Gov. Peter Shumlin says he'll unveil a major health care initiative later this week that's designed to strengthen Vermont's primary care physician network. A second goal of the plan is to lower the cost of private health insurance premiums.
The governor says his decision not to pursue a single-payer health care system this year doesn't mean that he won't propose some key health care reform plans.
One of these plans involves the Medicaid reimbursement rate that's paid to health care providers. In many cases, this rate represents less than 60 percent of the actual cost of the service. In order to make up the difference, these costs are then shifted onto people who have private health insurance policies.
It's estimated that between 15 and 20 percent of private premiums are due to the cost shift caused by Medicaid, Medicare and unpaid medical bills. Shumlin says this system has to be changed.
"It's absolutely critical that we finally fix our broken payment system where those that are serving Medicaid clients are so badly reimbursed that they either can't stay in business or they won't serve Medicaid clients in the first place," said the governor.
Shumlin says boosting the Medicaid reimbursement rate will help reduce the cost shift and encourage more physicians to see Medicaid patients.
"It is absolutely critical that we finally fix our broken payment system where those that are serving Medicaid clients are so badly reimbursed that they either can't stay in business or they will not serve Medicaid clients in the first place." - Gov. Peter Shumlin
"You're going to see me present a plan that increases provider reimbursements for Medicaid so that we can have more physicians participating in our whole universal health care system in Vermont,” said Shumlin.
Dr. Paul Reiss has an independent family practice in Williston and has been active in Vermont's health care debate. He says increasing Medicaid reimbursement rates will actually save the state money in the long term.
"You take care of people in terms of prevention early in their acute chronic illnesses, you prevent significant, much more complicated illnesses down the road,” said Reiss. “So the bottom line is we really need to invest in primary care."
And Reiss says Vermont needs to develop a health care system where all people have access to a primary care physician.
"We need to make sure that we have enough primary care practitioners to take care of Vermonters,” said Reiss. “And we need to make sure each Vermonter has coverage especially for primary care services."
Reiss says there's a financial incentive to boost the Medicaid reimbursement rates. That's because the federal government will pick up half of the tab.
"For states that are providing that additional funding, more than 50 percent of it is actually continued to be funded by the federal government because the federal government does augment or match what states put into their Medicaid program," said Reiss.
Shumlin will make his recommendation on Medicaid funding at a time when the state faces a $100 million budget gap for next year. Asked if he'll propose new revenue to pay for this program, the governor said, "stay tuned."
