For the week ending Friday, February 23, 2001
Approaching what should be the halfway mark of the legislative session, committees in both the House and Senate are working to move bills out of committee prior to March 1st, the "crossover date" by which bills must be voted out of the original committee of jurisdiction. In addition to regular committee work, House committees held evening public hearings on two of the most potentially controversial issues of this session: Act 60 reform, and parental notification for abortions performed on minors. This deeply personal and controversial issue has not received significant attention from the legislature in many years, and supporters of the bill requiring parental notification are eager for debate by the full House of Representatives.
In the Senate, the Committee on Appropriations gave approval to H.223, the Budget Adjustment Act, setting the stage for a Committee of Conference to address the differences between the House and Senate versions of the bill. The Senate Committee on Appropriations re-inserted language in the bill, authorizing a $24 million appropriation to the State Treasurer for cash in lieu of bonding. House Republicans had earmarked this money for other spending needs, including changes to Act 60. In committee action in the Senate, the Committee on Finance heard testimony on S.62, legislation proposing both licensing requirements for telemarketers and creation of a state "do not call" list for those people wishing to avoid such calls at home. This bill was introduced in the Senate in 1998, but failed to receive approval. The Senate Committee on Health and Welfare heard about federal health legislation from U.S. Senator James Jeffords (R-Vermont) on Tuesday. The committee also heard from private insurers Wednesday about their incentives to control utilization and improve the quality of outcomes.
Coming Up This Week
House Committee on Health and Welfare - The committee will be examining the confidentiality of medical records this week and next week they are expected to turn their attention to H.212, a bill introduced by Rep. Frank Mazur (R-South Burlington) and 73 other sponsors. H.212 focuses on health care costs, competition and community rating.House Committee on Appropriations – The committee will be marking up the FY02 Appropriations bill all week in an attempt to have a final bill before the week-long Town Meeting day break.
House Committee on Education – The committee will focus on S.116, the Nurse Loan Forgiveness program.
Certificate of Need (CON) Hearing
This week Senate Committee on Finance heard from David Demers, senior vice president of Fletcher Allen Health Care, Thomas Huebner, Chief Executive Officer of Rutland Regional Medical Center, and Norman Wright, President of VAAHS.Sen. Cheryl Rivers has introduced S.49, a proposal to eliminate the existing Public Oversight Commission that oversees the Certificate of Need process and replace it with the Hospital Policy Council, which would have a broad membership. Rivers wanted to hear from the hospitals about problems with the existing CON process. The three testifying agreed that BISHCA was thorough, rigorous, fair and effective if at times not always speedy. All agreed that additional staffing in BISHCA would solve the timeliness problem. There was also general agreement that the main drivers of increasing health care costs are utilization, technology, insurance market dynamics and cost shift not capital expenses.
Senate Finance on S.24
Thursday afternoon Senate Committee on Finance heard testimony from Leigh Tofferi, Director of Governmental Relations for BCBS, on S.24, Sen. Cheryl Rivers’ (D-Windsor) bill to require that BCBS's board members be publicly appointed. Tofferi traced the history of medical service corporations and the history of BCBS for the committee, noting that BCBS legislative mandate is to exist solely for the benefit of its subscribers, that it is committed to remaining independent and locally based. Sen. Rivers stated that BCBS used to be a much stronger player in negotiations with the hospitals and she believes that is no longer the case perhaps as a result of being "in bed" with the hospitals through VHAP. Rivers also noted that she was unhappy with the capping of prescription drug costs at $2,500. For these reasons among others she believes that by prescribing the members of the board of BCBS that the board would be more accountable. Under the proposal, designated memberships to the BCBS board would include the Secretary of the Agency of Human Services, the Dean of the College of Medicine at UVM, VA representative and legislative representatives. Tofferi concluded by stating that BCBS is meeting its goal of serving its subscribers, maintaining financial stability, and being an independent and Vermont based corporation. He expressed concern that the designated members may substitute the interest of their particular constituency for the interest of the greater good of BCBS and its subscribers.
Health Care Panel
This week in the State House, Ethan Allen Institute’s John McLaughry moderated a panel entitled: "Health Care in Vermont: What have we done? What should we do?" Below are the points made by each of the panelists.Steve Kappel, Health Care Policy Analyst, Joint Fiscal Office
- 6.8 % of Vermonters are uninsured, a very low rate
- We have little competition because Vermont is small
- Medicare doesn’t pay to Vermont as much as it does to other states because we are small, rural, and we use fewer services
- There will be a 12% rate of growth in health care costs
- In 2006, Medicaid will need 22% of the General Fund
- The question to reach solutions should be clarified, "What's the most important issue to solve?"
Henry Holmes, Insurance Agent for 30 years and former Legislator
- Community rating will erode the system
- Younger people are forgoing health insurance because of the cost and therefore not paying in to support the system
- Only one company writing insurance for individuals with a $3,500 deductible
- Lower per capita income than other states making a heavier burden on the individual
Jan Backus, former Senator and Chair of the Senate Committee on Health and Welfare
- The state needs a single payer system
- Health care is not a market system—no one wants to use health care services, not on a demand-supply system
- The customer does not pay for services as in a market economy
- Providers should not be paid on an outdated fee for service payment system; they should be paid an hourly fee like attorneys
- There is no place for private health insurance in a health care system
Hamilton Davis, former legislator and aide to Governor Kunin
- Vermont is the most regulated state in the country
- No market exists-the loop never closes –individual doesn’t pay costs
- Single payer system is a disaster-Canada, UK
- The cost shift is necessary because government will always refuse to pay actual cost of running the health care system so private sector must make up the difference
- Current rate of increasing costs is unsustainable
- No third party payments
Robert Opel, VP and General Counsel, BCBS
- Lower per capita income in Vermont than other states and individual bears the high burden of costs
- Market segment-by-segment solutions may exacerbate the problem
Robin Dayman, former Vermont Sales Coordinator for North American Preferred
- Vermont is in a precarious position exterminating health care services and insurance market
- The market is small-when self insured, individuals, and VHAP and Dr. Dynasaur are removed from the market basket
- Game being played between FAHC and the DHMC Alliance on costs
- Boston has 10 hospitals for 3.7 million people; VT has 13 hospitals (DH, Albany) for 600,000 people
- Median income is $48,000 and those with $51,000 qualify for VHAP
John McLaughry's comment
- Restore wellness to be the responsibility of the individual. When asked about an 18-year-old with rheumatoid arthritis with a $10,000 a year prescription drug bill, he did not have an answer.