Senate President Pro Tem John Campbell. VTD/Alan Panebaker

Statehouse leaders came together for a press conference on Wednesday to mark their many joint accomplishments this legislative session, but the conversation revisited one issue that appears will be an ongoing disagreement that will bleed into the next biennium.

House Speaker Shap Smith and Senate President Pro Tem John Campbell told reporters they are most proud of their efforts to reform the health care system, balance the budget, redraw the boundaries for House and Senate seats and help rebuild Vermont after Tropical Storm Irene.

They had much to agree on — including an ambitious proposal to reform the state’s sales tax system next year.

But when it came down to one of the remaining unresolved issues of the session — prescription drug monitoring — the two leaders openly disagreed in front of the TV cameras. It was a rare public instance of discord between Smith and Campbell, but both men have staked out positions they feel passionately about.

Legislation that originated from the Shumlin administration, which would have given law enforcement access to records from the state’s prescription drug database, ultimately floundered when members of the House and Senate conference committees couldn’t agree. The House wanted police to obtain warrants before running searches; the Senate opposed that requirement.

If Gov. Peter Shumlin’s failed last-minute effort to apply public pressure on the House to abandon that position is any indication, the “epidemic” of prescription drug use will likely become a campaign issue, according to Kristin Carlson of WCAX.

Smith compared the drug monitoring debate in the House to the discussion on vaccines because he said both were about “the balance between public benefit and individual liberties.”

“Members of the House felt strongly, they had a real concern about a reaching in to the prescription drug database by law enforcement,” Smith said. “It was a real challenge to see if there was any opportunity for compromise.”

The Speaker said he didn’t want to diminish concerns expressed by the governor and senators about the “epidemic” of prescription drug abuse in Vermont, but he said they’d have to find an approach that didn’t impinge on personal privacy.

Campbell openly lamented the Senate’s inability to move H.745 forward in his end of session farewell speech on May 5, and his frustration over the issue hadn’t abated four days later.

The Windsor Democrat said House members didn’t “understand” the legal ramifications of probable cause and reasonable belief. Campbell in turn blamed House members, the Vermont ACLU and some of the people who gave testimony for causing confusion about what he believes is the real issue: A need to clarify how the search process would work.

“Some of the issues the ACLU brought up were dealt with, but they were still on people’s minds,” Campbell said.

Campbell advocated for bringing together law enforcement, the ACLU and others. “It’s hard to understand without everyone in the same room,” he said.

When asked whether he thought House members were confused, Smith replied: “I think there wasn’t any confusion. People saw this issue through different philosophical lenses.”

The two men amicably agreed to disagree and then moved on to other topics.

House Speaker Shap Smith. VTD/Josh Larkin

The surprise of the presser? An open declaration that not only would Smith pursue sales tax reforms that would include cloud computing, but also that he would use it as a campaign issue. Smith said he wants to lower the sales tax to a nominal amount, from 6 percent to a much lower amount suggested by the Blue Ribbon Tax Structure Commission (between 1 percent and 2 percent) and expand the assessment to services. The sales tax currently applies largely to goods.

Smith said he supports a tax on cloud computing.

“My feeling is software that is delivered from the cloud should be treated in the same way as software bought at Staples,” he said. “The cloud issue illustrates the challenge we have with the tax structure. Now we have the opportunity to look more broadly at this issue, which isn’t going to get any easier. With the changing economy, we need to take a deep dive into these issues.”

Campbell said comprehensive reform of the sales tax issue is “not only important but also essential.” Last year, Campbell was outspoken about his opposition to the sales tax expansion proposal from the commission.

