Editor’s Note: This commentary is by Tom Pelham, who is a member of the Green Mountain Care Board. He was formerly finance commissioner in the Gov. Howard Dean administration, tax commissioner in the Gov. Jim Douglas administration, and state representative elected as an independent and who served on the Appropriations Committee.
In his recent misinformed commentary about the Green Mountain Care Board (GMCB), former state representative Paul Dame makes this statement: “While fewer and fewer people are comfortable with putting their family members into nursing homes, the Green Mountain Care Board has intentionally prohibited any new home health care agencies from getting a certificate of need. Why is this?” But rather than accurately answer his rhetorical question, former representative Dame points his finger at the GMCB.
But here’s the truth. Since 2010, state leaders have enacted a law establishing a moratorium on GMCB approval of new home health care facilities. This moratorium was extended by the Legislature in 2016 in Act 117, including the opportunity for review by the Human Services Committee of which Representative Dame was then a member. Yet, Act 117 passed without opposition. The most current version of this law is an extension to 2025 passed in the 2019 session and can be found here. Section 2 (d) of the current law clearly states:
(d) Notwithstanding any other provision of law, no CON shall be granted for the offering of home health services, which includes hospice, or for a new home health agency during the period beginning on the effective date of this act and continuing through January 1, 2020 2025.
Former Representative Dame also states, “[the GMCB] routinely approves the budgets of every major hospital and every insurance carrier with very little changes.” Technically, the first few words of that statement are true as the GMCB, by law, must approve hospital budgets and certain insurance rates. However, the last four words are not true. Prior to the creation of the GMCB in 2013, hospital budgets were rising at an average annual rate of 7.3% but since 2013 the average annual growth rate has been reduced to 4%. For the coming year, 2021, hospital budget increases were kept to a respectable 2.7% on average. The reader can find this information on page 2 here (hospital budget history) . If the reader wants a more thorough view of overall health care expenditures in Vermont, this link might be helpful: Expenditure Analysis.
Regarding insurance rates, the GMCB has an established history of saving rate payers money. This BerryDunn Report documents $108 million in such savings from January 2013 through December 2019. More recently, the rate increase requests of BCBSVT and MVP for 2021 at 6.7% and 6.4% respectively were reduced by the GMCB to 4.2% and 2.7% respectively. Here is a link profiling those rate reductions. These reductions alone, valued at almost $19 million, certainly cannot be categorized as “very little changes” as Dame’s commentary asserts.
Another misleading assertion by former representative Dame is that the GMCB has “more than tripled their own budget from around $2 million in 2010 to $7.7 million this year.” This, too, is inaccurate. The board was created in 2013 with an initial budget of $2.47 million. From that point, it’s true that the GMCB’s budget has grown, but much of the growth was driven by the transfer of responsibilities and funding by the Legislature from the Department of Banking and Insurance to the GMCB. In fact, these transfers and the board’s budgets were all approved, to the penny, by the state House leaders. The GMCB cannot simply choose to increase its own budget. As it should be, it cannot do anything without legislative and executive approval. For more current context are the recent reductions to the GMCB’s budget. In 2017 the GMCB’s legislatively approved budget was $9.57 million vs. a 2021 budget of $7.74 million — a more than 19% cut attributable to the GMCB’s efforts to stay within Gov. Phil Scott’s budget strategies to keep state government affordable. At $7.74 million, the GMCB’s budget equates to just over a 1/1000th of health care expenditures in Vermont.
Fortunately, former representative Paul Dame’s slanted view of the GMCB and the board’s persistent efforts to implement health care reforms are not widely shared by those on the ground of Vermont’s health care system. Here are some recent observations of others productively engaged in the hard work of making Vermont’s health care services as affordable and of high quality as possible.
Yes, of course the GMCB has imperfections, but groundless finger pointing will not lower the insurance premiums or deductibles of Vermonters or improve the quality of the health care they receive. The GMCB’s work is guided by Vermont’s open meeting law and nearly all its work is done transparently in an open, public forum. As we begin the new year, Mr. Dame is welcome to share his ideas on increasing affordability, access, and quality across Vermont’s health care system with the board at a public meeting or by accessing the board’s public comment portal. We look forward to hearing from him.