Category Archives: Health care

Are We Sure the Green Mountain Care Board Knows What the Hell It’s Doing?

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Shots fired!

In response to revenue cuts ordered by the Green Mountain Care Board, the University of Vermont Health Network is slashing services at multiple locations. Most egregious, to me, is the closure of Central Vermont Medical Center’s inpatient psychiatric unit.

Reminder that we’ve had a chronic shortage of inpatient psychiatric space more or less continuously since 2011, when Tropical Storm Irene put the final nail in the old Waterbury state hospital’s coffin. And now we’re cutting eight beds?

A cynical observer might infer that UVMHN disagrees with the Board’s mandate, and is forcing the issue with unpopular and/or unworkable reductions. Seven Days’ Derek Brouwer wrote that the Network’s announcement “ratchets up a long-simmering tension” between the Health Network and the Board.

The Board was in a ratcheting mood itself. It issued a huffy statement Thursday afternoon expressing deep concern with the cuts and asserting that it “was not consulted on, and did not approve, these reductions.”

Well, boo frickin’ hoo.

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“I Am Big. It’s the Pictures That Got Small.”

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Howard Dean floated onto his balcony this afternoon, favored the adoring crowd below with a regal wave, turned his back, and disappeared into the billowing curtains.

Okay, not really. What he did was issue a lengthy, self-indulgent statement about his dalliance with running for governor that didn’t actually make a commitment either way. In other words, stay tuned!

Methinks he’s getting a kick out of having #vtpoli-land hanging on his every word for the first time since he ran for president nearly a generation ago.

All he said about running was that he would hold “a press event when and if I file.” Curiously, he then sent a text to VTDigger declining its interview request because he is “not doing interviews until I file.”

Until, eh? Not “Until or unless”? Freudian slip? Intentional foreshadowing? Misdirection for the sake of drama? Only Dean knows for sure.

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Veepies Resurrexit a Mortuis

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It’s been a loooong time since I last awarded the Veepies — @thevpo’s honors for exceptional stupidity in our politics. But the end of the year seems to have brought out the stupid in folks, so here we go!

First off, the Any Old Excuse In a Storm Award goes to the fearless folk who wear the uniform of the Vermont State Police. This has to do with their continuing failure to bring Daniel Banyai into custody. They allowed the original arrest warrant to expire. Now, they seem to be in no hurry to act, in spite of the fact that Banyai is defying a court order to turn himself in.

That’s bad enough, but there’s one singular item in VTDigger’s account that spurred the Veepies Board of Trustees to action. VSP spokesperson Adam Silverman helpfully told Digger that Banyai is one of roughly 5,200 people in Vermont with some kind of active warrant. I guess that’s supposed to impress me? But c’mon now, most of those warrants are not at all time-sensitive. Banyai has been defying justice and terrorizing the town of West Pawlet for years, as chronicled in a recent New Yorker piece. He ought to be on top of the VSP’s priority list, and they shouldn’t have the temerity to even suggest that he’s merely one among thousands.

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From Now On, Doug Hoffer’s Press Releases Will Include an Audio File of an Exasperated Sigh

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On Friday, December 22, state Auditor Doug Hoffer did something almost routine — but did it in an unusual way.

The routine: Hoffer issued a memo pointing out that there’s no evidence that a state workforce incentive program has any beneficial effect. The unusual: He sent it out at 2:26 p.m. on the Friday afternoon of the Christmas holiday weekend. As you might expect, there was no immediate coverage from any Vermont news outlet, all of whose members had their eyes fixed on the nearest exit when the auditor’s missive hit their inboxes.

It’s almost as though Hoffer realizes that when it comes to state incentive programs, he’s a lonely voice howling into the void. So why not simply launch his note directly into the void?

Perhaps that’s just my inner cynic talking. But really, does it make any difference whether he shoves this thing over the transom on a holiday weekend or calls a press conference in a prime spot? It’s probably going to have the same effect.

Which is to say, no effect whatsoever.

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If They’re Pondering a Rebrand, I Suggest “Illpath”

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Vermont’s three-year prison health care contract with troubled provider Wellpath is off to a whizbang start. Right off the bat, 15 inmates at the Northwest State Correctional Facility were given the wrong medication by Wellpath providers for their substance use disorder. And now, we have a Wellpath employee in a highly responsible position who has — well, I’d call it a “checkered past” except that all the squares seem to be the same color.

In September, Wellpath hired Robert Stevenson to be its top employee at the Southern State Correctional Facility. Turns out Stevenson lost his nursing license in three different states for “diverting or wasting opioids,” according to VTDigger.

And we only know this because one of his subordinates looked up his record, discovered his malfeasances, and reported it to Wellpath. Its response? The whistleblower was fired.

I’d call this a clown car, but that would be unfair to clowns.

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Vermont Continues to Enable Health Care Sharing Ministry Scams

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Well, we almost did it.

Back in 2019, the Vermont Legislature adopted a bill imposing penalties on those who didn’t have health insurance. But the bill included an exemption for those enrolled in so-called health care sharing ministries instead of actual health insurance. That same year, the Scott administration and the Attorney General’s Office issued a consumer warning about the perils of choosing an HCSM over insurance.