Here are the legislative accomplishments Smith and Campbell touted:

• Funding for rebuilding state infrastructure after Tropical Storm Irene ($15 million of any surplus funds in fiscal year 2012 and $12 million in redirected capital budget funds).
• Redistricting House and Senate seats in a “nonpartisan” manner (the state has a lone U.S. congressman, so is not subject to federal reapportionment requirements).
• “Pulling the trigger” on the mental health issue, as Campbell put it, by planning to build a state psychiatric facility and substituting a number of institutional psychiatric beds with community mental health services.
• Balancing a budget that started out with a $65 million deficit. “That’s a testament to our good fiscal stewardship,” Smith said.
• Providing “property tax relief” to taxpayers by shoring up the Education Fund transfer from the General Fund with 50 percent of any surplus funds in fiscal year 2013. The transfer amount was eroded when lawmakers agreed last year to “rebase” it to 2008 levels, creating a $27.5 million reduction in the transfer.
• A ban on fracking for oil and gas in Vermont and new protections for Vermont’s rivers and streams and Lake Champlain.

A reporter asked the two men what unfinished business they were most concerned about, Campbell said he was disappointed they weren’t able to get the “fair share” legislation out. The provision would have allowed the Vermont-NEA to collect dues from non-union members who take advantage of union activities. He said the measure would be his No. 1 priority in the next legislative session.

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Vermont Department of Health Commissioner Harry Chen. VTD/Alan Panebaker

Lawmakers this session wrestled with tough choices that will affect health care for Vermonters for the foreseeable future. From how to set up an online health insurance marketplace to whether to allow parents to opt out of childhood vaccinations for philosophical reasons, health care legislation was often at the center of serious, and sometimes contentious, debate.

At the beginning of the session, H.559 stole the show. That bill, which ultimately passed, set the framework for how the state will set up a health benefits exchange where individuals and small businesses will purchase their insurance in an online marketplace.

Toward the end of the biennium, public health advocates and parents’ rights groups battled over the benefits and possible risks posed by communicable diseases and childhood immunizations. In the end, anti-immunization forces won and the philosophical exemption remained in place.

Lawmakers also passed a bill that would prohibit minors from using tanning beds, and a mandate on insurers to release patient claim denial information.

Several important pieces of legislation stalled at the end of the biennium. A provision known as Death with Dignity or physician-assisted suicide, which would have allowed Vermonters with terminal illnesses to take their own lives, failed. A bill requiring insurance coverage for midwifery services languished in the Rules Committee. Senators and representatives couldn’t come to an agreement on a proposed expansion of police prescription drug monitoring.

The following is a rundown of what health care legislation passed (and what didn’t) in the 2012 Legislative session.

House Bill 559: “An Act Relating to Health Care Reform Implementation”

The “exchange” bill sets the stage for the state’s implementation of the federal Affordable Care Act. The exchange is a federal requirement that states create an online marketplace where people buy health insurance. The Shumlin administration plans to use the tool to draw down federal money that will help transition into a universal health care system.

A major part of the big health care bill involved how to define the “small group” market that would buy insurance from the online insurance marketplace. The original version of the bill would have required individuals and businesses with 100 or fewer employees to buy plans from the exchange. It also would have prohibited high deductible “bronze” plans.

After a backlash from a large segment of the business community, lawmakers (backed by the Shumlin administration) shifted sails and changed the bill to allow the bronze plans and decreased the business size to 50.

Small businesses and individuals will have to buy insurance from the exchange under the state law. Critics say mandatory participation in the exchange will dismantle the state’s current insurance market. The federal law does not require this, and other states are not taking this approach. The issue is being taken up by the U.S. Supreme Court, which is expected to rule on the individual mandate in June.

For Vermonters who are insured by larger businesses, the status quo will remain until 2016 when they will join the exchange insurance pool. In 2017, the state plans to start a universal health care system.

For those who work for small businesses and are self-insured, things will change in 2014. Those Vermonters will have to buy insurance on the exchange, which has been likened to a travel website for health insurance. Low- and moderate-income individuals will be eligible for federal subsidies to cover their insurance costs. A family of four making up to $92,200 would be eligible.

One bill that never caught traction this session would have bumped up the financing plan due date for both the exchange and the universal health care system to before the October election. Gubernatorial candidate Randy Brock introduced the bill this session, but it never made its way out of the Senate Committee on Health and Welfare. Act 48, last year’s landmark health care law, requires a financing plan by Jan. 15, 2013. That date is now firm.

