2006 Legislative Updates:

 March 17, 2006

The House debated H.861 -- Health Care Affordability for Vermonters -- for two days, March 2nd and 3rd. During this second day of debate, the Republicans offered several amendments. Here are selected portions of the debate.

Chronic Care Infrastructure and Prevention amendment offered by Rep. Alan Parent (R - St. Albans)

Rep. Parent:

This amendment allows Vermonters to purchase medical insurance from out of state insurance carriers.

Rep. Milkey (D - Brattleboro): How will Vermonters take advantage of an insurance company in North Dakota?

Rep. Parent: This proposal will more than nudge people to use the Internet to shop for insurance outside of Vermont.

Rep. Milkey: The biggest complaint of Vermont providers is different policies, claim forms, and reimbursement rates. It is unlikely Vermont providers want to join out of state networks. And providers would be subject to more laws, different claim forms and procedures. There would be no one in BISHCA to help consumers deal with insurance companies from another state.

Rep. Parent: Not every point is feted in any bill -- and that is the case with this amendment.

Rep. David Sunderland (R - Rutland Town): Out of state insurance companies would need to be certified by BISHCA. Vermonters are purchasing drugs out of state through the I-Save RX program. Why not insurance companies from out of state? Yesterday, we heard that the Vermont health care system is broken. Now, we are hearing it is pretty good -- I'm confused. Which is it?

Rep. Parent: Vermont could be the 1st state to say we need a national plan, common documents, claim forms and procedures.

Rep. Harry Chen (D - Mendon): The Health Care Committee considers this an unfriendly amendment. We defeated it 0-10-1.

The one absent vote was Rep. Malcolm Severance (R - Colchester) who was not present for the committee neither meeting nor floor debate. The Parent amendment failed 52-85-12.

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Employer-Sponsored Insurance Plan amendment offered by
Rep. Pat O'Donnell (R - Vernon)

Rep: O'Donnell: My husband and I own a business and we provide insurance to our employees. We feel we have a responsibility to our employees. This is not easy. We see it as a cost of doing business and it is a tax write off. This is why the Chamber of Commerce is not opposed to ESI. I've worked on Medicaid for a long time. I got beat up expanding Medicaid and I got beat up limiting Medicaid.

Rep. Steve Maier (D - Middlebury): Is this amendment language taken from the Governor's bill?

Rep. O'Donnell: Yes.

Rep. Maier: How would it work?

Rep. O'Donnell: State would pay a stipend to the employee to get insurance from their employer.

Rep. Maier: How many would this cover?

Rep. O'Donnell: Can't find the numbers this minute.

Rep. Maier: Would the employer be required to spend more money?

Rep. O'Donnell: As we discussed in committee this morning -- the member has the numbers.

Rep. Maier: JFO's estimate is $45 million for ESI.

Rep. O'Donnell: I'm not sure of JFO's numbers -- but I am confident in OVHA's figures.

Rep. Maier: So we could end up with the complete privatization of Medicaid?

Rep. O'Donnell: No. My goal is to decrease the Medicaid deficit and increase the number of insured without adding to the cost shift.

Rep. Maier: The Health Care Committee did hear from the member this morning. Because of concern for the ESI mandate and cost shift to the employer, we voted to oppose this amendment 1-9-1 -- we view it as unfriendly.

The O'Donnell amendment failed by a roll call vote 55-82-12.

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Amendment offered by Rep. Anne Donahue (R - Northfield) to report economic and financial impact studies to the legislature by January 2007

Rep. Donahue: Catamount Health is a can of worms. We need the studies to make our decisions -- right now there is no second option. The biggest ticket item in this bill is the $132 million to get one third -- only one third -- of the uninsured covered. We face a $200 million deficit in four years -- we are mortgaging the Medicaid enrollees.

We agreed to the Global Commitment because we are in a hard place with Medicaid. There are reasons to be nervous about the bill's assumptions about cutting costs -- what if we don't save the projected dollars? Catamount allows for 8.5% inflation growth. Nothing else in our budget grows at that rate -- this is not sustainable funding. This is a plan for a disaster -- there is an elephant in the room. It's Medicaid.

