Phil Scott rebukes Vermont health board, calls for ‘active oversight’ from executive branch

Tension between the Green Mountain Care Board and Gov. Phil Scott came to a head this week as the administration announced it plans to tighten regulation of the independent body. 

Scott outlined his intentions in an incendiary letter that accompanied his signature on S.285, a bill that gives the care board more than $4 million to come up with a “patient-focused, community-inclusive plan” for setting hospital budgets. 

Scott said he “reluctantly” signed the bill, but also instructed the executive branch to hold the Green Mountain Care Board “accountable for providing thoughtful and effective regulation in the upcoming hospital budget and health insurance rate reviews.”

The letter is the latest indication that the Scott administration and the care board are out of step when it comes to health care in Vermont. The administration wants the Green Mountain Care Board to regulate, not legislate. 

Board members, on the other hand, have become increasingly concerned about ballooning hospital spending and the implications of the cost of care. They argue that coming up with innovative ways to regulate hospitals is well within the board’s purview. 

Kevin Mullin, outgoing chairperson of the Green Mountain Care Board, accused Scott of overstepping. He said the board is ready to work with the administration, but noted the board has legal standing to ignore the administration’s attempts to intervene in this year’s budget cycle.

“Clearly this letter is an overreach of statutory authority for oversight” by the Scott administration, Mullin said. “We will work collaboratively with them because this is something that’s very, very important to Vermont’s economy but (Scott) just doesn’t have the statutory authority to exert influence over the board.”

The care board, established during the Shumlin administration, exists outside of the executive branch of state government. The five-member body is responsible for regulating hospital budgets, insurance rates and the state’s only accountable care organization, OneCare Vermont. State law gives Scott the right to appoint board members from a short list compiled by a nominating committee, but the board itself is independent. 

Scott’s press secretary, Jason Maulucci, said in an email Friday that the administration intends to participate in the Green Mountain Care Board’s regulatory process “like any other stakeholder.”

Maulucci said the board could ignore the administration, but doing so would “distract from the work the Board must do this summer to stabilize the healthcare system. As the Governor’s letter indicates, failure to do so will result in proposals to change the role of the Board.”

The battle between the governor and the Green Mountain Care Board stems from a difference of opinion over leadership in health care policy. Care board members sought to play a larger role in state policy through S.285, a bill that was designed to give the board greater authority to regulate hospital budgets. 

But after hospitals and Scott administration officials opposed the bill, legislators blunted it considerably, inserting language that affirms that the executive branch — not the care board — should chart the course of health care policy in the state. 

Instead, the final bill gives the Green Mountain Care Board more than $4 million to come up with the “patient-focused, community-inclusive plan” for setting hospital budgets. The bill also directs the Agency of Human Services and the care board to work together on a new proposal that may, but not necessarily, include the budget-setting authority the board wanted.

Scott’s letter calls for “rigorous oversight” of the care board’s activities to ensure “full transparency.”

Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems, said his organization opposed the bill. 

“We do agree with the position that the Green Mountain Care Board should focus on predictable and fair regulation, not policymaking and planning,” he said.

Mullin said Scott’s reaction to S.285 mirrors the position of hospital leaders who resisted the bill from the start.

“We can’t just let the status quo go on forever. … (Hospitals) would like to just be left alone. I understand that,” Mullin said. “But unfortunately, Vermonters can’t afford for them to be left alone.”

Correction: A previous version of this story incorrectly stated that the governor’s office did not respond to requests for comment.

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