My question is how many people work in the health insurance industry in Vermont and how many of them will be unemployed by the end of this year? Then, since the state does not actually have to begin funding it until 2013, how many of those insurance industry workers will be unemployed by the end of 2012?
As of right now, the single-payer system in the bill passed by the Vermont house wouldn't go into effect until sometime around 2017 because it's contingent upon receiving an ACA waiver, which they can't get before 2017 (if the Wyden-Brown proposal to amend the ACA to make state innovation waivers available earlier were adopted, that would change).
In the meantime, the bill provides for the establishment of an ACA-friendly health benefits exchange in which private insurance is available, with the aim that this exchange ultimately provide the infrastructure for the single-payer system a few years down the line. What's interesting is that the bill calls for a "unified, simplified administration system" for insurers offering plans through the exchange (the system to which they refer includes "claims administration, benefit management, billing, or other components"). So they're already looking to streamline the administrative side of (private) insurance, completely independent of the single-payer phase of the plan.
And when the single-payer part finally goes into effect, there's still a role for the private sector on the paper-pushing front (namely, they'll probably be doing most of it):
§ 1826. ADMINISTRATION; ENROLLMENT
(a)(1) The agency may, under an open bidding process, solicit bids from and award contracts to public or private entities for administration of certain elements of Green Mountain Care, such as claims administration and provider relations.
There are other possible (reduced) roles for private insurers, such as offering supplemental coverage beyond the single-payer's benefit package, though the legislature has kicked the can down the road a bit on deciding whether or not to allow private insurers to offer this kind of coverage (the bill calls for recommendations to the relevant legislative committees on this point by 2012).
But will be there be a substantially reduced role for private insurers (and, presumably, few jobs in that industry in the state) in the future? Yes, administrative savings is one of the strong, though probably not among the most important, selling points for Vermont's proposal. But any money saved--money that stays in the consumer's pocket instead of going into the health care system--is going to be coming out of somebody else's pocket. That goes for everything: nationally, if we want our health spending to be less than 17% of GDP, then that likely ultimately means having fewer jobs in the health-related sector and directing those savings into some other sector.
That said, like most single-payer bills, Vermont's does devote some attention to those on the losing side of the administrative savings. Namely, it commits the state government to:
A strategic approach to workforce needs, including retraining programs for workers displaced through increased efficiency and reduced administration in the health care system and ensuring an adequate health care workforce to provide access to health care for all Vermonters.
