The man who helped spearhead health care reform efforts under outgoing Gov. Peter Shumlin is getting a major role in the administration of Governor-elect Phil Scott.
Al Gobeille, chairman of the Green Mountain Care Board since Shumlin appointed him to the position in 2013, will serve as Scott’s secretary of human services. As the head of the five-person board that regulates almost every aspect of the health care system in Vermont, Gobeille has been at the center of payment-reform efforts under Shumlin.
Gobeille says he looks forward to continuing that work in his role as secretary of the Agency of Human Services, which, with an annual budget of about $1.5 billion, is by far the largest agency in state government.
“When you look at health care in Vermont, and you think about all the reform work we’ve been doing, the most important thing in government is basically the Agency of Human Services,” Gobeille says.
Gobeille was among a number of appointments announced by Scott’s transition team Tuesday afternoon. Deputy Attorney General Susanne Young will serve as Scott’s secretary of administration; Rebecca Kelley will serve as director of communications; John Quinn will serve as chief innovation officer; and Tayt Brooks will take a role as director of affordability and economic initiatives.
Gobeille has been among the most vocal proponents of the so-called “all-payer model,” which seeks to transform the way Medicaid, Medicare and private insurers compensate health care providers for procedures and services.
"When you look at health care in Vermont, and you think about all the reform work we've been doing, the most important thing in government is basically the Agency of Human Services." — Al Gobeille
In October, the Shumlin administration entered into a contract with the federal government that will give Vermont more latitude over how Medicare dollars can be used. Gobeille said at the time that the arrangement would hasten Vermont’s transition away from the “fee-for-service” compensation model that he and others say will eventually bankrupt the health care system.
During his gubernatorial campaign, Scott had expressed some skepticism about the all-payer proposal. Gobeille, however, says he and Scott intend to work within the all-payer framework as they move forward with reform efforts.
“Let me be really clear – it wasn’t like I was trying to convince him,” Gobeille says. “It was more of a conversation about how we would go about it.”
Gobeille says his role as secretary of human services will extend far beyond the health care reform work he focused on at the Green Mountain Care Board.
“You know, you have to run the agency really well for the most vulnerable today," he says. "Talking about [health care] reform in the future is really important, but that doesn’t mean you can look away from the central mission that they perform.”
The agency includes the Department of Health, Department of Corrections, Department of Aging and Independent Living and the Department of Vermont Health Access.
Scott’s pick for this high-profile position was being closely watched in the Democratically-controlled Legislature. Addison County Sen. Claire Ayer, the Democratic chairwoman of the Senate Committee on Health and Welfare, says she’s buoyed by the selection.
Ayer says with Gobeille’s term on the Green Mountain Care Board expiring next year, she and other legislators had been worrying about his departure from the health care scene.
“I think this might be one of the best choices we have for how we work with Al Gobeille’s departure – he’ll be just moving,” Ayer says.
"I think this might be one of the best choices we have for how we work with Al Gobeille's departure — he'll be just moving." — Sen. Claire Ayer, Senate Committee on Health and Welfare chairwoman
Ayer was on the committee that forwarded Gobeille’s name Shumlin for consideration for the board in 2013. Gobeille and his wife own and operate a number of restaurants, and Ayer says the committee was looking for someone with his kind of business experience to lead the board.
“But I never imagined that he would gain the breadth and depth of understanding that he has in health care,” Ayer says. “It’s been a wonderful thing to see.”
Ayer says Gobeille has proven a “quick study,” and she says his ability to distill complex policy dilemmas might make him a useful spokesperson for the agency’s many thousands of clients.
“It could be a real advantage to people who need the services of the Agency of Human Services, because the governor and the administration will understand them better because of Al,” Ayer says.
Still, Ayer says that as secretary, Gobeille will be “carrying the water for the governor.” And she says lawmakers and the administration face inevitable tension over how to balance limited resources with expanding needs.
Gobeille says he appreciates the gravity of the decisions he’ll soon help consider.
“You’re at the heart of the issue of government – what are the priorities? And how do you pick priorities?” Gobeille says.
