Mark Larson, chair of the House Health Care Committee
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It’s official. The Vermont House passed H.202, the landmark universal health care bill on third reading Thursday. The vote, 90-49, was along party lines, and so was the running set of arguments that occupied a second day of interrogations, amendments, roll call votes and speeches.
The Republicans in the House are on record: There is nothing about H.202 they could learn to love. The GOP oratory, delivered with decorum, was a let-me-count-the-ways-we-hate-it recitation. After grilling Rep. Mark Larson, D-Burlington, the chair of the House Health Care Committee, for 15 hours, Republican members wrapped up their protest of the bill with a member by member explanation of each vote cast against it.
In a repeat performance of the night before, the GOP members, who didn’t have the numbers to scuttle the bill, made their displeasure known to the rest of the body over the course about 15 hours of House debate.
Indeed, the only point on which the right and left agreed regarding this issue is the indisputable fact that health care costs are rising too quickly, at a rate of $1 million a day.
As it became clear that the speechifying and inquisition was nearing an end, the two parties held dueling press conferences. The Dems declared victory; the GOP demanded that self-insured employers in Vermont be exempted from participation in the universal health care bill.
House Speaker Shap Smith called the legislation a “bold step forward” and praised both sides for carrying on a civil and substantive debate. The tenor of the discussion on the House floor, he said, is a “testament to the way we do things in Vermont.
“This bill puts us on a path to meet the challenge (of creating) a structure for cost containment, for putting together a universal plan and puts us on a path when we have a benefit package we can be sure to pay for it,” Smith said.
Larson, who was heralded by the Dems for his leadership on the issue, said the bill would enable the state to “tackle a problem that has nagged us for decades.”
As for the GOP’s criticism that the bill is “an empty shell” and that it raises more questions than it answers, Larson said in reference to the extensive questioning over the last two days: “I’m not sure there are questions that haven’t been answered several times.”
The bill now goes to the Senate.
Senate President Pro Tem John Campbell declared the senators will “do due diligence” and will ensure that medical coverage is extended to all Vermonters. He described the bill as the first step toward building a sustainable health care system.
As for the criticism leveled by Republicans that the legislation has been created in haste, Campbell declared: “We are not moving too fast.”
In a press conference, Rep. Oliver Olsen, R-Jamaica, told reporters that the new bill creates uncertainty for business, particularly large self-insured entities that he said would have to pay twice under the new bill. Olsen said the companies would be obliged, as proposed in the Hsiao plan, to pay a payroll tax, in addition to maintaining insurance benefits their workers expect. This is the crux of the “uncertainty” businesses are concerned about, he said.
“One thing we’ve heard about our fragile recession is that uncertainty delays hiring,” Olsen said. “This bill creates great uncertainty, particularly for the 106,000 Vermonters who are part of self-insured plans.”
Olsen said the state’s biggest employers – IBM, General Electric, General Dynamics – have made it clear that the “uncertainty” in this bill will be a great risk to their employees.
“We call on the governor and legislative leaders to promise these employers they will not have to pay for a system they will not use,” Olsen said.
Rep. Anne Donahue, R-Northfield, said her party had offered many amendments that were rejected by the Democratic majority. “Unlike Congress, I hoped to see (us) working together,” Donahue said.
Donahue is concerned that insurers will leave the state.
“This is where the rubber hits the road,” Donahue said. “We are going beyond the point of no return.”
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Thank you for your coverage of this and many important issues. If you could try to include reference to how Progressives and Independents vote (in general) I think that would help readers/viewers understand the context of the debate further. It is my understanding that the Progressives supported the measure (100%) while there were two indepedents that voted yes and one that voted no.
In particular, Independent (and he truly is) Adam Greshin from Warren voted yes. He is a business person with extensive experience in the NYC business culture as well as the ski industry here in Vermont.
By adding this depth of information, readers/viewers would get a better undestanding of the actual issue and the situation. One that goes byond the partisan vote lines that get drawn. If this legislation were going to be so bad for business, there is no way he would have voted yes.
