• Oversight of new health care system is eyed
     | May 26,2013

    MONTPELIER — As lawmakers embark on a health care reform initiative that will endow state bureaucrats with unprecedented influence over the medical industry, they’re also beefing up independent oversight of the government agents now regulating everything from insurance rates to hospital budgets.

    But while the Legislature this year OK’d modest funding increases for the Vermont Office of the Consumer Advocate, watchdogs say that as Vermont progresses toward single-payer health care, lawmakers will need to more closely guard the public interest.

    “If we stay on this path we’re on now, then the state will become everyone’s new health insurance company,” says Rep. Paul Poirier, a Barre City independent. “And frankly, I don’t trust government any more than I trust the insurance companies we have today.”

    Poirier this year led the charge to install new checks on the Green Mountain Care Board, a five-person panel endowed by lawmakers in 2011 with the power to approve or deny insurance rates and hospital budgets, and set costs for various medical procedures.

    The board will also be responsible for deciding what services Vermont’s single-payer health plan covers, and what kinds of out-of-pocket expenses residents will have to absorb.

    Vermont has had an Office of Health Care Ombudsman since 1998 to help wronged consumers navigate for solutions in a Byzantine health care industry. A name change this year to the Office of the Consumer Advocate reflects the expanded duties lawmakers have added to the organization’s role.

    Rep. Michael Fisher, a Lincoln Democrat and chairman of the House Committee on Health Care, says the office will oversee “pretty much everything going on” at the Green Mountain Care Board.

    “As we’re contemplating next steps, I think there is even more of a need to have a well-financed public advocate who is speaking out for Vermonters around these major decisions that have an impact on their pocket books,” Fisher says.

    As the Green Mountain Care Board evolves into its new role, Fisher says, it will become increasingly difficult for individual residents to influence the process.

    “As we contemplate moving toward a system that is much more publicly financed, I think that individual Vermonters would have a hard time sitting at the table and speaking out for themselves and their individual interests,” Fisher said.

    Trinka Kerr, director of the Vermont Office of the Consumer Advocate, says that if her organization is going to be able to fulfill its statutory role, then it will need a larger budget than it’s had in the past. A patchwork of state and federal funding accounts for the approximately $900,000 budget this year at the 10-person operation.

    The state uses an RFP process to select a nonprofit organization to perform the duties of the Office of the Consumer Advocate. Vermont Legal Aid has always submitted the successful bid.

    “In terms of speaking for the public for hospital budgets and all the cost-control efforts that the (GMCB) wants to do, along with pilot projects and certificates of need and all sorts of other things, we just didn’t have the resources to really jump in on those,” Kerr says.

    Lawmakers considered a number of funding mechanisms before deciding on a “bill-back” provision that will put insurance companies, hospitals and other entities regulated by the GMCB on the hook for oversight-related costs incurred by the Consumer Advocate.

    “And this funding this year hopefully is going to help us beef up our staff to be able to carry out those responsibilities,” Kerr says.

    Poirier says the funding mechanism is a faulty one. Ultimate bill-back authority lies in the hands of the GMCB — the same entity over which the Consumer Advocate is supposed to be watching.

    “You can’t be giving the financial control to a board that might not like what the Consumer Advocate is doing,” Poirier says.

    Poirier says the money needs to come from residents in the form of either a tax or fee.

    “This is about protecting the consumer interests, and the only way that’s going to happen is if consumers are the ones paying for the office,” Poirier says.

    Poirier also says the office needs far more than $1.5 million. He says that as single-payer ramps up, he envisions something akin to the Department of Public Service, except for health care.

    “We’re talking about a $5 billion industry here,” Poirier says. “We need a serious, well-staffed, well-funded department that makes sure consumers interests’ are always the first consideration.”

    A provision in legislation passed this year creates a study to evaluate longer-term funding sources for what Fisher says will be a growing arm of public advocacy.

    Kerr says the devotion of new resources is the only way to ensure that her organization will be able to keep pace with the rapid rollout of health care reform in Vermont.

    “In the past our expertise has been with individual consumers, and state policy that is related to state programs,” Kerr says. “And as we’re developing the expertise to deal with this more system-wide oversight, we need to hire people with the experience and skills to really be able to have an impact on what the Green Mountain Care Board does.”

    Kerr says that as the Legislature ponders various models for what that oversight looks like, they should preserve a model that keeps the Consumer Advocate a nonprofit organization operating outside of state government.

    “When we talk to consumers, a lot of times they appreciate we’re not part of state government — it gives them some confidence,” Kerr says. “There’s a lot of people that don’t trust the government.”

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