2006 Legislative Updates:

 March 20, 2006

For health care public policy junkies, the first week back, after Town Meeting break, seemed to be in slow motion. There was little progress on H.861.

The biggest news was the renewed desire by legislative leaders to restart the research needed to complete the studies on economic impacts and financing options required by H.524 -- last year's health care reform bill. No timeline was offered for finishing the studies. However, there is agreement that the effort should go beyond Power Point presentations. Instead, legislators are looking for a detailed report.

The mystery of the week was written on the white board in the 3rd floor Health Care Committee meeting room. The last item on a committee agenda was "Vision bill: up to & to include H.564" This is the Vermont Hospital Security Plan introduced by Rep. Topper McFaun (R - Barre Town). The bill would provide hospital care to all Vermonters and offer premium relief. H.564 would establish a global hospital budget for the state and an individual hospital budget for each hospital. The bill would also establish the Vermont Hospital Security Trust Fund. The fund would provide a negotiated annual payment to each hospital.

Tuesday March 21: Senate Finance and Health and Welfare Committees meet jointly with Dr. Ken Thorpe to discuss the H.861 approach to health care reform.

Senate Health and Welfare Committee:

The Senate Health & Welfare committee spent all week listening to the administration present their employer sponsored insurance (ESI) plan for health care reform. The ESI initiative requires that people eligible for Medicaid enroll in their employer's health care benefits program. A 100% state subsidy would be provided for those under 150% of the federal poverty level (FPL). Partial premium assistance would be provided to those between 150% and 300% FPL.

The administration was represented by John Crowley and Herb Olson, Commissioner and General Counsel of BISHCA; Joshua Slen, Director of the Office of Vermont Health Access (OVHA); and Dr. Paul Jarris, Commissioner of the Department of Health. During the week, the committee aggressively questioned -- sometimes with humor -- the administration's approach.

Senator Leddy (D - Chittenden): How would you characterize the cost increase to employers under ESI?

Commissioner Crowley: This is not a tax but an increase cost to employers. Our governor doesn't believe in a taxpayer-financed health care system. Medicare is the biggest single economic threat to our country. Insurance should be purchased in the private sector.

Senator Kevin Mullins (R - Rutland): What is the cost to employers?

Commissioner Crowley: Attorney (Herb) Olson will cover that.

Senator Ginny Lyons (D - Chittenden): Is ESI an open eligibility plan?

Commissioner Crowley: Again, I hope attorney Olson knows.

Senator Lyons: Your basic benefits plan -- what is the universality of coverage?

Commissioner Crowley: Attorney Olson will cover that.

Senator Leddy: I don't see any link between the Chronic Care Initiative and the administration's insurance model.

Commissioner Crowley: Dr. Jarris will answer that.

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Senator Leddy: Who is responsible for implementing the BluePrint and the Chronic Care Initiative?

Dr. Jarris: H.861 has very aggressive timelines -- we will need to hire others to implement alternative organization structures.

Senator Leddy: It is baffling -- on the one hand OVHA is committed to becoming a managed care organization and on the other the BluePrint is creating yet another organization.

Dr. Jarris: If we only look at an insurance model, these approaches will fail.

Senator Leddy: We agree, but the governor's plan is just looking at the insurance model.

Senator Jeanette White (D - Windham): Are we only looking at Western medicine?

Dr. Jarris: We do want to limit this to evidence based medicine -- simply throwing the door open doesn't work.

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Senator Leddy: Josh (Josh Slen was part of the "audience" in the committee room), you are not on the agenda until tomorrow. You are welcome to stay but we won't be taking your testimony until later in the week.

Director Slen: I'll stay, I find this a fascinating subject.

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Senator Leddy: Josh, now it is your turn to testify. We promise to listen and believe.

Director Slen: Those are two different things.

Senator Leddy: You have a stranglehold on the obvious.

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House Health Care Committee: The committee spent the week reviewing S.310 -- the Common Sense Initiative. The bill is a result of the Senate coming to "consensus" -- that is the governor's term -- with the administration. Their discussion focused on common forms and procedures, information technology, medical event reporting, consumer price and quality information, and creating a multi-payer database.

Hans Kastensmith with Capital Health Associates -- a consulting firm hired by the Commission on Health Care Reform -- testified on his examination of health information technology in the state. He also discussed the initiatives underway to improve the use of information technology in Vermont hospitals.

Paul Harrington, Executive Vice President of the Vermont Medical Society, expressed concern about the lack of administration resources for implementing common insurance forms and procedures for processing insurance claims. He went on to say he does support S.310's provision authorizing BISHCA to prescribe the credentialing process used by hospitals and the insurance companies.

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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.