Health care bill en route to the governor

By Carl Etnier, May 6, 2011

Green Mountain Care is set to become law now that the House and Senate have passed the final version of the health care reform bill, which was hammered out in conference committee earlier this week. The House approved the bill Thursday on a 94-49 vote.

The legislation now heads to the governor’s desk where it is expected to be signed into law with fanfare. Gov. Peter Shumlin, a Democrat, is the architect of the single-payer health care plan, and he will likely sign the bill into law next week.

The House vote was intensely partisan with minority leader Rep. Don Turner, R-Milton, noting afterward that no House Republicans had supported it. He complained that the House GOP was shut out of the three-member House delegation to the conference committee, and he called on Shumlin “to ensure that minority position concerns are addressed.”

One Republican, Rep. Anne Donahue, R-Northfield, who voted against the legislation, said she would collaborate in implementing the state’s pioneering reform of its health care system.

Rep. Mark Larson, D-Burlington, and chair of the House Health Care Committee, reminded lawmakers that the health care reform initiative is the result of the problems inherent in the current system.

“Too many Vermonters continue to be uninsured, and even more face financial risk if they get sick or hurt because of inadequate insurance,” Larson said. “Vermont businesses continue to struggle with the skyrocketing cost of health insurance. And the way that we fund health care is inequitable, inefficient, and unfair to many. It continues to support the ability to cost shift, one to the other.

“Most importantly, our health care system lacks the ability to control costs and to ensure that the dollars Vermonters do spend provide Vermonters with quality and go towards things that help Vermonters get better when they’re sick or hurt, or to stay healthy, to avoid not just the cost of getting sick, but also just to preserve their health,” Larson said.

Green Mountain Care sets the state on a path towards universal health care coverage for Vermonters, regardless of where or whether they are employed. It would not, strictly speaking, be a single-payer system, as private supplemental insurance plans will continue to be available, and federal programs like Medicare and Medicaid will continue, but Larson expects the plan to reduce the number of insurers now operating in the state. He also says that the coverage of Green Mountain Care will be such a comprehensive benefits package, he is not “sure why somebody would want to purchase additional insurance beyond that, but that would be a choice that they could make.”

The conference committee resolved a number of issues that had mobilized health care activists in the waning days of the session. The Senate had specified that illegal immigrants be excluded from the coverage of Green Mountain Care. The final bill asks for a study of the costs of including or excluding undocumented immigrants. Larson pointed out that fear of deportation keeps illegal workers from seeking treatment when they need it, and if their condition worsens so much that they require emergency care or hospitalization, then those costs are borne by other Vermonters. It’s possible, he said, that it would be less expensive for everyone to cover even those aliens without papers.

Another thorny question relegated to further study is whether to cover and require payments from those eligible for TRICARE and other federal coverage. In this case, too, Larson said, it’s possible that creatively including these individuals in Green Mountain Care could lower costs for everyone.

Health insurers were both helped and hurt at the conference committee table. The bill’s supporters want Vermont to set up by 2014 a health benefit exchange of the type mandated by the federal Affordable Care Act. Some people had feared that no insurance providers would want to participate in Vermont’s exchange; the bill now requires that the state try to entice at least two insurance companies to underwrite Vermonters. On the other hand, the number of insurance company representatives allowed to serve on the Green Mountain Care advisory committee was reduced from three to one.

The bill was a signature issue in Shumlin’s gubernatorial campaign. In the Legislature, it has been the subject of intense lobbying, both by supporters and opponents. With passage virtually a foregone conclusion, representatives largely confined themselves to clarifying or debating the changes from the conference committee.

A few had the energy left to argue the larger questions of the bill. Rep. Cynthia Browning, D-Arlington, lamented the “lost opportunity” to help uninsured and under-insured Vermonters sooner than 2014. She also said that there were so many unanswered questions, it was like “Scarlett O’Hara health care: ‘We will think about that tomorrow.’”

Rep. Willem Jewett, D-Ripton, countered that the current approach is not working, and though the bill “does not provide a solution to our problems, it does provide a process through which we can reach one.”

Deb Richter, a physician who has lobbied for decades for single-payer health care, was on hand for the vote, and she was “overjoyed” at the passage of “an amazing piece of legislation.” She says that she gets a lot of letters from people who don’t understand the legislation, so she expects to be part of a group that travels around the state to explain to Vermonters how the bill works. When asked whether she would like to be a member of the five-member board the bill creates to implement Green Mountain Care, she replied, “I would never turn away a position that could be helpful to the process.”