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Here is a link to Rep. Greshin’s statement following the vote. http://vtreform.files.wordpress.com/2011/03/greshin-vote.doc
Rep. Greshin states that he voted yes “with trepidation.” He points out that he supported three of the opponents’ amendments, which he considered improvements to the bill.
His statement makes it clear he is not a supporter of the bill; he voted to “move it forward.”
And indeed, opposition to H. 202 was bi-partisan. The lead amendment proposed to withdraw the establishment of an entitlement before we know the plan design, cost and financing (which for some of us is one of the problems with H. 202) came from a Democrat, Rep. Browning from Arlington.
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I second what the previous commenter said. Thanks.
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Having ALL Vermonters in a “single-payer/few-payer” system would create the greatest savings. Any such system must include all people on a government payroll; state, county and town. No one should have a “Cadillac” plan, obtained by union “negotiations” at tax payer expense.
That way all Vermonters have the same plans and the same services. That would be democracy and fairness. All treated equally before the law. No big host of people would be required to administer it.
Plans with high deductibles should also be offered to people who want them.
It would be the lowest cost way to go, the least complex and the easiest to administer, AND create the greatest savings.
That is the way it is done in Europe.
I lived in Europe for 28 years under a single-payer system that covered ALL workers, including government workers, professors in colleges, policemen, teachers, loggers, farmers, business owners, etc. It is a fair system that provides care at about half the cost per person per year AND covers everybody, AND has better outcomes; lower infant mortality, longer life expectancy.
Medicaid and Medicare have 10% administrative costs and 90% benefits.
HMOs have 20% administrative costs and 80% benefits.
The additional 10% HMOs keep is about $250 billion per year which is used for lavish offices and multimillion dollar paychecks for top management, PR, advertising, and paying politicians, etc., to keep the gravy train going.
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I agree with you that if this is enacted, that there should be no “waivers” for cadillac benefits for unions and our elected officials, including Leahy, Sanders, and Welch. However, your argument doesn’t hold for the salaries of insurance companies. Members of the “five member death panel” will have quite substantial salaries by Vermont standards, $170,000 a year for the chair, and $100,000 for each of the remaining 4 members. And they will be able to bring in consultants and advisors when needed…I already see a growing bureaucratic mess in the future. I am a healthcare provider and I can tell you from experience that Medicare and Medicaid are already rationing services. What do you think will happen when more people are added to the roll? And coverage doesn’t mean that services will be available. I am already hearing from people in the healthcare field that they are already starting to look for employment elsewhere…and are making plans to move out of the state in the next three years should this legislation pass. The US is not Europe. Healthcare services in other countries, including Europe are facing their own crises, in fact, many other countries are moving towards more free-market solutions. And we are moving towards socialized healthcare in this country…ironical isn’t it?
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“free market solutions” in the context of health care is an oxymoron
and BTW, there’s nothing “socialized” about this proposal
doctors & nurses will not work for the government (although many do at the actual socialized system called the VA); and note that while everyone at General Dynamics is paid by taxpayers, we don’t refer to the defense industry as “socialized”
government will not own pharmaceutical companies
government will not own the hospitals or the nursing homes
government will not own the company that handles the administrative tasks
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Congratulations to the Vermont House for taking this bold action to reform health care. Onto the Senate!
