Legislative leadership rescues health care reform bill

May 09, 2014

Vermont Digger
By: Morgan True
Democratic leadership has found a way to resurrect a health care reform bill that earlier in the week looked as though it was on life-support.

In its new form, S.252, a bill that originally set deadlines for the development of financing plans for Green Mountain Care, now includes no scheduled date requirement for the Shumlin administration to reveal how it plans to pay for a government-funded universal health care system.

Sen. Tim Ashe, D/P-Chittenden, had said at a Tuesday conference committee meeting that the House and Senate versions of S.252 could not be resolved in a timeframe that would allow the conference committees compromise to get approval in the House. That’s because House Republicans had said they would not vote to suspend the rules to allow it to be brought to floor more quickly.

But the conference committee continued to work toward a compromise, and when one was reached, the language the conferees agreed to was introduced as a strike-all amendment to an all-but-forgotten, House-passed bill that was languishing in the Senate Finance Committee.

The bill, H.596, would have shifted responsibility for overseeing the sale of hospital assets from the Department of Financial Regulation to the Green Mountain Care Board and made changes the regulatory process. By striking out that language and inserting the conference committee report, the Democratic majority in the Senate was able to suspend its rules to message the bill back to the House in order to get it on the notice calendar for Friday.

That will allow House Speaker Shap Smith, D-Morrisville, to bring the bill to a vote on the House floor Saturday – which is expected to be the last day of the session – without the three-fourths majority he would need to suspend the rules, effectively bypassing the need for minority party support.

Typically a bill would be held for another day before landing on the governor’s desk, but the governor is able to request the bill be sent to him without that hold, which he is likely to do as the compromise included two provisions requested by his administration.

The compromise reached by the House and Senate includes a set of principles meant to guide lawmakers next session when they begin to craft the laws that will shape Vermont’s planned universal health care system.

It strikes House language that would have set a Jan. 15, 2015, deadline for the governor to present lawmakers with a financing proposal to pay for Green Mountain Care. The Shumlin administration was supposed to present the financing plan to the Legislature in January 2013. The governor’s refusal to reveal tax proposals to fund the new system has been a source of contention throughout the session.

The compromise does keep two provisions that lawmakers on the House Health Care Committee fought hard to keep, one requiring urgent care centers to treat patients regardless of whether they have insurance and another increasing regulations for and banning certain practices by pharmacy benefit managers.

A section regarding the use of adverse childhood experience questionnaires was watered down to just a study and report without any application of the questionnaires, which can be predictive of health complications later in life.

It leaves out controversial language in the Senate version that made Green Mountain Care the secondary payer for populations that will continue to get their primary health coverage elsewhere – such as Medicare beneficiaries, federal employees and people in the military.

Instead, the compromise bill uses House language making Green Mountain Care the “payer of last resort,” an insurance term meaning the state would essentially provide those populations with supplemental coverage in areas where the Green Mountain Care benefit is more generous – a change that was supported by single-payer advocates who described the secondary-payer language as carving certain populations out of the program.

The sections included at the behest of the administration include a housekeeping measure providing jurisdictional clarity to the Green Mountain Care Board and the Department of Financial Regulation for the oversight of certain types of insurance.

Another extends a statutory deadline to 2016 for the development of a uniform set of codes for health care procedures across payers and providers, as well as uniformity to a process known as claims edits. Claims edits are a set of rules applied automatically when processing claims that detect and correct simple errors and check the validity of the claim information.

Current statute requires the uniform practices to be in place by 2015, but when the law was passed Vermont intended to piggy-pack on practices being developed at great cost in Colorado. Those rules have not been completed, and the Vermont statute doesn’t include funding to develop them independently. The extension is to allow time for the Colorado process to be completed, so it can be duplicated in Vermont.

The bill also includes a variety of study reports to be completed by the administration and presented to lawmakers to help guide them in crafting health care reform legislation next session, which are an amalgam of House and Senate proposals.

Rep. Mike Fisher, D-Lincoln, chair of the House Health Care Committee, said the compromise was bittersweet.

“Of course it’s frustrating to lose pieces that you’ve worked on all year, but there’s some aspects that are still there that we’re really satisfied with,” he said.

Fisher cited the pharmacy benefit managers and urgent care regulations that were included in his committee as among the provisions he thinks will have real impact. The continued direct enrollment piece for small businesses is important because it will give peace of mind to employers mandated to purchase insurance through the exchange.

Correction: An earlier version of this story misstated the majority needed to suspend rules.