Rutland Herald
By Peter Hirschfeld
Vermont Press Bureau
MONTPELIER — When Gov. Peter Shumlin signs into law the health care reform bill finalized by legislators Tuesday, Vermonters won’t see any immediate differences in the way they pay for or receive medical care.
“Most Vermonters won’t see any change in their lives,” said Sen. Claire Ayer, an Addison County Democrat and chairwoman of the Senate Committee on Health and Welfare.
Lawmakers however say the “historic” bill sets in motion the most ambitious reform initiative the nation has ever seen. And while enormous hurdles remain — namely, the creation of a public financing system for what is now a $5 billion industry — legislators say they now have a “road map” that charts a course toward universal care.
“This bill acknowledges that everybody, every Vermonter, should be entitled to health care,” House Speaker Shap Smith said. “With that right will come responsibility, and we know we will need everyone to chip in as well.”
Precisely what “chipping in” means is a question left by lawmakers and administration officials for another day. By January of 2013, the administration is to return to the Legislature with a plan to fund, with some manner of tax, a health care sector that represents close to 20 percent of the state’s entire economy.
Ayer said lawmakers understand the political pitfalls that threaten efforts to enact a publicly funded system. Once residents understand just how much they pay to cover not only themselves but others as well, Ayer said, the electorate will come on board with the plan.
“We are going to do the most amazing public education job ever done,” Ayer said.
House and Senate Republicans chided the Democratic supermajority for “rushing” toward a public financing system without first understanding the costs to businesses and individuals.
Rep. Heidi Scheuermann, a Stowe Republican, borrowed from Warren Buffet a metaphor he used to describe the lead-up to the Great Recession.
“It’s a like a guy jumping out of a 50-story building,” Scheuermann said. “For the first 45 stories, he thinks he’s flying.”
Lawmakers finished work on the defining bill of the 2011 legislative session Tuesday as the House and Senate reconciled differences between competing versions of the health care reform bill.
One key difference centered on the issue of undocumented immigrants, and whether or not they would be covered by the universal benefits package envisioned in the reform bill.
A bipartisan Senate amendment offered by Sens. Randy Brock, R-Franklin County, and Dick Sears, D-Bennington County, explicitly prohibited undocumented immigrants from receiving benefits.
The amendment angered some of the most ardent supporters of the bill, who successfully got the question of who’s in and who’s out consigned to a study. Also relegated to study are some of the most complex and controversial components of the publicly financed system — such as who pays and how much.
But the bill also includes more immediate changes to the state’s health care system, notably in the areas of cost containment and payment reform. A five-person board — to be appointed by Shumlin from a list of candidates vetted by the Legislature’s nine-person “nominating board” — will oversee the major aspects of the reform process. Independent of either branch of government, the so-called “Green Mountain Care Board” will, upon its inception in October, begin to change the ways in which health care providers are reimbursed for performing various procedures.
The bill also looks to constrain increases in health premiums by exposing private insurers to heightened public scrutiny during the rate-review process.
When private insurers request a rate increase, under language in the reform bill, they must notify customers as to why they’re seeking the increase and what the hike will do to premium costs.
Cassandra Gekas, health care advocate for the Vermont Public Interest Research Group, said consumers will have fuller access to insurers’ books as well as a public-comment period in which to challenge any rate increase.
“Insurance companies have buried administrative costs and executive bonuses for too long, causing premiums to skyrocket,” Gekas said. “(The reform legislation) will help put an end to unreasonable rate increases this year, and make sure that Vermonters finally have a voice in the rate review process.”
Brock said he worries the legislation could irreparably harm Vermont’s health care system, even if lawmakers one day decide to abandon plans for the publicly financed system.
He said the five-person reform board will have the power to alter immediately the ways in which providers are reimbursed. The legislation, he said, effectively allows an “unelected, unaccountable” board to “set wages and price controls” on doctors.
“And I worry tremendously about what the effect might be on some doctors’ willingness to practice in this state,” Brock said.
The Senate approved the final version of the health care bill in a 21-9 vote Tuesday afternoon that fell largely along party lines. The House is expected to OK the legislation in a vote scheduled for today, and it is expected to arrive on Shumlin’s desk in about two weeks.
peter.hirschfeld @timesargus.com