For the week ending April 19, 2002
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Week in Review The spotlight remained keenly focused on the House of Representatives this week, as that chamber debated three significant issues of this legislative session -- Medicaid reform, school choice and Act 60. While the House busied itself with these lengthy debates, action in the Senate was much less intriguing. The Committee on Appropriations continues to mark-up the FY 2003 budget, and should deliver a final product for consideration by the Senate next week. Finally, in the background, there are rumors of an emerging deal on reapportionment, the key to adjournment this year. Having realized that a protracted partisan fight over the issue would serve no one’s interests, House and Senate leaders have begun to hash out the details for a reapportionment plan that would be satisfactory to both chambers. Once that deal is cut, both the House and Senate can focus on finishing the other work of the session, including the Transportation Appropriations bill, the Capital Construction Bill and the FY2003 budget. Public Hearing on Nursing Shortage The Senate Committee on Health and Welfare will be holding a public hearing on the nursing shortage on Wednesday, April 24th from 4 p.m. – 6 p.m. in Room 11 at the State House in Montpelier. Anyone who wishes to testify should attend this hearing. Medicaid Budget, Reform and Cigarette Tax The House spent two long days debating a proposal to reform the state’s Medicaid program and to fund the program with an increase in the cigarette tax. During his budget address in 2001, Gov. Howard Dean called upon the legislature to pass a 67-cent increase in the state cigarette tax. The House ultimately chose to raise the tax 36 cents, just enough to fund the programs they had reinstated. The politics behind this debate were fascinating. On one side there was a small group of Republicans that didn’t support any tax increase. On the other side a majority of Democrats and a handful of Republicans supported a tax increase of 67 cents. In addition Speaker of the House Walter Freed (R-Dorset) has vocally opposed raising the tax at all, and he was certainly not interested in raising the tax any more than absolutely necessary. Had he not taken such a hard stance against a cigarette tax increase, he would have played into the hand of Senate president pro tempore Peter Shumlin (D-Windham), who has been vocal in his support for raising the tax by 67 cents or higher. In the final analysis, the House cigarette tax debate was more about leadership than Medicaid reform. While Speaker Freed won this battle, this contentious debate will continue when the Senate puts its mark on the Medicaid reform bill. The final phase of the cigarette tax debate will occur in Conference when the two bodies hash out their differences. Reimbursements There were no changes in the House passed Medicaid budget on the reimbursement levels from levels reported last week in the areas of hospitals, nursing homes or physicians. Also, home health is not requesting an increase this year. All three House committees endorsed the move to reinstate most of the governors proposed cuts to the hospital reimbursement levels, as did the full House. The Senate Health and Welfare Committee made their recommendations to the Senate Appropriations Committee on Friday regarding the Medicaid budget. Their recommendations were certainly less generous than the House-passed bill but slightly better than the Governor’s recommended budget. Below is a comparison of the different levels. Governor House Senate H&W Hospital Outpatient (1,681,356) restore ($840,678) Hospital Inpatient ($497,203) ($266,359) ($497,203) DSH payment ($187,150) restore restore Physicians no increase $300,000 $300,000 The Senate Health and Welfare Committee also recommended funding the Nurse Loan Forgiveness program at $180,000, consistent with the House-passed budget. H.755 Gross Negligence The gross negligence provision in H.755 had a full airing, with more than three hours of debate before the House of Representatives on Tuesday. Rep. Stephanie Bourdeau (R-Hyde Park) led the discussion for the House Government Operations Committee’s proposal for instituting a simple negligence standard with arguments centering on protection of the public. The Medical Practice Board and the Office of Professional Regulation supported the simple negligence language. Led by Rep. Peg Flory, the House Judiciary Committee and a contingent of bi-partisan House members proposed to clearly define negligence and insert a competency standard in the unprofessional conduct statute. VAHHS, the Medical Society and the Dental Society supported this amendment. . By a vote of 81-56, however, the House rejected the amendment offered by Rep. Peg Flory (R-Pittsford). The bill is now being reviewed in the Senate Government Operations Committee which heard testimony from several groups including VAHHS on Thursday. Single Payer Attempt Thwarted On a 36–98 vote, the House defeated an amendment offered Thursday by Rep. Elaine Alfano (D-Calais) on H.765 to establish a single payer health care system paid for by a payroll tax and an income tax surcharge. The plan would have established the Vermont Health Care Plan which would be governed by a board that would annually propose to the General Assembly a comprehensive health benefit plan covering a broad range of services including acute care, long term care and dental care. This plan would be available to all Vermont residents and the expenses would be supported by federal Medicaid revenues, cigarette and tobacco taxes, a personal income tax surcharge and a health care payroll tax with $500,000 appropriated by Legislature for start-up costs. Both tax rates would be set annually by the Legislature at a rate necessary to meet any and all expenses of the plan after accounting for the payments from federal receipts and tobacco taxes. No Action On… · H.416 Medical Record Confidentiality
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