Now it’s 2023, and there are almost certainly more Vermonters in HCSMs now than there were four years ago. (HCSM participation grew dramatically during the Covid pandemic as many lost their insurance coverage due to unemployment, and were desperate for any cheaper option.) And we haven’t done much about it at all.

This issue came to my attention when I was writing up former health care reform opponent and former Trump administration appointee Darcie Johnston’s employment with the Alliance of Health Care Sharing Ministries. I didn’t include Vermont’s own sad little history because (1) I needed to do more research and (2) I do try to keep these posts from getting painfully long. But now it’s time to tell Vermont’s part of the story.

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Darcie Johnston, Now Advocating for Scammy Christian “Health Ministries”

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Hey guys, remember Darcie Johnston? Former head of Vermonters for Health Care Freedom, the conservative advocacy group that fought tooth and nail against single-payer health care? Wannabe campaign consultant with a dismal track record? Former Trump administration functionary who had a lead role in one of its many fuckups during the early days of the Covid pandemic?

Well, it has come to my attention that Johnston is now Deputy Director of something called the Alliance of Health Care Sharing Ministries, which lobbies in D.C. and state capitols on behalf of an industry that profits off the gullibility of conservative Christians — a business model that’s never been known to fail.

Health care sharing ministries market themselves to Evangelical types as a cheaper option for health coverage — but when it comes to regulatory oversight, insist they are not insurers at all, just simple humble charities. The last thing they need is pesky state or federal regulators sticking their noses into the Lord’s work.

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A Deal We’re Likely to Regret Someday

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Blue Cross and Blue Shield of Vermont is about to be swallowed whole by one of its much larger cousins. The deal seems benign and, since it holds out the promise of lower costs for health insurance, it’s virtually certain to go through.

The unintended consequences will come later. As will the intended consequences.

The proposed deal, first announced in May, is on a fast track to approval. The state Department of Financial Regulation set aside a two-week window for public comment, which closes the day after tomorrow. Next week, the DFR will hold a public hearing. After that, approval seems a certainty. The two partners have said they want to finalize the arrangement by October 1.

The deal involves BCBSVT, which I will call “Vermont Blue” for clarity’s sake, becoming “affiliated” with Blue Cross Blue Shield of Michigan, or “Michigan Blue.” And despite the seemingly collegial tone of “affiliation,” it’s a takeover. Like a shark devouring a tasty fish.

Or, to change midstream to a different animal analogy, Michigan Blue is the dog and Vermont Blue will be the tail. Michigan Blue insures more than five million people; Vermont Blue, at 200,000, will effectively be a rounding error on Michigan Blue’s bottom line.

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We’re Not Retreating. We’re Advancing to the Rear.

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What is an institution to do when it makes a decision that kinda blows up in their face? Well, one option is to stick with the decision but modify it just enough to quiet the critics. Or to put it metaphorically, apply enough lipstick to a pig and make people stop noticing it’s a pig.

As it happens, two august Vermont organizations are currently engaged in the messy business of searching for the minimum acceptable capitulation. Vermont State University is trying to figure out how many books it will have to preserve, not because it wants the damn things, but because it desperately needs to quiet the howls of criticism; and the Green Mountain Care Board is looking for a way to give away $18 million while convincing us that they’re not giving away $18 million.

VSU’s nascent leadership continues to fumble its plan to close the campus library system… sorry, create something better than libraries… no wait, they’ll still be libraries but unencumbered by books… oops, now we’ve got a “refined plan” that will select the most academically important volumes while disposing of the rest. (You can tell they’re proud of their plan because they posted it online last Thursday with no formal announcement or public event of any sort.)

Gee, it’s almost as if the original plan was thrown together in haste with minimal forethought. Which inspires no confidence in the ability of this administration to lead a troubled system out of its current straits and into a better tomorrow. The future of VSU’s library system is way down on the list of critical issues to be addressed. If they can’t handle this without it blowing up in their faces, how will they address a massive structural deficit when they’ve already squandered their credibility dicking around with the library plan?

And all the while, they insist they’ll implement this vaguely defined thing by the end of June, come Hell or high water.

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Housing the Homeless as Economic Development Strategy

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We could view homelessness as a moral failure… or a failure of capitalism… or a failure of individuals to live productive lives… or a problem in need of resources we can’t afford to commit…

Or… just spitballin’ here… a waste of potential and precious human capital.

For this discussion, we’re leaving out the moral and ethical dimensions of the issue. We’re not declaring an obligation to protect our most vulnerable. We’re putting on our green eyeshades and considering homelessness from a purely bottom-line point of view.

To hear the Scott administration tell it, extending the emergency motel voucher program is kind of like taking a pile of money and setting it on fire. It produces a bit of transient warmth, but it’s otherwise a waste of resources. Legislative Democrats and even some housing advocates often fall for this: They tacitly accept the premise instead of making the economic case for (a) giving everyone a roof to sleep under in the short term and (b) ending homelessness in the longer term.

When you look at it that way, you find that we can’t afford not to end homelessness. There is abundant evidence that addressing homelessness is an economic winner — not just in the long term, but almost immediately. So let’s stop talking about whether we can afford $72 million for another year of motel vouchers or $31 million for a stripped-down version of the program or a few hundred million to provide enough housing for all. Instead, let’s talk about the economic positives of a humane policy choice.

(I don’t pretend that any of this is my idea, but it ought to be more of a factor in our policy debates.)

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