Rep. Paul Poirier is single-minded on single-payer
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By DANIEL BARLOW Vermont Press Bureau - Published: November 18, 2009
MONTPELIER – Rep. Paul Poirier isn't holding his breath waiting for health care reform to come down from Washington, D.C.
Poirier, a Barre City independent, has spent the last several months talking to people about health care reform and his idea that Vermont could launch its own public option health insurance as a way to reduce costs and insure more people.
At the Statehouse Tuesday morning, more than a dozen lawmakers gathered around a cafeteria table to hear Poirier's pitch, which would combine all of the state's health care plans under one program that would compete on the private insurance market.
"I proposed mandatory health care for all Vermonters in 1988 and the bill didn't go anywhere," Poirier said Tuesday morning between meetings with health care reform advocates and lawmakers. "Twenty-two years later, the discussion hasn't moved an inch."
Poirier's proposal requires all Vermonters have some form of health insurance. Those who go without health insurance would be fined at 50 percent of the cost of the least expensive insurance plan premium each month. It also requires that all employers offer health insurance to their workers.
Requiring health insurance – a tactic used by Massachusetts and under consideration in the federal proposals – would be coupled with a Vermont public health insurance option. Poirier said he would take all of the state's plans – Medicaid, Vermont Health Access Plan, Dr. Dynasaur and Catamount Health – and roll them all into a single program.
That program would offer to sell health insurance to any Vermonter or business and, much like how VHAP and Catamount are run now, offer subsidies to residents that could not afford to pay the full premiums. Under this plan, businesses too, if their payroll was lower than a certain amount, could get assistance to offer plans to their employees.
Also part of the equation would be establishing a Vermont benchmark for health insurance offerings – a minimum baseline that all plans, public and private, would adhere to. Poirier said the state's public plan would reimburse providers at the going Medicare rate plus 10 percent.
"This plan would include wellness coverage, early prevention, everything our Blueprint for Health does," Poirier said. "The private insurance companies could have a plan that offers more than the benchmark, but they could not go under it."
Vermont has three major health insurance companies operating here – Blue Cross/Blue Shield, MVP and Cigna. Leigh Tofferi, the director of government and public relations for Blue Cross/Blue Shield of Vermont said Tuesday that he was not familiar with the proposal that Poirier is working on.
But Tofferi did say that the company is not opposed to the state offering its own health insurance program for open enrollment so long as it competes on the same level playing ground as their products.
"If there was a true competitive environment, that's fine," Tofferi said. "But our concern would be that the program would have competitive advantages that we don't, such as paying lower rates to providers."
What has been notable about Poirier's latest health care reform effort is that he has reached out to advocates and other lawmakers before the Vermont Legislature reconvenes in January, said Peter Sterling, the executive director of the organization Vermonters for Health Care Security.
Sterling, a supporter of a single-payer health care system, said Poirier is laying the groundwork for what could be a successful effort to bring a Vermont public health insurance option to a vote in the Legislature.
He also thinks it is a movement that other single-payer advocates may be able to get behind.
"Paul has the right idea and this is the right vehicle," Sterling said. "And he is building the coalition necessary to get this done."
Poirier's proposal is right now a four-page outline detailing, in rough terms, the direction of the bill, which is being written by Legislative Council now. But he said he is willing to work with lawmakers to include other issues, including tort reform, a Republican favorite, to gain across-the-aisle support.
Sen. Richard McCormack, D-Windsor, who attended Tuesday's meeting at the Statehouse, warned that lawmakers should not put too much hope into getting tri-partisan support for a public health insurance option. He pointed to President Obama's experiences as an example.
"The President has bent over backwards to the other side and he has been attacked and called a communist," he said.
But after years of debating health care reform (the Legislature passed a single-payer health care system in 2005 only to have the bill vetoed by Gov. James Douglas), what makes this proposal any different than the half dozen or so others that are proposed in every session?
Poirier said the severity of the problem – Vermonters are expected to spend $5 billion on health care in 2010 – and the willingness of lawmakers to make progress changes the equation. He said Rep. Steve Maier, D-Middlebury, the chairman of the House Health Care Committee, has agreed to hold hearings on his bill early next year.
"Now is the time," Poirier said.
Daniel.Barlow@timesargus.com
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