Health bill would allow waivers in 2014


Landmark health care reform legislation signed into law last year by President Barack Obama provides states the option of seeking a federal waiver to opt out of some requirements of the bill as long as certain standards are maintained. That provision was sought by U.S. Sen. Bernie Sanders, a Vermont independent. But the law currently does not allow those waivers until 2017.

Campaign promise

Shumlin, a Democrat sworn in to office earlier this month, promised during the campaign that he would seek a single-payer health care system for the state. He said acquiring the needed federal waivers would be the easy part of implementing such a system. Vermont's congressional delegation is hoping to prove him right.

Sanders joined U.S. Sen. Patrick Leahy and Rep. Peter Welch, both Democrats, at a Statehouse press conference Tuesday morning to announce the "State Leadership in Healthcare Act," which would allow states to move forward with state-level plans three years sooner.

"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. The goal is clear - quality, cost-effective health care for all Vermonters," Sanders said. "This is essential not only for the well-being of all Vermonters but for job creation. We must do all we can to lower the crushing costs of health care that are now devastating Vermont businesses and their employees."

Sanders plans to introduce the bill in the Senate for himself and Leahy. Welch will introduce the bill in the House.

Last year's health care changes extend access to health insurance to about 32 million more Americans. But Shumlin and the state's congressional delegation said Tuesday that states should be allowed to make additional improvements on their own to help better control costs.

Allowing waivers in 2014 will keep states from spending money on health insurance exchanges, which are required for all states by 2014. A state receiving a waiver to implement its own system would likely dismantle the exchange, anyway.

A waiver would allow states to collect federal funding - including Medicaid, Medicare and the Children's Health Insurance Program - to finance state-level pilot health care systems. Those plans must be as comprehensive and affordable as the federal model and cover as many people, however. Waivers will not be granted for plans that offer lower quality or less affordable coverage, according to the Vermont officials.

The bill also calls for HHS to create an application that includes required waivers.

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Shumlin said the legislation will deliver federal money required to implement a state-level plan that covers all Vermont residents in a more timely manner. "We want to do it better and faster than the federal law contemplates. We want to control costs and cover everyone," Shumlin said. "I am so pleased that our congressional delegation supports us in this effort, and I thank them for introducing this important legislation."

The announcement of the legislation comes as the GOP-led U.S. House prepares to vote this week on repealing the federal health care law. While the measure is expected to clear the House, it will almost certainly come to a halt in the Senate, which remains under the control of Democrats.

Leahy said repeal efforts are a step backward. Allowing states to obtain waivers sooner will help better the federal legislation, he said. "While some in Washington are trying to turn the clock back on health reform, Vermont instead is moving forward. This state waiver bill will give Vermont and other states the choice to go above and beyond what the federal health care law does by devising their own reforms," he said. "Vermont has always been a leader in health care quality and access, and this bill will give our state the flexibility we want to offer Vermonters the best care and coverage while controlling costs."

Welch, in a telephone interview, said the proposed changes to federal law will allow Vermont to move forward the way it best sees fit. "We've got to get our arms around the costs and single-payer flexibility would give the governor and the state the ability to do the job," he said. He noted, however, that other states could develop their own plans, which might be very different from what Shumlin hopes to implement.

"If another state wanted to pursue it through another way that works for them, they could," Welch said. "We believe there is a way to get support from among Republicans who may be against single-payer. The waiver is not promoting single payer, it's promoting flexibility," he added.

While "leadership is coming from Vermont," other states are also interested in obtaining a waiver, Welch said, including "red" states. "I've been talking regularly to Gov. Shumlin and he's said some pretty conservative governors are interested in having some flexibility," Welch said.

Cooperation is also expected from the White House, Welch said. "[HHS] Secretary [Kathleen] Sebelius is the one we've had contact with and she's a former governor herself and has indicated significant interest in this. I think we'll find cooperation from the White House in this," Welch said.

Tuesday's press conference precedes a report expected to be delivered to lawmakers today by Dr. William Hsiao, a Harvard University economist. Hsiao was hired by the state to design three separate universal health care plans for the state, including a single-payer plan, according to the law passed last year that calls for the health system options.

"This is just the beginning of this process, and there are other waivers we will need to get it done. If we work together, I am convinced we can persuade the federal government they should not stand in our way," Shumlin said.

Contact Neal P. Goswami at


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