Killed Bill: Senate Panel Deals Blow to Health Care Reform

March 21, 2018

Seven Days
By John Walters

When Democrat Peter Shumlin became governor in 2011, he carried the promise of a single-payer health care system for Vermont. Less than four years later, he abandoned his central policy goal. On Friday, a Democrat-dominated legislative committee balked at a much less comprehensive idea. For health care reform advocates, it was yet another blow.

Earlier this month, the Senate Health and Welfare Committee approved S.53, a bill that would set a path to publicly funded universal primary care for Vermonters. But then it went to the Senate Appropriations Committee, which essentially gutted the proposal. Its version simply calls for a study of the concept.

Don't think we'll be revisiting single-payer anytime soon.

"I think people have a form of PTSD on health care," said Senate Health and Welfare chair Claire Ayer (D-Addison). Her panel spent more than a year on S.53. But early Friday evening, she watched that work go up in smoke. By her account, she'd asked to testify before the Appropriations Committee. Instead, the panel adjourned for an hour and came back with a new version, which it quickly approved. The substitute bill was dubbed the Kitchel amendment, for Appropriations chair Jane Kitchel (D-Caledonia), but she said it was actually written by Senate President Pro Tempore Tim Ashe (D/P-Chittenden), who is a member of her committee.

Universal care advocates took to social media, trying to spark a last-ditch rally. "We want the amendment defeated and the original bill passed," said Dr. Deb Richter, a veteran single-payer advocate. But a reversal seems very unlikely. Indeed, as of Tuesday afternoon Ayer was floating a compromise that essentially adopts the Ashe formulation.

Even the bill rejected by Appropriations was a major retreat from S.53 as it was introduced in early 2017. It called for a universal primary care system in Vermont by January 2019, and it had 13 co-sponsors.

Thirteen. That's nearly half the Senate — only three votes shy of a majority.
By contrast, the bill that emerged from Ayer's committee simply stated the legislature's intent to create a universal, publicly financed primary care system by January 2022. And there were plenty of conditions, such as identifying a funding source, ensuring there would be no new paperwork for providers and paying adequately for primary care.

Those caveats would give future legislatures plenty of chances to pull the plug. Still, that "intent" language was too much for Senate Appropriations to swallow.

"I'm not ready to commit to a publicly financed insurance product," Ashe said in an interview. He acknowledged that there were "off-ramps" but opposed the statement of intent. "Intent language doesn't have full force, but it does state that the legislature favors this particular outcome."

On this issue, the chamber's Democratic/Progressive leader finds himself in league with the moderates in his caucus.

The new Appropriations Committee bill calls on the Green Mountain Care Board, which regulates hospital and insurance costs, to explore how to achieve universal primary care "whether publicly financed or covered by health insurance or other means."

Two items of note: First, the bill abandons any commitment to public funding. And second, it gives the issue to a board that's packed with Republican Gov. Phil Scott's appointees — and his administration is no friend to publicly financed health care. Seems like a prescription for a negative report come January.

Ashe and Kitchel protested that they did the best they could, having received the bill just before the deadline for moving legislation out of committee. "We needed to get the bill out, and most members were not ready to say they had settled on a particular method of doing [universal primary care]," Ashe said.
Ayer begs to differ. "They could have taken testimony before they officially received the bill," she responded. "They knew it was coming. I kept the pro tem informed."

Ayer is right; it's not uncommon for committees to take testimony before actually receiving a bill. Besides, in theory, Appropriations' only role is to vet the money portion of a bill. According to the legislature's fiscal experts, Ayer's legislation would have cost $5,500 at most in the new fiscal year.

In truth, Kitchel's panel did what it claims not to do: It made a policy decision. Members didn't like the substance of a bill, so they rewrote it. Ayer does have the authority to restore the bill in her committee, but she knows that further compromise will be required if she wants to get a bill through the Senate. An already watered-down piece of legislation will be diluted once again.

And the single-payer vision seems more distant than ever.