By Nancy Remsen, Free Press Staff Writer, BFP

MONTPELIER — Dr. Deb Richter is accustomed to
the slow pace of progress toward the health
reform she favors, but she comes back to the
Statehouse again and again to push for change.
She was on hand Wednesday when senators took
another small step.

The Senate voted 28-2 to give preliminary
approval to a bill that directs the Legislature’s
Health Care Reform Commission to hire experts
to write three sets of plans that would
implement a universal health care system in
Vermont beginning in July 2012. One of the
options must be a government-administered,
publicly financed health benefits system.

“It is a good bill. It will get the ball rolling,” said
Richter, an advocate of a single-payer system
she sometimes describes as “Medicare for all.”
Medicare is a federal health insurance program
that covers all Americans over age 65. Richter is
sure the design for a single-payer system will
show it to be “the most fiscally conservative way
to cover everybody.”

The Senate’s health reform bill wouldn’t commit
the state to change, said Senate Health and
Welfare Committee Chairman Doug Racine, D-
Chittenden. Rather, it would give next year’s
Legislature and new governor detailed
information to help them make decisions about
the next steps they could take to achieve
universal access and better affordability.

Racine said the design process “is a necessary
step to make change.”

The bill senators endorsed Wednesday was a
political compromise among three Democratic
gubernatorial candidates. Racine, Senate
Appropriations Chairwoman Susan Bartlett and
Senate President Pro Tempore Peter Shumlin are
among five Democrats running for governor.
Initially, they disagreed about who should
coordinate the planning called for in the bill.

“I believe now we are one big happy family,”
Racine reported as he asked senators to
substitute the compromise bill for his committee’
s original version. Rather than create a new
board to oversee the planning process, the bill
calls for using an existing commission. The
panel’s membership would change to include two
more nonlegislative members and two fewer
lawmakers.

Another change proved more controversial —
although not among the gubernatorial
candidates. It would cap growth in the collective
rate increase for the state’s 14 hospitals at 4
percent for each of the next two years.

Appropriations Vice Chairwoman Jane Kitchel, D-
Caledonia, explained that this would address the
mushrooming cost of health care until
policymakers have made reform decisions.

Health care expenditures in Vermont are
predicted to hit $5.9 billion by 2012, and
hospitals account for 42 percent of total
expenditures, Kitchel said.

Sen. Kevin Mullin, R-Rutland, said officials at
Rutland Regional Medical Center warned him the
cap would create serious financial problems. He
wouldn’t support it, he said.

Sen. Randy Brock, R-Franklin, said he heard
similar worries from officials at Northwestern
Medical Center in St. Albans.

“We are troubled,” confirmed David Yacavone,
director of state legislative affairs for the
Vermont Association of Hospitals and Health
Systems, during a break in the floor debate. “The
4 percent rate reduction is going to lead to
insolvency in some cases.”

Kitchel argued, however, that the proposal wasn’
t reducing rates, it was limiting the increase to 4
percent.

Bartlett said the proposal allowed for exceptions
to the limitation: “The protections are there so
no hospital is going to go bankrupt.”

Sen. Robert Starr, D-Essex/Orleans, noted that
school districts, state government and
businesses all have had to tighten their belts and
operate with zero increases. “And we are
worried about these facilities and giving them a
4 percent increase?” he said.

“Why don’t we say zero?” asked Sen. Phil Scott,
R-Washington.

Senators agreed to add the hospital provision to
the bill by a vote of 21-9, then gave a sweeping
vote of support to the package.

The bill could come up for a final vote today.
Once it reaches the House, many new provisions
will be added. The House and Senate divided
work on health care reform this session.

Gov. Jim Douglas said he supports efforts to
constrain health spending but had yet to review
the hospital rate cap the Senate endorsed.

He wasn’t enthusiastic about the health reform
planning provisions.

“Vermont is in the beginning stages of
implementing federal health care reform,” he
said. “There is so much to do, I don’t think we
need another distraction.”

Still, he said the money for the work would come
from the Legislature’s budget: “The Legislature is
free to spend its budget on whatever it wants.”

Contact Nancy Remsen at 578-5685 or
nremsen@bfp.burlingtonfreepress.com.