Tom Pelham: Just the facts, hold the fiction — a response to Paul Dame

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.

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6 thoughts on “Tom Pelham: Just the facts, hold the fiction — a response to Paul Dame

  1. Having spent many, many weeks and weeks in the hospital, seeing other people at many times of the year, it is pretty clear our system is broken. It’s very clear for so many who have to wait month for any help, and this was PRE covid

    Paul Dame had it right. Vermonters are getting fleeced every day of the week……..this is just another example.

  2. The medical community system along with higher education have one thing in common…..”Lazy Cultures” sustained by easily accessible funds from ever increasing health insurance premiums and student loans.

    Year after year, cost increases in health care and higher ed are simply passed on to consumers. Little or no creative effort is made to contain costs because it is so much easier to simply pass them on to consumers. Until this lazy culture of willing acceptance of escalating costs is broken, the GMCB will be in a losing battle with consumers as the ultimate victims.

    The medical community’s and higher ed’s “lazy culture” of readily accepting rising coast can be broken with focus, perseverance and smart work. Suresh Garimella, President of UVM, is showing concrete results in his effort to break the “lazy culture” relating to cost increases.

    President Garimella recently announced that for the 2021/2022 academic year, UVM would freeze tuition, room and board and reduce student fees. This would be the third year in a row that tuition has been held to zero. Garimella stated: ” We need to reduce the cost of attendance; annual tuition increases, even small ones, are not indefinitely sustainable.”………Why can’t this thinking be moved next door to the UVM Medical Center?

    There is a need for the GMCB to go through medical institution budgets line by line…….but the real savings are to be made by changing cultures.

    Time for the GMCB to begin the push to eliminate the “lazy culture” in Vermont’s medical system……Suresh Garimella can help lead the way.

    An excuse that medical care and higher ed are different is not an acceptable response.

  3. Guaranteed benefits create entitlements and the gravytrain with myriad nonprofits riding the Medical Industrial Express.

    We need to get rid of the model entirely – competition not CON. This could fall in a day if we all received Health Saving Accounts w/direct benefits which is also an entitlement but places the onus upon the industry to compete and create options that have value.

  4. Our health care system is unsustainable. Individuals, businesses, taxpayers, and even our own government cannot afford the ridiculous high cost of health care. Whatever Vermont has done to control health care costs has not worked and it will never work because Vermont is not addressing the real problem. Health care costs have risen faster than inflation for decades and there is no legitimate reason for this.

    It seems to me that members of the GMCB receive excellent salaries to rubber stamp hospital budgets and insurance rate increases. If goals cant be met goals are changed only for the benefit of the hospitals and insurance companies and not the ratepayers.

    Mr. Pelham can not claim that insurance rates would have risen even faster without the GMCB. Maybe the public would have said “NO” to the unsustainable rate increases. I could go on and on about how the Vermont Legislature and the GMCB have failed the ratepayers of Vermont. It will be a shame to watch it all crumble but that is what I foresee for the future.

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