Political Overview

Lawmakers face a key “crossover” deadline this week for advancing legislation that must pass this year. All bills must be voted out of most committees by the end of the day on Friday, March 21st to have a chance of passing this year. There are exceptions for some money bills, including the budget and the miscellaneous tax and fee bills. As a result, committees will be burning the midnight oil this week to advance their priority bills by the end of the day on Friday.

Some of the bills slated for action this week include a major Act 60 reform proposal, a jobs bill, a renewable energy bill, permit reform and the FY04 budget bill. Only a few health care bills of interest to VAHHS will meet the crossover deadline, including S.17, the bill related to abuse of vulnerable adults and a bill to restructure the agency of human services.

The House Health and Welfare Committee is scheduled to take up H.128, the certificate of need and hospital governance reform bill starting on March 18th, but it is uncertain if they will be able to complete their work by Friday, March 21st. The chairs of the Senate and House Health and Welfare Committees have hinted that they believe reforming the certificate of need process may take more than one year. Since this is the first year of the biennium, any bills that do not pass this year will remain “on the wall” and carry over until next January.

House Speaker Walter Freed, R-Dorset, and Senator James Leddy, D-Chittenden, made comments at a recent Lake Champlain Chamber of Commerce legislative breakfast that seem to confirm that the CON reform bill will not pass this year. Specifically, Freed and Leddy said that while health care costs are increasing dramatically no significant health care cost control legislation will pass this year, such as budget caps and capital construction caps.

The biggest threat and opportunity for hospitals and nursing homes for the remainder of the session continues to be Medicaid. Key leaders on the House Appropriations Committee will unveil a proposal in the very near future that replaces most of the existing co-pays and deductibles that Medicaid recipients now pay with a premium collected by the state. It is too early to know whether this proposal has any legs. If the proposal does move it will be one of the most significant changes made to the way Medicaid is financed in years.

Specific issues addressed this week by the General Assembly include:

Anesthesiologist Assistants (H.375, S.144)

Two identical bills were introduced in the House and Senate this week that propose to establish a system for certifying Anesthesiologist Assistants (AAs) in Vermont. The House bill is H.375, while the companion Senate bill is S.144. VAHHS supports these bills because they will help alleviate the severe nursing shortage faced by Vermont’s hospitals. The Senate Health and Welfare Committee is scheduled to take up S.144 on Wednesday, March 19th. Representatives from Fletcher Allen Health Care and Southwestern Vermont Health Care Corporation are scheduled to testify.

Agency of Human Services Reorganization

The House Health and Welfare Committee took a straw vote in support of a draft bill that reorganizes the Agency of Human Services on Friday, March 14th. The draft bill delegates the responsibility to restructure the agency to the secretary of the agency according to broad goals and principles set forth in the bill.

The bill tries to strike a balance between giving the secretary free reign to restructure the agency and retaining some semblance of legislative control. For example, one provision allows the secretary to transfer appropriations within the agency as part of restructuring, provided that the total amount appropriated to the agency remains the same. But this authority is subject to approval by the joint fiscal committee (made up of the chairs and key members of the money committees in the House and Senate). The bill also establishes a “Legislative Oversight Committee on Human Services Restructuring,” consisting of two members from each of the house and senate committees on health and welfare, government operations and appropriations. By December 15, 2003, the secretary must present draft legislation and a report on the budgetary impacts and transitional costs of restructuring to the Legislative Oversight Committee on Human Services Restructuring.

The draft bill will now go to the House Government Operations Committee for its review. The bill will likely then be introduced as a committee bill sponsored by both the House Health and Welfare Committee and the House Government Operations Committee. The original plan was to include this agency restructuring language in the FY04 budget bill. However, due to a time crunch, it now appears that the bill will be sent over to the Senate as a stand-alone bill.

FY04 Medicaid Budget

The House Appropriations Committee started their deliberations regarding the FY 04 Medicaid budget late Friday, March 14th. Rep. Patty O’Donnell, R-Vernon, and Rep. Tom Pelham, I-Calais, presented a broad overview of the proposal they have been working on to replace the current co-pays that Medicaid beneficiaries pay with premiums (with the exception of co-pays for emergency room visits and the preferred prescription drug list). O’Donnell said that she and Pelham obtained information from EDS, the company that processes Vermont’s Medicaid payments, and found that the current Medicaid co-pays are extremely regressive, with the oldest, sickest and lowest income Vermonters paying the most. Pelham added that their research indicated that some Vermonters pay as high as 17 percent of their income in co-pays while others pay a mere one percent of income. The premium-based proposal would require that recipients with higher incomes to pay more. A preliminary figure of 3.5 percent of income was mentioned. This proposal would get rid of the means testing proposed by Governor Douglas. In addition, O'Donnell’s proposal will get rid of the 5 percent co-insurance obligation for inpatient and outpatient hospital services for beneficiaries of PC-Plus that is part of the Governor’s Medicaid proposal.

VAHHS continues to lobby to restore the cuts made last summer in “elective” inpatient hospital admissions for VHAP. Rep. O’Donnell understands the issue and plans to raise it with the entire House Appropriations Committee when they deliberate on the Medicaid budget starting on March 18th.

Certificate of Need (H.128, S.63)

This was the first week this session that no committee in the House or Senate considered hospital governance or CON reform legislation. However, the House Health and Welfare Committee plans to take up H.128 when they reconvene on March 18. The committee will likely receive a third draft of the bill at that time. They are scheduled to discuss the new draft during the entire week of March 18-21.

S.76, Medical Marijuana

S.76, a bill that proposes to allow some patients suffering from serious medical conditions to use medical marijuana, passed the Senate by a 22-7 vote. The bill will go to the House where a similar measure passed with overwhelming tri-partisan support during the last biennium. Republican Governor Jim Douglas opposes the bill. At this point it is unclear if the House Republican leadership will want take up this bill and challenge their new Governor or if they will protect the Governor and deep six the bill in committee.


S.25, Child Passenger Safety Seats

The Senate Transportation Committee took additional testimony on S.25, a bill that requires booster seats for children up to the age of eight traveling in a motor vehicle, among other things. VAHHS supports this bill. The committee still has a few questions about the bill but expects to take it up again on Tuesday, March 25th.