Vermont House to begin health reform debate Tuesday

By Nancy Remsen
Burlington Free Press, March 21, 2011

MONTPELIER — Tuesday the Vermont House of Representatives begins debate on health-care reform — one of the most important bills of the session for Democratic Gov. Peter Shumlin and the Democratic majorities in the Legislature.

Originally touted as an initiative that would head the state to a single-payer system, the 96-page bill now carries a new, less controversial name: “Road map to a universal and unified health system.”

The name change hasn’t eliminated the strong feelings the bill evokes.

The bill emerged from the House Health Care Committee on a party line, 8-3 vote. Six Democrats, a Progressive and one independent, formerly a Democrat, supported the bill; the three Republicans voted against.

“There are just way too many unknowns for me,” said Rep. Jim Eckhardt, R-Chittenden.

Eckhardt said he wasn’t persuaded a single-payer system, by whatever name it’s given, was the remedy for the current, broken payment system. That’s why he worried about committing the state to that solution.

“My feeling is, once it is on its way, you can’t pull back,” Eckhardt said. “How do you say start over?”

Rep. Paul Poirier, I-Barre, voted for the bill and sees it as much more benign. “I’m the sponsor of a single-payer bill, and this isn’t a single-payer bill,” he said. “Change scares people, but this bill doesn’t really do that much.”

The measure, he said, creates a process that could lead to a reformed health-care system. “We are going to be back next year with Health Care Reform Two,” he said. “There are so many places in this process where there are safety checks.”

Steve Kimbell, commissioner of the Department of Banking, Insurance, Securities and Health Care Administration, praised the House bill and said it sets in motion two important changes:

• It creates a health benefit exchange, an insurance marketplace required by the recent federal health reform law. Kimbell said having an exchange that complies with federal specifications would make Vermont eligible in 2014 for as much as $400 million a year to provide insurance subsidies and tax credits to low and moderate-income Vermonters.The exchange could transform — with federal waivers — into Green Mountain Care, a unified, state-coordinated health-insurance program open to all Vermonters.

• The bill establishes a board with authority to regulate health-care costs. For example, the board is charged with reforming the way medical providers are paid to encourage preventive treatment and chronic disease management rather than encouraging procedures.

“We have implemented a strategy that fundamentally, and for the first time, promotes cost control,” said House Health Care Committee Chairman Mark Larson, D-Burlington. “We aren’t talking about shifting costs. We are talking about controlling skyrocketing costs.”

The board, which would be created this summer, long before it could assume its regulatory role, also would be charged with laying the groundwork for a more unified health-insurance system. It would, for example, develop the health benefit package for Green Mountain Care.

Rep. Christopher Pearson, P-Burlington, who voted for the bill in committee, said the House vote is a measure of lawmakers’ political courage to move toward the more unified system that studies in 2000, 2006 and this year all say would save money.

“This bill alone doesn’t deliver the kind of reform many people want to see and some people are afraid of,” Pearson said. “But it puts in place a process so we can get there and do it right.”

For critics and skeptics, the biggest unanswered question is the cost of reform.

Rep. Tom Koch, R-Barre, sees the cost controls that supporters are touting as “nothing but rent control. It doesn’t work,” he said. “We are going to ruin a good health-care system.”

“Our members said they want to understand the cost and impact,” said Cathy Davis of the Lake Champlain Regional Chamber of Commerce. The bill gives the Shumlin administration until January 2013 to deliver a plan to pay for Green Mountain Care.

“Waiting two years is difficult,” Davis said. Businesses want more certainty about what the change would mean.

Rep. George Till, D-Jericho, said the bill sets out a backward process. He would have preferred if the financial model had been developed before the Legislature committed the state to a path of change. Still, Till voted for the bill, because the Legislature’s financial experts are to provide lawmakers with a fiscal analysis by April 21.

Till also called significant the elimination of references to a single-payer system. It recognizes the reality that the state can’t set up such as system. The state can simplify and centralize claims administration, but it can’t force businesses that self-insure their workers to abandon that coverage because of federal law.

Despite his support, Till said there are risks to the bill. One area of concern is whether the changes would result in doctors’ leaving the state.

Till has been conducting an online survey among physicians licensed in Vermont and had received 469 responses as of Friday. He said 62 percent support a single administrative pipeline, but those responding were nearly evenly split about a single-payer system. Some 28.3 percent said they would stop practicing in Vermont if the state adopted a single-payer system.

“Removing the single-payer language hopefully helps with that,” Till said.

Koch spoke for many in the House Republican caucus last week when he tried to win an extra day to review the bill. He objected to Democratic leaders’ plan to hold a “token session” today, when most lawmakers wouldn’t be in town. That session would allow debate to begin Tuesday.

“It was being rushed,” Koch said. “It is complicated. It affects everybody in the state. We need time to read it, to analyze it, to write any amendment we may have.”

Even given time to study the bill, however, Koch said he doesn’t expect to find answers to the many questions he has.

“The bill is putting the train on the tracks and pushing it down the hill without any brakes,” he said.

Shumlin countered that criticism.

“We can’t move fast enough,” Shumlin said, noting how fast health-care costs have escalated in recent years and the projected trend for growth in the future if nothing changes.

“Criticism about pace is strictly designed to kill the bill,” Commissioner Kimbell said. “I find the too-fast criticism incredibly ironic. The main criticism voters have is that government can’t get anything done.”