2006 Legislative Updates:

  February 21, 2006

"There are two things you don't want to see being made -- sausage and legislation." Attributed to Otto von Bismarck (1815-1898).

H.861 - Health Care Affordability for Vermonters: The House Health Care Committee reported out their bill by a 9-2 vote last Thursday. The committee worked through a dozen or more drafts before they felt comfortable enough to vote on it. Here is a selection of comments made by committee members as they marked up, line by line, 32 pages of legislative language:

"A word is missing in this sentence."

"It is just too crazy a financing system we have."

"We need to soften the language here."

"Are we sure we will get a waiver from CMS?"

"This word is redundant."

"That was the decision last night -- are we going back on it?"

"Are we getting answers from OVHA?"

"There are no changes on page 3."

"Here, we need to harden the language."

"Consider the change done."

"This is warm and fuzzy language."

"Should that be subsection 1 and 2, or should it be subsection 1 or 2?"

"My constituents don't want high deductible plans."

"How should we define 'uninsured"?"

"Are we getting answers from BISHCA?"

"Where does the comma go?"

"Let's undo the change from last night."

"Yesterday, I thought we solved the residency issue."

"Get Charlie [Smith, secretary of administration] in here."

"This language is elegant."

"That's a term I learned from my wife."

"Let Ways and Means figure out how to finance it."

"No changes on page 11."

"Robin [legislative counsel and drafter of bill], could you sort that out?"

"That is certainly is not the intent."

"Was that in the last draft?"

"This language is awful!"

"Why can't the administration be here before 4:30 -- we need an answer now."

"How did we define chronic care?"

"If the patient had a broken hip, would she be covered under this section?"

"Let me tell you what it means to me...."

"My constituents want primary and preventive care."

"Is it or isn't it in the bill?"

"Robin, how would you phrase that?"

"Has Ken [Thorpe, health policy consultant] modeled those numbers?"

"What is the take up rate?"

"Sorry, I'm just mumbling."

"We should include the naturopaths."

"This is a section we need to drill down into."

"Page 18, no changes."

"Let the good doctor [Rep. Harry Chen] work on it."

"We can't do it all -- this is just a first step."

"My constituents want a road map so they know where we are taking them."

"What's our definition of 'insured'?"

"Was that a medical society or hospital association suggestion?"

"We need to add a word or two -- it just isn't clear enough."

"We will have to educate Vermonters on that."

"Why do we need an outside vendor to manage chronic care?"

"What did the family docs say when they were in here last week?"

"Actuarially equivalent -- are we sure?"

"Robin, we are going to have to tweak that a little."

"Chicken or egg problem -- define benefits or cost first."

"I'm not trying to be difficult -- I just think we should do the hospitals first."

"That's a hard section -- can we deal with it later?"

"Will the Health Access Oversight Committee work with us?"

"What did we do last session in H.524?"

"Are we factoring in demand elasticity?"

"Can we afford this benefits plan?"

"Is it voluntary?"

"Will we attract enough of the uninsured?"

"Employers might drop their insurance and let the state do it"

"We'll get to the vision thing later."

"Ken [Thorpe, health care policy consultant] needs to help us on the premiums."

"So it isn't mandatory, that's good."

"Steve (Kappel from the Joint Fiscal Office], would you mind explaining the reinsurance thing again?"

"I defer to Robin."

"Let's leverage federal dollars."

"Is there a level of comfort with his section? Can we move on?"

"Another pilot project -- do the hospitals really want this?"

"My constituents are scared of catastrophic medical expenses."

"Do we dare do more studies?"

"Are we doing anything for the under-insured?"

"We obviously can't figure that out today."

"If we are working late tonight, I have a child care problem"

"So, it isn't mandatory?"

"An HSA [Health Savings Account]doesn't qualify."

"What is the attachment point?"

"The governor can call it anything he wants -- looks like a tax to me."

"Will this muddy the waters for future legislators?"

"No changes on page 27, thank god."

"Do we appropriate any money in this bill?"

"I need convincing on that one."

"It's late and I need to go, so I can coach my hockey team."

"Does this attract too many of the uninsured?"

"Can the Joint Fiscal Committee give us some help in the off session?"

"Steve, can you walk us through the global commitment again?"

"My constituents want to know what we are doing for them."

"You've done well, Robin."

"What happens if we get rid of the 12-month waiting period?"

"We are a citizen's legislature -- none of us are experts."

"This is complicated stuff."

"We are talking about health care reform, aren't we?"

"Legislation is much more diverse than sausage; law is much greater in scope. And it is much more indeterminate. The legislative process in Congress and the states is sui generis, incomparable, not like anything else in our experience -- and pretty much the way it ought to be." Comments by Alan Rosenthal, professor of political science at the Eagleton Institute of Politics at Rutgers University.

Vermont Health Care for All would like to thank VPIRG for their generous support of the 2006 Legislative Updates. They are also available on the VPIRG website http://www.vpirg.org. They will be produced throughout the 2006 Legislative session by Paul Forlenza. Forlenza can be contacted at paul@forlenza.us or 802-453-3592.