Why not just expand Medicaid? If we had the data from the studies, H.861 might look like a good plan or a bad plan. Without the data, how are we to determine its viability? Do we have to move ahead this year? Yes, because we have been working on this since 1995. Other than Catamount, we can agree on other things in this bill. If Catamount doesn't get the enrollees, it just stays as a child's plan. If it turns into a parent's plan, it will turn into a monster. Without the data, we can't see beyond the first bend in the road. This amendment has the support of the hospital association.

Rep. Tracy: We know that not having insurance is not good for Vermonters' health. Studies show that 2 to 3 times more people without insurance die than those with insurance. The uninsured hits us all in our pocket book. We don't need studies to show we have a problem and need a chronic care initiative. FDR said "take a common sense approach, try it, if it fails, try again until it works."

Rep. Lucy Leriche (D - Hardwick): Our committee heard testimony this morning on this amendment. We defeated it 2-8-1 and consider it unfriendly.

The Donahue amendment failed 54-80-15

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Amendment offered by Rep. Tom Koch (R - Barre Town) refining eligibility and residency requirements

Rep. Koch: My amendment takes eligibility language from H.861 and adds provisions that to be eligible the individual must have filed an income tax return and must not have employer insurance at least as favorable as Catamount. Additionally it tightens up the residency requirements for providing coverage to uninsured Vermonters. And it requires that premiums be calculated annually.

Rep. Maier: This morning the Health Care Committee heard from the member from Barre (Rep. Koch) and rejected the amendment as unfriendly by vote of 3-7-1. Our definitions are similar to those in VHAP and we haven't seen any problems. Also, we had concerns that this amendment would not integrate well with the chronic care initiative.

Rep. Janet Ancel (D - Calais): Some low-income Vermonters don't file income tax returns. And the administration can improve residency rules. So, I don't think we need this amendment.

The amendment failed on a roll call vote 21-82-36. By this time many Republican members had walked out of the House Chamber. This was a procedural maneuver to prevent debate continuing on H.861. However, the Speaker made a ruling that allowed the House to continue consideration of H.861 and the amendments.

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Amendment offered by Rep. Koch to appropriate funds for grants to primary care clinics

Rep. Koch: I must like losing battles. Emergency rooms are misused by people who show up on a Saturday night with a pain that started three days ago. Why? Because the primary care provider isn't available on the weekends. Many of these problems could be treated by a physician's assistant. So why not have primary care clinics open all the time? This amendment provides $1 million in seed money to start this process.

Rep. Maier: The Health Care Committee heard from the member this morning. We are concerned that this amendment might increase costs because of the rural nature of Vermont. The committee voted to reject this amendment 0-10-1. We consider it an unfriendly amendment.

This amendment failed on a voice vote.

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Amendment to transfer funds to the Vermont National Guard offered by Reps. Joseph Krawczyk (R - Bennington), Mary Morrissey (R - Bennington), Greg Clark (R - Vergennes)

Rep. Krawczyk: This amendment would redirect money to the Vermont National Guard to fund family support and counseling services to National Guard members and their families through June 30, 2007. I was anticipating studies to help me evaluate H.861. Yesterday, Rep. Tracy said, "We don't need any more studies." But H.861 does have more studies. So, why not use the money for a more immediate and worthwhile purpose.

Rep. Tracy: I want to correct the record. I said we have enough information to move forward on H.861. Yes, we do need more studies to go the next steps after H.861. A similar National Guard bill came out of the Appropriations Committee this morning. I request a "no" vote on this amendment.

Rep. Leriche: I resent using our troops as pawns to deny moving forward on health care.

The amendment failed on a roll call vote 58-76-15.

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At 6:15 p.m., the Speaker called for a final vote on H.861. The bill passed 77-58-14 on a roll call vote and now moves to the Senate.

Following 8 hours of debate, a preliminary vote was taken on H.861. The bill passed second reading by 81-56.

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.