Health reform — outside legislative spotlight in 2014
May 18, 2014
By: Nancy Remsen, Free Press Staff Writer
MONTPELIER – Health care reform could easily have been the spotlighted topic of the 2014 legislative session given the nonstop headlines about Obamacare and insurance exchanges for the past six months.
Add to that the fact that Gov. Peter Shumlin and the 2011 Legislature put the Vermont on a course leading to Green Mountain Care, a government-financed health insurance system that would cover all Vermont residents beginning in 2017 — a monumental change less than three years away.
Instead Gov. Peter Shumlin chose to trumpet only opiate addiction in his inaugural address and lawmakers focused their energies on more bite-sized initiatives such as mandating the labeling of genetically modified foods, raising the minimum wage, setting standards for share land development and banning drivers from using cellphones.
Health reform remained out of the limelight for much of the session and the bill finally drafted was inconsequential enough that legislative leaders were prepared to let it die if negotiations were going to delay adjournment. The final bill includes four principles "to guide financing of health care" and directives for six reports and a symposium.
Inaction was a fine result from Dr. Deb Richter's perspective. Richter, an advocate for publicly funded health insurance covering all Vermonters, visited the Statehouse throughout the session to monitor whether lawmakers would backtrack on Green Mountain Care.
Dr. Deb Richter, advocate for publicly funded health insurance covering all Vermonters, monitored the Legislature all session to make sure lawmakers didn’t backtrack on the promise to keep the state headed toward implementation of Green Mountain Care in 2017.
When the Legislature adjourned without changing course, Richter said, "In my view it was mission accomplished."
Those Vermonters who worry about the risks associated with a single-payer health insurance system suggest Shumlin and the Democratic majority in the Legislature chose to take a bye in 2014 on big decisions about Green Mountain Care that might feed Vermonters' anxiety about health reform in an election year.
The administration certainly wanted to avoid calling any more attention than was necessary to the troubled rollout of Vermont Health Connect — a government-run online marketplace for health insurance mandated by the federal Affordable Care Act.
"I don't think the governor wanted to talk about it. That is why he led with the heroin problem," said Darcie Johnston, head of the only organization dedicated to challenging Shumlin's drive to establish the first state-run health insurance system in the U.S. "Kudos to him, he succeeded."
Those who support the plan to consolidate and expand government-financed health insurance under one umbrella argue this was a year to prepare for the analysis and decision-making that will be required next session.
House Health Care Committee Chairman Michael Fisher, D-Lincoln, explained that the 2011 law authorizing Green Mountain Care, Act 48, left few decisions to be made this year.
The 2015 session will be the year for decisions, which was why Senate President Pro Tempore John Campbell asked five committees to review Act 48 "to ensure that we fully understand the legislative task ahead."
Senate Finance Chairman Tim Ashe, D/P-Chittenden, elaborated on the background work his committee did.
"Our focus was on putting ourselves in the best position to make the best decision on a new health care system next year," Ashe said. The committee mapped out actions expected of the administration. They include submitting a preliminary application asking the federal government to allow Vermont's Green Mountain Care experiment, setting timetables to receive important information about those affected by Green Mountain Care and figuring out where independent physicians fit into the long-term Vermont health system equation.
Green Mountain Care remains a high priority for the governor even if he focused on other issues this session, said House Ways and Means Chairwoman Janet Ancel, D-Calais. "He has been rock solid in his commitment to make this change."
Neither the governor nor the Legislature could ignore the troubles that plagued Vermont Health Connect from opening day on Oct. 1 right into the session. The federally mandated online marketplace struggled with so many technical problems that Shumlin quickly arranged for small employers to be able to bypass it and buy their federally approved plans directly from insurance companies.
"From a systems perspective, it was really important to understand what had happened," House Speaker Shap Smith, D-Morristown, said. The House Health Care Committee had administration personnel report weekly.
"I don't think action was necessary," Smith also said. The only exchange-related provision in the final health care bill specifies that the business bypass Shumlin set up in the fall could continue.
Johnston of Vermonters for Health Care Freedom criticized the Legislature for being wimpy watchdogs over Vermont Health Connect. "It was a failed exchange and it still isn't working correctly."
"The majority party seemed to buy the very weak arguments of the administration," she continued. "There just doesn't seem to be the fire in the belly to go up against the governor."
House Health Care Chairman Fisher countered that critics focused only on the problems of Vermont Health Connect, not on its successes. "The reality is mixed," he said, noting that some Vermonters gained access to health care for the first time and others saw their out-of-pocket costs shrink.
Lawrence Miller, reassigned by the governor in January from his post at secretary of commerce to help bring Vermont Health Connect through the troubled waters, credited lawmakers with asking the administration tough questions about the lessons that government needed to learn to succeed with future ambitious projects. Miller will become head of health care reform for the administration in June.
Lawrence Miller, who will become chief of health care reform for the Shumlin administration on June 1, introduced himself to the House Health Care Committee on April 18 and fielded questions about how state government will do a better job managing future health initiatives.
Republican Leader Don Turner of Milton said accountability about the exchange was a priority for his caucus during the session. "When the Legislature is there, it keeps a little pressure on them."
Still he said he went home last week without assurance that the Legislature would continue oversight of the exchange.
Mum on financing
Opponents of Shumlin's publicly financed health care plan have protested since the Green Mountain Care law passed about the delivery timing of the administration's plan for paying for the new system. They wanted it before the 2012 election, but the law said Shumlin could deliver it in January 2013.
Last year, however, Shumlin pushed off providing his financing proposal until January 2014. This year, he failed to deliver it in January. He suggested his staff might have something in March and now says the long-sought report will be ready in 2015 — after yet another election.
Democratic legislators mostly defend the governor's decision to delay, but the House version of the health bill included a deadline for delivery of the plan and a financial penalty. Those provisions disappeared in the final negotiations on the bill.
"I personally think the governor got to the leadership and told them what he would accept," Turner said.
"Whatever fell by the wayside was a mere function of lack of time," Ashe declared. "The administration had nothing whatsoever to do with the negotiations over the final health care bill."
Democrats insist the Shumlin administration must deliver next winter or jeopardize his health reform legacy.
"The administration needs to give the best possible plan at the earliest possible date," Ways and Means Chairwoman Ancel said. "The later we get the proposal, the further out the state date of any change will be."
Ancel said she wants to assure Vermonters that the Legislature won't rush its evaluation. "We will take as much time as we need to evaluate it."
Dr. Richter said she doesn't believe the public is in a rush to see the financing plan. "Mostly what people want are honest answers," she said, adding, "It is better to get it right."
Shumlin's political critics say the delays in producing the financing plan have cranked up public and business uncertainty about the future.
"Vermonters need answers. There is so much insecurity," House Republican Leader Turner said. "Until you get something from the governor that says this is what I'm going to do, you really can't discuss it on Main Street and explain the magnitude of what he is trying to do."
Johnston at Vermonters for Health Care Freedom plans to make the inaction on Green Mountain Care financing an issue in the election.
The governor and other supporters of publicly funded health care will "have to explain how they are going to pay the $2 billion it is going to cost," she said. "Democrats throughout the state should have their feet held to the fire on that question."
Richter said she doesn't believe health reform will become a liability in the 2014 election. "The majority of Vermonters want a publicly funded, universal health care system," she said. "Candidates who support it shouldn't be afraid to talk about it."
Contact Nancy Remsen at 578-5685 or email@example.com. Follow Nancy on Twitter at www.twitter.com/nancybfp