By Anne Galloway, Bennington Banner
The Senate Finance Committee got it from all sides on Friday. The subject? H.202, the universal health care bill. Lobbyists and advocates across the spectrum (right to left) pitched amendments in a last-ditch attempt to shape the bill before it goes to the floor of the Senate this coming week.
In speed-dating mode, during 90 minutes of testimony, insurance brokers, representatives from business associations, lobbyists for doctors and insurers, and advocates for a single-payer health care style system converged on the committee to make their final pitches and complaints.
About a dozen individuals handed out written testimony and new draft amendments to the bill.
None of the aforementioned constituencies are happy with the latest iteration of H.202, as it emerged from the Senate Health and Welfare Committee on a 5-0 vote.
Members of Health and Welfare altered the bill to satisfy business interests, and the compromise has engendered resistance from all sides, as evidenced by the testimony Senate Finance heard on Friday.
If the tug-of-war over H.202 is any indication, the fight over future legislation is sure to be intense. After all, H.202 is, in essence, a visionary document that sets more studies in motion and gives a board authority to make more recommendations regarding the development of a single-payer style health care system. It doesn’t include concrete decisions about any of the nitty gritty stuff — what the benefits package will look like, how providers will be paid, how much the system will cost and how it will be financed. That gnarly bit of sausage-making is yet to come — in 2013, well after the next election cycle.
At the moment, the bone of contention is tangential to that single-payer vision. Opponents of H.202 are dismayed by the way the Shumlin administration uses the federally-mandated insurance exchanges as a stepping stone toward a single-payer style health care system.
The Shumlin administration has pushed for language that would give them enough wiggle room to create an integration plan for a “single-payer exchange” under the federal Affordable Care Act; businesses want specifics built into the plans for the exchange that allow them as much “choice” and flexibility as possible.
Business representatives who testified last Friday say the Senate’s changes to the bill don’t go far enough to protect them from regulations that they say could drive up their health care costs.
Single-payer advocates, on the other hand, say the bill is now slanted toward corporate interests and lawmakers have lost sight of the original intent of the bill, which, activists say, is to provide universal care to Vermonters. The Health Care is a Human Right Campaign held a press conference on Friday to publicize their amendments to the bill and insist that lawmakers “put people first.” Activists object to certain economic sustainability requirements in H.202 that they say could set the universal health care effort up for failure.
Sen. Ann Cummings, D-Washington, chair of Senate Finance, tried to reassure business leaders and advocates alike. “It’s no one’s intention to have fewer people with insurance and more expensive (insurance) plans going forward,” she told the lobbyists and activists who packed the room. (At one point, the committee had to open the door onto the hallway to allow for the influx of visitors.)
Cummings’ committee is expected to send H.202 to the Senate Appropriations Committee early this week. The Senate will likely vote out the bill before the end of the week. At that point, it will go to conference committee, where members of the House and Senate will hammer out a compromise version of the bill.
The evolution of H.202
H.202, as passed by the House, was originally more closely aligned with Professor William Hsiao’s report to the Legislature, which recommended that the state pursue a single-payer health care plan. H.202 attempts to create a roadmap that would enable the state to adopt most of Hsiao’s recommendations for a single-payer plan. (The label single-payer in the House plan, however, was dropped for political reasons in favor of a unified, universal health care system.)
According to Hsiao, a uniform payment system is the only way to ferret out waste and ensure quality care for patients. He described the current health insurance and medical delivery as fragmented. Insurers and state and federal governments reimburse providers at different rates for the same procedures; providers are rewarded for the number of procedures they perform as opposed to preventing illness; and insurers spend a large percentage of the money they receive in premiums on administrative costs, which include marketing and lobbying. Hsiao showed that a variety of interests — insurance companies, brokers, pharmaceutical and prosthetic corporations, lab companies, hospitals and sometimes individual doctors — siphon money from the system. Under a single-payer payment program, Hsiao said it’s also possible to control waste, fraud and abuse and prevent duplicative procedures.
He proposed a “single-pipe,” or uniform claims management system, for billing, as opposed to the current “fragmented” payment system, in which insurers and state and federal plans pay providers at different rates for the same procedures.
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