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There is an important question that should be answered by our legislature about H 202. H 202 lays out some parameters around the setup of the state exchange as required by federal reform. H 202 makes it clear that it will require most employers and individuals in the State to purchase coverage through the state run exchange and not allow off exchange options (barring the private market from offering options to employers and individuals). The exchange will of course offer only a couple options and likely only invite one insurer to play. Taking away the ability of employers and individuals to choose from options off the exchange through the private market is irresponsible and dangerous on several fronts. 1) Federal Health care reform envisioned the exchanges existing as an alternative to the private market, much like the US postal system provides alternatives to companies like Federal Express and UPS. In fact that analogy was used by supporters of Fed reform. 2) Many employers have been innovative with their plans by adopting consumerism and wellness elements and integrating them with creative designs. With these plans they have improved employee health (financial and physical), productivity and employee satisfaction rates.These employers view their approach to benefits as an important investment in their Human capital. It is clear that the exchange can’t/ won’t be able to replicate these designs. Not allowing employers the freedom to decide for themselves if the exchange is best for their business is, well, simply bad business. 3) Details around cost, design and financing of the State run exchange are lacking. This has been a hang up for many proponents of the bill. Allowing for off the exchange options would mitigate that concern as a “safety net” would be in place should the exchange not “get it right”.Think of it from this perspective , if a company were making a major computer system change you would not destroy the old system until you new the new system was functioning as planned. You would run parallel systems. It’s a matter of common sense. 4) The proposed set up of the exchange in H202 essentially creates a monopoly situation which is dangerous, the absence of off the exchange options will stifle innovation and accountability for the few powerful folks running the exchange will not be as strong as it would otherwise be. This is not a comment calling for the killing of H202, rather is is a plea to modify it to reduce the risks H202 poses to our economy.
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Response to Patricia Crocker.
You’re speaking in total ignorance of heath care in Europe. Europeans think of Americans a barbaric for not having universal health care and they’re right. I was in Hungary last year and suffered a retinal tear. I was treated on a Sunday afternoon with the standard treatment done in the US (but not on weekends!) The total cost was $100 and this included the follow up visit. For a Hungarian it would have been free. That amount would have almost been my copay alone in the US under a so called ‘Cadillac’ plan. Ignorance is what causes a lot of our problems, being informed would help solve them. A Single- payer universal health care system is a solution to health care being a stock market commodity to be profited from by Wall Street parasites.
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Lew nice,
Yeah its hard to explain to Americans who’ve never really experienced it how it; how, even though the states “Isn’t Europe” that we ARE “barbaric” with our healthcare and they (Europeans) have learned something that we haven’t yet learned here in the states.
I feel like though we lead the world in so many ways, some good and some not so, that our healthcare system just isn’t one of the them.
Well said.
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Lets just call it finally – ‘UNIVERSAL’ health care for all Vermonters, declare the world has changed a little bit for the better, remain calm, and move on.
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P. Crocker is right one point-if this bill passes-there will be a whole state that got what it wished for but may not be happy with the long term outcome.
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Thanks to Mark Larson for his calm, professional and adroit leadership sheparding H.202 through the General House Assempbly. His answers to questions were thorough and logical. How unfortunate that opponents to the bill continued to ask and repeat the same questions over and over.In effect, their performance is “the empty Shell” or perhaps better the “emporer’snew clothes” in their disguise of supporting the status quo of Vt’s big business. What is great about disconnecting health care from place of employment is that more creative and innovative entrepreneurs in Vermont will be free to create equally creative and innovative small businesses rather than staying with the big corporations of IBM, General Dynamics, specifically for reasons of getting health insurance. We will see much greater fluidity and resources strengthening the Vermont ingenuity and indeopendent thinking for which we are known.
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I would direct folks to read: http://pnhp.org/blog/2010/11/19/will-the-wydenbrown-state-waiver-enable-single-payer/
Dr. Don McCann, from Dr. Carey’s national organization, points out the following:
“What about the funds for Medicare? Medicaid? CHIP? Taft-Hartley plans? What about ERISA requirements? What about the multitude of other funding requirements such as the VA system, academic institutions, safety-net institutions, community health centers, the Indian Health Service, the U.S. Public Health Service, and the many others?
“There is no authorization in the Wyden/Brown bill, PPACA, nor any other existing law or regulation to fold many or all of these programs into one single payer system. Think of trying to run a partial single payer system (an oxymoron) while still having to deal with the massive Medicare and Medicaid programs. The point is, don’t let up on your advocacy, thinking that Wyden/Brown is our entry to single payer. We would still have a highly fragmented financing system.”
