For the week ending Friday, January 11, 2002
Political Overview
Vermont's citizen lawmakers returned to Montpelier this week as the General Assembly convened for the second half of the 2001-2002 biennium. Gov. Howard Dean's final State of the State address to a Joint Assembly of the House and Senate included a mixture of patriotic reflections as a result of the September 11 terrorist attacks and a recitation of the Governor's priorities as he leaves office after eleven years. Health care again took center stage. The Governor asked the House and Senate to rely on the Governor's Bipartisan Commission on Health Care for guidance on health care cost containment. He proposed that small businesses be allowed to buy into the Vermont Health Access Program (VHAP) and expand eligibility to include all Vermonters who earn below 300 percent of the federal poverty level. He also reiterated his desire to tie hospital budgets to their certificate of need process, in an effort to curb the "skyrocketing costs of health care."The state budget and the reapportionment of the House and Senate will influence every issue before the legislature. Lawmakers will struggle to deal with the state's declining revenues after several years of enjoying strong budget surpluses. Revenue estimates anticipate at least a $35 million deficit in FY 2002 and a $50 million deficit in FY 2003.
On reapportionment, the inherent politics have grown particularly fierce. For the first time legislative district lines will be re-drawn with one chamber controlled by Republicans and the other by Democrats. Historically, the House and Senate have deferred to each other to draw the lines for their respective chamber's districts with the power split between Democrats and Republicans. Senator Peter Shumlin (D-Windham), the President Pro Tempore, made it very clear that if the House attempts to redistrict Democrats out of their House seats, the Senate will not proceed with a reapportionment bill. If the Senate does not take up a reapportionment bill, the Vermont Supreme Court must determine new district lines. A lengthy political standoff may take time away from other issues and any bitter partisanship resulting from the outcome of reapportionment may bleed over to other policy issues under consideration by the General Assembly this session.
Certificate of Need Regulation
VAHHS President Bea Grause testified Thursday before the Senate Government Operations Committee on Certificate of Need legislation.Ms. Grause informed the committee of VAHHS' CON priorities and reported hospitals were open to discussions regarding the CON process. Ms. Grause reported that she was already working with BISHCA to establish policy goals to frame any possible changes. Senator Doyle chaired this hearing, which very thoroughly raised many CON issues through a long list of witnesses that included: Senators Nancy Chard and Ann Cummings, Commissioner Betsy Costle, CVH President Daria Mason, VAHHS General Counsel Anne Cramer, VAHHS President Bea Grause and Public Oversight Commission member John O'Kane.
The Senate Government Operations Committee doesn’t generally have jurisdiction over CON issues and therefore, any continued consideration of S.260 will occur in the Senate Health and Welfare Committee. Sen. Nancy Chard (D-Windham), chair of Health and Welfare, has promised a comprehensive review of the CON process in her committee.
Privacy of Medical Information
The House Health and Welfare Committee voted H.416 out of committee on a 9-1-1 vote. H.416 proposes to enact stronger privacy regulations in Vermont for medical information. Because of it’s layering affect on top of the pending federal HIPAA regulations, VAHHS submitted written testimony suggesting ways to mitigate the impact of many provisions affecting hospitals. The focus of VAHHS President Bea Grause's testimony was intended to guide the Committee to pass legislation that promotes the privacy interests of our patients without impeding the delivery of health care services and without adding layers of expense to the health care system.The Committee agreed on most of VAHHS' concerns. They removed a section that proposed burdensome accounting and documentation. This section required providers to make entries relating to all "disclosures between health care providers for the purpose of providing healthcare," which presumably covered all treatment communications. The committee also expanded the provider response time to produce health information and in other sections decided to defer to federal HIPAA regulations.
H.416 will be referred to the House Judiciary Committee. Judiciary will likely consider H.416 during the next few months but as yet there are no indications that this bill is on the fast track. VAHHS will continue to monitor this legislation.
Other Meetings
In addition to meeting numerous legislators this past week, Ms. Grause met separately with Governor Dean and House Majority Leader Walter Freed. Governor Dean asked VAHHS for support on the cigarette tax and his VHAP buy-in proposal. Ms. Grause briefly discussed VAHHS legislative priorities and proposed to work more collaboratively with the Administration and BISHCA this session. Representative Freed strongly opposed the cigarette tax and suggested closing or consolidating some of Vermont's hospitals as a way to rein in rising health care costs.
This Week's Upcoming Agenda
House Appropriations Committee – The focus this week will be on the FY03 overall budget.House Health and Welfare Committee – The committee will spend the whole week reviewing existing Medicaid law including eligibility and benefit levels.
Senate Appropriations Committee – The focus this week will be on the FY02 Budget Adjustment Act.
Senate Health and Welfare Committee – The committee will look at the Health Access Oversight Committee report, the Area Health Education Centers, the Pharmacy Benefit Manager and review the Hogan Commission report.
House Government Operations Committee – The committee will be reviewing the term of gross negligence on Wednesday.