Vt. lawmakers approve health care measures

By The Associated Press
Bennington (Vt.) Banner, April 25, 2012

MONTPELIER (AP) -- The Vermont Senate on Tuesday passed stage two of the state's push to get as close as it can to a universal, single-payer health care system by late in this decade.

By a 20-7 vote, the Senate approved a House-passed bill that sets up a regulated health care marketplace, or exchange, and requires employers with 50 or fewer workers either to enroll their employees in the exchange or let them do so on their own, taking advantage of federal tax credits or subsidies to help them pay for it.

"It's our intention to use the ... exchange as sort of a pivot point," said Sen. Claire Ayer, D-Addison and chairwoman of the Senate Health and Welfare Committee, in an interview after the Senate vote. "We want to take full advantage of it in terms of helping us define some of our cost-saving processes, develop our health information technology and get ourselves on a path to a single-pipe payer."

Minor differences between the Senate and House versions likely will be worked out in a legislative conference committee before the bill is sent to Gov. Peter Shumlin, who is a strong backer.

Tuesday's vote was the latest action in year two of a multi-year effort Shumlin began shortly after taking office last year to move Vermont well beyond the overhaul passed by Congress two years ago and closer to a Canadian-style, government-backed universal health coverage system.

But the long-term plan is fraught with uncertainty. The U.S. Supreme Court is expected to rule in June and could strike down parts of or the entire federal package. That would deprive states like Vermont the federal funding that is crucial to their own overhaul efforts. A change in federal administrations in the November election also likely would halt Vermont's march to a top-to-bottom shakeup of its $5 billion a year health care system.

Even backers of the legislation acknowledged there are lots of questions, not only about whether Vermont will get to complete the changes that Shumlin made a centerpiece of his 2010 election campaign, but on how the big interim step -- the health benefits exchange -- would work.

Sen. Ann Cummings, D-Washington and chairwoman of the Senate Finance Committee, likened the passage of the legislation amid so many questions to "driving down the highway in a pea soup fog."

Backers said the exchange would allow people a simple, computerized system to shop for health insurance, selecting things like the level of coverage, the level of copays they were willing to bear and other features. The actual payments to doctors, hospitals and other providers, would still be made by insurance companies, at least at first, Ayer said.

One principle of insurance is that the bigger the risk pool -- the number of people covered -- the easier it is to keep costs down. The bill imposes a requirement in stages that people sign up for health insurance through the exchange, starting with workers in companies with 50 employees or fewer.

Critics faulted the mandate. Jeffrey Wennberg, executive director of Vermonters for Health Care Freedom, a group opposing the state's overhaul efforts, said the legislation "means that within two years upwards of 100,000 Vermonters will be forced to drop their current health insurance whether they want to or not, and purchase insurance through the exchange, which is untested, and undefined."

The Vermont House also had health reform on its agenda Tuesday, easily giving preliminary approval to a bill calling on health insurance companies to make public their claim denial rates, executive salaries and other data.

Rep. Sarah Copeland-Hanzas, who described the measure to her House colleagues, said it was aimed at making Vermonters smarter health insurance consumers.

Senate gives final approval to health care exchange bill

By Anne Galloway, April 25, 2012

The Senate passed H.559, the health care exchange bill, Tuesday evening, 20-7.

The legislation allows Vermont to take advantage of federal subsidies and tax credits associated with the federal Affordable Care Act. The Shumlin administration plans to use the exchange as a stepping stone toward financing a single-payer health care system.

The bill requires individuals and employers with 50 or fewer workers to buy insurance through the exchange beginning in January 2014. Vermont is the only state so far to pass a mandate for companies to purchase health care coverage on the exchange. In 2016, the federal law will require all businesses with 100 or fewer workers to become part of the exchange.

Senators who support the bill said the exchange program will benefit small companies that struggle to pay health insurance premiums for workers.

Sen. Claire Ayer, D-Addison, told her colleagues that the federal government will look at 2014 participation rates in determining how much financial support to provide the state in 2015.

“We need the strongest healthiest exchange we can get,” Ayer said. “We need everybody in.”

Several attempts to delay implementation of the exchange failed, as did a proposal on Monday from Randy Brock, the Franklin Republican who is running for governor, to require the Shumlin administration to reveal its financing plans for the proposed single-payer health care system before the November election.

With the exception of three votes, the Senate approved the bill along party lines. (Sens. Vince Illuzzi and Kevin Mullin voted for the exchange; Sen. Bob Hartwell voted against it.)

Sen. Diane Snelling, a moderate Republican from Chittenden County, explained why she opposed H.559.

“I hoped by this time to be able to support the movement toward health care reform,” Snelling said as she explained her vote. “I am still deeply troubled by the process while there are many worthy changes in the bill it became too complicated and was broadened too far.”

Senators proposed a number of amendments to H.559, which evaluates the quality and cost of health insurance plans.

Here is a sampling:

Pollina Amendment

Sen. Anthony Pollina, D/P-Washington, proposed an amendment to H. 559, which would bolster insurance payments for mental health treatment. The Senate Finance Committee proposed to delay legislation on mental health coverage until next session, pending a report from the commissioner of financial regulation as to where to draw the line between primary and specialty mental health services. Pollina’s amendment gives the commissioner until October 1, 2013, to adopt rules establishing such guidelines, additionally proposing a section that would prevent health insurance plans from requiring higher co-payments for mental health services than for general medical care. The proposed changes would apply to new or renewed plans in 2014 and extend to all plans by 2015.

The Senate passed the amendment on a voice vote.

Mullin Amendment

Sen. Kevin Mullin, R-Rutland, proposed an amendment that would make it easier for prescribers to get prior authorization from insurers for medications that require such pre-approval. The final version of the amendment requires insurers to respond to urgent prior authorization requests within 48 hours and non-urgent requests within 120 hours. The language proposed by the Senate Finance committee allowed two business days for urgent requests and seven business days for non-urgent requests. That amendment passed.

Mullin also sought to limit insurers to five prior authorization request forms. Currently, insurers like Blue Cross/Blue Shield and MVP Health Care have about 100 forms, representatives said. Having numerous forms, they said, allows them to get specific information regarding the drug in question, making the process more efficient. Mullin said this system makes it difficult for prescribers to navigate the system to get prior authorization. That amendment was ultimately struck down in committee.

Sears Amendment

Sen. Richard Sears, D-Bennington, proposed to remove three sections of H.559, including a section on sports injuries. The section became a subject of heated debate on Monday, when Sears insisted the language be changed to state that coaches must have “actual knowledge” of a head injury in order to be legally required to pull student athletes from a game.

The wording was changed to “an objectively reasonable belief under the circumstances.” The Senate approved the new language.

Illuzzi-Miller Amendment

Sens. Vince Illuzzi, R-Essex-Orleans, and Hinda Miller, D-Chittenden, proposed to delay implementation of the health care exchange by one year to January 2015.

The Senate defeated the proposal by a narrow margin, 15-12.

Illuzzi Amendment

Illuzzi failed to persuade his colleagues to adopt a proposal to ensure brokers are “reasonably compensated” along with a provision that would have given the Secretary of the Administration the ability to modify the implementation planning for the health insurance exchange bill should the U.S. Supreme Court strike down the individual mandate requirement in the Affordable Care Act.

Editor’s note: Taylor Dobbs contributed to this report.

CORRECTIONS: Sen. Illuzzi was listed as a D/P. He is a D/R. Sen. Kevin Mullin voted for H.559; he was originally left off the list of supporters.