Healthcare Act” moves the availability of state waivers from 2017 to 2014. This would allow a state to avoid the expense of setting up an exchange – which is otherwise required in every state in 2014 – only to dismantle it later.

The federal waiver would allow a state to:

a) Collect all the federal funding and use for financing coverage for individuals through a plan designed by and for that state.
b) Coordinates this waiver process with Medicare, Medicaid and CHIP waiver processes that may be required depending on the design of the system. The state

The federal waiver would not allow a state to:

a) Offer lower quality or less affordable care to their residents than would be available in the exchange.
b) Obtain waivers from the health insurance market reforms implemented under the law such as those benefiting ending the use of pre-existing conditions to exclude individuals from coverage or those allowing young adults to stay on their parents’ plans longer.

How does the waiver provision of the law work?
Step 1: The state passes a law to provide health insurance to its citizens.
Step 2: The Secretary of Health and Human Services and Secretary of the Treasury review the state law and determine that the plan is:

a) At least as comprehensive as its residents would receive in the exchange;
b) At least as affordable;
c) Deficit neutral to the federal government; and,
d) Covers at least as many people.

Step 3: If the federal government finds that the alternative state system meets these requirements without certain federal rules, states can get a waiver. The state plan could receive waivers from:

a) The section requiring establishment of the exchange
b) The designs for how federal subsidies would have to reduce premiums and co-pays.
c) The employer penalty for providing coverage
d) The individual mandate.

http://www.sanders.senate.gov/graphics/011411state_waiver_fact_sheet.pdf

The Affordable Care Act: Supporting State Innovation
http://www.healthcare.gov/news/factsheets/2012/02/state-innovation02222012a.html