2006 Legislative Updates:

  January 22, 2006

Dr. Kenneth Thorpe: Last week there continued to be controversy surrounding Dr. Thorpe's presentation to the Health Care Reform Commission. The report examined the financing options for health care reform in Vermont. Many in the health care reform community were expecting to see an option for broad based financing of a universal access system. This was not the case.

In Massachusetts, Thorpe recently released a study called "Action Costs Less" that examined three financing options for the years 2006 - 2015.

Option 1: "Inaction"

For the next ten years, average annual growth of wages will be 3.2%; gross state product 4.8%; health care costs 7.5%.

Option 2: "Universal coverage, expanded in a combined public and private system; cost containment, quality improvement"

Number of uninsured and underinsured drops to virtually zero, health care spending is 4% lower and first year savings are $800 million.

Option 3: "Universal coverage, expanded in a solely public system, cost containment, quality improvement"

Number of uninsured and underinsured drops to virtually zero, health care spending is 13% less, first year savings is $6 billion, 5 year savings $42 billion and $105 billion in 10 years.

There was much speculation as to why option 3 was missing in the Vermont presentation.

Statehouse lobbyists had different opinions.

• "Thorpe ran out of time on his contract."
• "The data is available but is not being released."
• "The option would not be studied at all.

There was no consensus on why that part of the study was missing.

Vermont Chapter of the American Academy of Family Physicians: Three primary care physicians testified this week before the House Health Care Committee. Dr. David Rice, president-elect of the Vermont Chapter, said, "We want and support a medical home for each Vermonter. The first step to better health care is to give every Vermonter access to primary care."

"Fifty percent of our patients have a chronic illness", Dr. Rice said, "Half of those have multiple chronic diseases." He stated that family physicians needed tools and resources to effectively manage these patients.

"We need loans to capitalize and implement health care information systems at the physician practice level. Better management of patient information allows us to better manage the physician relationship with patients"

Rice said, "In our practice we have a full time staff of 16 to support five physicians." Appropriate information technology and common claim forms would enable the physicians to significantly reduce their administrative staff.

House Health Care Committee: The committee declared their vision for health care reform this session is "everybody covered, everybody pays, bend the cost curve."

Last Friday, the committee started the mark up of "An Act relating to Health Care Affordability for Vermonters." The six-page bill uses the Coalition 21 principals as the framework for reforming health care in Vermont.

The first draft focused on Chronic Care Management and increasing Medicaid reimbursement to equivalent Medicare rates.

Throughout the day, Rep. Topper McFaun (R - Barre Town) forcefully urged the committee to expand the bill to provide hospital coverage for Vermonters.

There was much discussion about what to include or not include in a bill this year. Here are selected comments made throughout the day:

• Rep. McFaun: "My bill H.564 - 'The Vermont Hospital Security Plan' -- is the only one to cover everyone. Providing coverage for hospitals is good for businesses and reduces administrative costs -- everyone is in."
• Rep. Harry Chen (D - Mendon): "But we need to look at reality."
• Rep. McFaun: "During the public hearings in the fall, we heard the reality -- Vermonters saying help me out."
• Rep. John Tracy (D - Burlington): "I don't want to move too fast on this. We need to educate Vermonters first."
• Rep. Chris Louras (R - Hardwick): "Adding hospitals substantially changes the committee's bill."
• Rep. McFaun: "We can go further than just chronic care. There is a huge piece we are not dealing with. Hospital coverage goes hand in hand with chronic care management."
• Rep. Chen: "Chronic Care is not the end all solution but it is something we can get done now."
• Rep. Steve Maier (D - Middlebury):"This is just one section of the bill, there is more to come."
• Rep. Gini Milkey (D - Brattleboro): "MVP tried a chronic care program and it didn't change the growth curve."
• Rep. John Tracy: "What can we do this year? Focus on the uninsured population."
• Rep. Gini Milkey: "Do baby steps - the uninsured first. Second step is the under-insured."
• Rep. Maier: "This year we can create a model for covering the uninsured. Later we can use the model with other populations."
• Rep. Sarah Copeland-Hanzas (D - Bradford): "Convince me why we need to do a pilot for IT. Why not just do it?"
• Rep. McFaun: "I'm with Sarah -- the technology exists, the pilots are already done."
• Rep. Chen: "Ok, do it, no pilot."
• Rep. Malcolm Severance (R - Colchester): "People worry about hospital costs -- we should consider reinsurance."
• Rep. Tracy: "I don't want to bring something out that doesn't go anywhere."
• Rep. Lucie Leriche (D - Hardwick): "Some hospitals are interested in pilots to do global payment, maybe we should pursue these."
• Rep. Joe Baker (R - West Rutland): "Because of my job, I like to take the scientific point of view. We need to establish a list of hospital changes and identify all the variables."

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.