But that’s exactly what H. 202 is: a partial single payer. Moreover, Hsiao’s financing model assumed ALL of these waivers, because he was directed to do so. We won’t get them. The bill recognizes that, and Mr. Kimball and Dr. Rader-Wallach have said so. Therefore, folks should be honest about this and quit using Hsiao’s estimates of savings for what we are doing. And quit making promises about what we can pay for, since we won’t have those savings.
Clearly, even Physicians for a national Health Program understands that this dream of single payer isn’t possible at a state level. That’s why they are working for a National Health Program.
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An interesting insight.
I hope you’re right.
However, as we look ahead to the discussion of how to finance the new system, we have to deal with the (admittedly) rough proposal in Hsiao’s report. He recommended that the self-employed pay both portions of the tax – that of the employee and the employer (as the self-employed already do for the payroll tax). If this happens, what you envision will probably not occur because few will be able to afford to pay 29% off the top before federal & state income taxes (15.3% payroll tax and approx. 14% for the new health care system). If so, many would be inclined to keep their current jobs and pay half that much.
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It has been a long trip from the time Howard Dean began Dr. Dinosaur to finally passing H202 out of the House. There have been bumps along the way, but we are near the end.
The consistent problem has been the persistent tendency of the GOP and its business allies to reject looking at the rising new moon out of loyalty to the old. The advocates of reform are on the right side of history and will prevail.
John A. Burgess
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Moving too fast on health insurance reform … yeah … but’s that only because anything involving social responsibility that has been debated for the last half century moves too fast when it actually moves.
On the other hand nation destroying tax breaks for rich and wonderful just can’t happen with enough speed.
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“The advocates of reform are on the right side of history and will prevail.”
One can only hope so just to prevent the needless suffering that thousands of Vermonters will have to yet endure at the hands of the brutal non-system (and Vermont is relatively humane by American standards) before we finally get this in place.
“If you could try to include reference to how Progressives and Independents vote (in general) I think that would help readers/viewers understand the context of the debate further.”
Dave: Thanks for your post. I was there when the final vote was tallied and on the night before when the legislature stayed at it until 1:00 am. All progressives and independents (greshin and Poirier) voted yes. Chris Pearson, P-Burlington, made a great closing statement, as did both Poirier, very much in favor, and Greshin, not necessarily in favor of the bill, but of moving forward. Only two democrats, both from the southern part of the state, Browning (Arlington) and Corcoran (I believe, from Bennington. I am writing this from memory on the fly, so could be wrong) turned against the bill. Other than that it was right down party lines, with the Independents and the progressives siding with the democrats.
Mark Larson made a superb stand in defense of H.202 in the face of withering interrogation, so much of it the same questions phrased differently as Ann’s article suggests. He was grilled for hours, for instance, by Tom Koch, R-Barretown, who was rather snide about his criticisms, like he was a vice-principle scolding Larson, who withstood it excessively well. He was on the right side of history.
“General Dynamics is paid by taxpayers, we don’t refer to the defense industry as “socialized”
Right on, Doug. Have you ever wondered why people scream and shout about single-payer health care as socialized, but just love single-payer defense?
For those worried about physicians leaving the state there is this link:
http://thinkprogress.org/2011/03/25/vermont-single-payer-health/
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There has never been and never will be a law passed with certainty about cost. Accused criminals will be tried and punished. Do we know the cost? The legislature will begin in January and end in ? Do we know the cost? The roads will be cleared of snow. Do we know the cost? Taxes will be collected. Do we know the cost or revenue? And when Vermont became a republic in 1776 or a state in 1791, did we know the cost? Would the Vermont GOP have voted no to independence in 1776 or statehood in 1791 for lack of certainty?
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Let me start by saying Bravo to this system and to the house for taking this step. I do see a necessity for “where we go one we go all”, I want to see this system in effect from the CEOs to the janitors. I do wonder what happens to union workers who are currently covering an ever increasing percentage of healthcare as part of their compensation, is it safe for them to assume what ever percentage this system cuts those costs by will be added to their base salaries.