So far this session there are no bills of interest in election law, which has been our focus for the past couple of years.
This year, health care is at the top of our agenda, with a number of bill of interest now under discussion in the House and Senate committees. They are (the summaries that follow are from Dr. Deb Richter's VT for Single Payer campaign):
H100 and S88 Health Care Financing and Universal Access
Single payer bills identical in almost all respects, introduced by Rep. Mike Obuchowski of Bellows Falls and Sen. Dick McCormack of Windsor County. Applies to all Vermont residents. Pays for hospital services (starting July 1, 2012), and primary care, preventive care, and other essential services (starting July 1, 2013). Financing: broad-based taxes plus Medicaid (waiver sought)and Medicare (waiver sought). Hospital budgeting: Hospital care guaranteed under a global budgeting process using spending caps. Supplemental private insurance allowed for services not covered by bills. Health care professionals reimbursement: Payments negotiated with a Health Care Board taking into consideration capitation, fee for service, performance incentives, Medicaid rates. Health resource planning: Current methods applied on a regional basis. Cost containment: Cost containment targets for each sector. Out-of-state care: Provided for. Malpractice reform: None
Comment: These bills establish a universal, publicly-financed health care system for all Vermonters, with cost containment measures and system-wide administrative savings.
H.491 Single-Payer Health Care System
Single payer bill introduced by Rep. Susan Davis of Washington and others. Applies to all Vermont residents. Pays for hospital, primary care, preventive, and other essential services (starting Oct. 1, 2011). Financing: After study (Jan. 15, 2011), taxes might include some of the following in combination: payroll tax, income tax, scaled fee, plus Medicaid (waiver sought) and Medicare (waiver sought). Hospital budgeting: Retains current budget approval process. Health care professionals reimbursement: Payment by negotiated rates. Health resource planning: Current methods applied regionally. Cost containment: Reduced administrative paperwork, adjustments in system capacity, preventive care measures, chronic care management. Out-of-state care: Provided for. Malpractice reform: Establishes mandatory arbitration in medical malpractice cases.
Comment: This bill establishes a universal, publicly-financed health care system for all Vermonters, with cost containment measures and system-wide administrative savings.
H.512 Vermont Hospital Security Plan
Single payer bill for hospitals introduced by Rep. McFaun of Barre Town. Applies to all Vermont residents. Pays for health services provided in hospitals (starting Jan. 1, 2012). Financing: After study (Jan. 1, 2001), taxes that might include some of the following in combination: payroll tax, income tax, value-added tax, sales tax, annual fee, other consumption taxes, plus Medicaid (waiver sought) and Medicare (waiver sought). Hospital budgeting: Global budgeting process. Health care professionals reimbursement: No mention. Health resource planning: Current methods applied on a regional basis. Cost containment: Global budget spending caps. Out-of-state care: Provided for. Malpractice reform: Mandatory arbitration in medical malpractice cases.
Comment: This bill is a logical first step toward a universal health care system for all Vermonters. It results in reduction of administrative spending. It reduces private insurance premiums directly by an estimated 40 per cent and workers' comp premiums by an estimated at 12 percent.
S.181 Cost Containment in Hospitals
Hospital cost containment bill introduced by Sen. Susan Bartlett from Lamoille County. Applies to all Vermont residents. Pays for inpatient hospital services under a global budgeting process (starting 2011). Financing: Proportional charges on private insurance, plus Medicaid (waiver sought) and Medicare (waiver sought). Hospital budgeting: Global budgeting process. Health care professionals reimbursement: No mention. Health resource planning: Retains current methods. Cost containment: Global budget spending caps. Out-of-state care: Provided for. Malpractice reform: None
Comment: The bill shares some of the advantages of H.512 above. It does not however guarantee hospital budget financing because it depends on taking back a portion of private insurance premiums on an ongoing basis. This is not the same as H.512's approach. H.512 reduces the costs of private insurance premiums by 40 percent and workers' comp insurance by 12 percent, after which it uses a tax package to fund hospital budgets.
H.510 Public Health Care Coverage Option
Mandated health insurance coverage plan introduced by Rep. Paul Poirier of Barre City and others. Mandates under penalty health insurance for all Vermont residents (by April 1, 2012). It provides the option of publicly-subsidized insurance, called Green Mountain Care, for Vermonters eligible on a sliding income scale. Pays for hospital care for all Vermonters. Financing: Ten percent payroll tax (businesses with more than four employees), candy and soda tax, portion of current cigarette tax, Green Mountain Care insurance premiums, plus Medicaid (waiver sought)and Medicare (waiver sought).. Hospital budgeting: Global budgeting process. Health care professionals reimbursement: Medicare rates as a base-line. Health resource planning: Retains current methods. Cost containment: Hospital spending limits, reimbursement rates pegged to Medicare rates. Out-of-state care: Provided for. Malpractice reform: None.
Comment: Insurance mandates have led to higher health care costs, as in Massachusetts.
H.372 Vermont Freedom Health Plan
Preventive and prenatal health services bill introduced by Rep. Mike Fisher of Lincoln. Applies to all Vermont residents. Pays for prenatal and preventive services (starting 2011). Financing: After study, taxes might include income tax or tax surcharge, tax on payrolls over $20,000. Hospital budgeting: Retains current methods. Health care professionals reimbursement: Negotiated, with options for uniform reimbursement, reference pricing, limits on specialists. Health resource planning: Retains current methods. Cost containment: Not addressed. Out-of-state care: Not addressed. Malpractice reform: None.
Comment: A step, but a very small one, toward applying system principles to a defined sector of health care. Any cost savings will be proportionately small.
Another bill, H.485, falls under our position on state finance, which states in part that the LWVVT supports land use assessment rather than fair market value... The bill would impose a land use change fee of 10% of the sale price of land being sold for a purpose other than its current use.
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