Week in Review

Both the House and Senate continued to spend considerable time in floor debate this week, working to clear each chamber’s calendar of the many bills advanced to the floor prior to Town Meeting recess. In contrast to recent weeks where major issues of the session were in the spotlight, this week the House spent more time debating some of the lower profile issues. In the background, however, several key House committees completed action on major appropriations bills. The Committee on Institutions advanced the FY 2003 Capital Construction bill, while the Committee on Transportation advanced the FY 2003 Transportation Appropriations bill. The Committee on Appropriations will review both of these bills prior to debate in the House. Finally, the Committee on Appropriations should finalize the FY 2003 State Appropriations bill early next week. These are the three major “money” bills of the session, and their passage by the House will be a significant milestone for the session. In other committee action, the Committee on Ways and Means continued its work on an Act 60 reform bill, but has yet to develop a strong consensus of support for the plan before the Committee.

The Senate also spent considerable time on the floor debating a variety of bills, including legislation dealing with the abuse of elderly and disabled Vermonters and the disposal of products containing mercury. Late Friday, the full Senate heard a second reading of S.254, a bill to allow small businesses and individuals to buy into the Vermont Health Access Plan (VHAP). The “VHAP Buy-in” bill stalled mid-week when several Democratic Senators questioned the bill’s merits, bringing passage of the bill into question. The Governor and the Senate Democratic leadership support the bill, therefore passage by a narrow margin, while better than outright defeat, would not be welcome. In Senate committee action, the Reapportionment Committee came close to advancing a re-districting plan for the Senate, but this plan stalled at mid-week. Taking their cues from the Senate that recently began tinkering with the House re-districting plan, the House Committee on Government Operations also produced a plan for re-districting the Senate. The plan calls for fifteen two-member Senate districts, a dramatic departure from the current scenario. This approach would break up the powerful six-member Chittenden County Senate district and would likely favor Republican candidates. Such tinkering is a first in Vermont, where tradition has always held that each House would draw its own districts. That tradition has fallen by the wayside this year since opposite parties control the House and Senate. Adjournment could depend on how long this political gamesmanship lasts.

Medicaid Reform

On a 7-4 committee vote, the House Health and Welfare Committee passed a proposal to reform the existing Medicaid program that attempts to balance quality, access and cost containment.

Some of the changes recommended in the bill include capping state Medicaid expenditures, shifting some of the financial responsibility to recipients, and scaling back the benefit plan for the “optional population” to be comparable to the state employees’ plan. VAHHS generally supports this legislation, and has suggested two changes:

· Eliminate the Medicaid spending cap since an overall spending cap would ultimately reduce available funds for the optional Medicaid programs. As an alternative, a spending cap could be placed only over the optional portions of the Medicaid plan.

· Place the responsibility for collecting beneficiary cost sharing with OVHA.

VAHHS will continue to work to get these provisions in the bill. The committee also included a 67-cent tobacco tax increase in this bill as recommended last week to the House Appropriations Committee.

S.254 VHAP Buy-In

The VHAP Buy-In bill, a bill championed by the Dean Administration jumped its first hurdle in the Senate on Friday as it passed second reading by a vote of 22-7.

S.254 proposes to enable both businesses with fewer than 20 employees and individuals to buy into the state run health care program. The estimated premium for the plan would be $200 per month ($100 paid by the employer and $100 paid by the employee), an amount considerably lower than private insurers charge. Supporters of the bill claim that the cost shift would be minimized because currently uninsured persons would be covered by this legislation. As an added incentive, the bill calls for a reimbursement rate to providers of Medicare plus 10%. Opponents, on the other hand, argue first that although the bill aims to insure the currently uninsured, many businesses would attempt to become eligible for this insurance because it would be considerably cheaper than the current cost of insuring their employees.

Sen. John Bloomer (R-Rutland) expressed concerns about the bill throughout the more than two-hour debate. He and other Republican Senators questioned the proponents of the bill about many of the problems they saw in the proposal. Ultimately, 22 Senators supported the bill and some have suggested they will reconsider their support if some of the problems in the bill are not fixed prior to 3rd reading scheduled for Tuesday.

H.725 Conversion of Non Profit Health Care Entity

The full House passed H.725, a bill to establish a coordinated state review of non-profit health care entity conversions to for-profit ventures. The bill was passed with overwhelming support on a 127-7 roll call vote. This bill allows for a coordinated BISHCA and Attorney General review process for the conversion of non-profit insurers or non-profit hospital assets to a for-profit entity. VAHHS worked with BISHCA and the AG to modify provisions of the bill to create a single application and a coordinated process for review of the conversions by the two agencies of state government. VAHHS remains concerned that definitional language in the bill gives the state overly broad powers in determining what transactions might be reviewed by the state. The Association will continue to work to improve the bill in the House.

The AG considers H.725 critical to its position on the Blue Cross Blue Shield non-profit holding company proposal, S.219, which is currently under consideration in the Senate Finance Committee.

No Action On…

· H.416 Medical Record Confidentiality
· S.258 Open Meeting Law
· Gross Negligence
· S.286 CON Regulation

On the Agenda This Week

House Appropriations Committee – The focus this week will be on finalizing the FY03 budget bill.

House Health and Welfare Committee – The committee will focus this week on H.660 regarding substance abuse.

Senate Appropriations Committee – This committee will continue to hear from various state agencies regarding their budgets in preparation of receiving the FY03 budget from the House.

Senate Health and Welfare Committee – The committee will begin discussions on the Medicaid program and will also receive a status report on the Pharmacy Benefit Manager program.

House Government Operations Committee – The committee will continue to review H.755 and H.761 regarding the Professional Regulation Board, the Medical Practice Board and the definition of gross negligence. This committee will jointly review these bills with the House Judiciary Committee.

Healthcare Roundtable April 2nd

A group of six legislators interested in universal health care coverage will be holding a Healthcare Roundtable in the Well of the House on April 2nd beginning at 7:00 p.m. Interested parties are encouraged to attend and voice their opinions, pro and con, regarding this policy goal. If you plan to testify, call Rep. Carolyn Partridge at 1-800-322-5616 or email her at cpartridge@leg.state.vt.us.