Senate Bill 199: “An Act Relating to Immunization Exemptions and the Immunization Pilot Program”

One of the most contentious issues of the year boiled down to chicken pox.

A bill introduced in the Senate would have eliminated a “philosophical exemption” for parents who choose not to vaccinate their children against certain diseases.

Vermont is one of 20 states that allow the exemption along with exemptions based on religious or health reasons.

The bill passed the Senate on an overwhelming 25-4 vote.

The House did an about-face, voting overwhelmingly to keep the philosophical exemption. Ultimately, a conference committee agreed to keep the exemption but require schools to produce immunization rates for each vaccine. Parents would also have to sign a form each year saying they had reviewed educational information and recognize the risk to the community at large.

After more spirited debate, the Senate finally accepted that compromise.

Act 97: “An Act Relating to Restrictions on Tanning Beds”

Kids trying to get a wintertime tan will have to go to warmer climates instead of using a Vermont tanning bed.

A law passed this session makes it illegal for a “tanning facility operator” to let anyone under 18 years old use a tanning bed.

While lawmakers and the Shumlin administration agree on the underlying reason for the law — preventing melanoma and other cancers — putting it into effect could pose some problems.

For one, according to Department of Health Commissioner Harry Chen, “We don’t even know where these tanning beds are right now. We have to figure out what’s the best way to find them.”

The state Office of Professional Regulation does not regulate the facilities. Chen said the Health Department would have to work with local law enforcement, which would be in charge of enforcing the law.

Gov. Peter Shumlin announced last week he would allow the bill to become law without his signature — a sort of public display of disapproval that falls short of a veto.

Death With Dignity, S.103 “An Act Relating to Patient Choice and Control at End of Life”

A bill that some lawmakers have pushed for a decade almost made it up for debate in the Senate but faded away yet again.

Sens. Claire Ayer, chair of the Senate Committee on Health and Welfare, and Hinda Miller tried to bring the issue up for a vote as a rider on the tanning bed bill.

After a lengthy debate, the effort to discuss the issue on its merits failed on an 18-11 vote.

The bill tracks an Oregon law allowing terminally ill patients with fewer than six months to live the ability to be prescribed a lethal dose of medication.

The issue pits some members of the medical community against each other. The Vermont Medical Society opposes the measure. Some physicians say it goes against the oath they took to do no harm as physicians. Others say it will increase the rate of suicide.

Supporters of the bill say it is about allowing patient autonomy and allowing them to make their own decision to end suffering at the end of their lives.

S.200: “An Act Relating to the Reporting Requirements of Health Insurers”

A bill requiring health insurance companies to report claims they deny is on its way to the governor’s desk.

Much of the denied claims information is available publicly, but it is difficult to find and does not currently show up in the state health care claims database.

Rep. Mike Fisher, chair of the House Committee on Health Care, said access to the data would allow consumers to compare insurance companies based on how many claims they deny and what kind.

Just in case they are curious, people will have access to information on things like CEO salaries for insurance companies also.

H.777 “An Act Relating to Licensed Midwives and Certified Nurse Midwives”

A bill that would require insurance companies to cover home births regardless of whether a midwife carries malpractice insurance lost its way this session.

In 2011, the Legislature passed a bill requiring insurance companies to cover midwife services. Families, however, ran into hurdles after the bill went into effect. Blue Cross Blue Shield of Vermont, however, declined to cover many home births since midwives in Vermont do not carry malpractice insurance.

The bill requiring coverage until 2014 regardless of whether the midwife carries malpractice insurance passed the House 76-46.

From there, it went to a Rules committee on a timing technicality. Rep. Chris Pearson, who championed the bill, tried to attach it to another bill without success.

Rep. Mike Fisher, chair of the House Committee on Health Care, said there was strong opposition to the bill in the Senate. He said he was concerned it would drag down another bill.

H.745 “An Act Relating to the Vermont Prescription Monitoring System”

A bill dealing with police access to electronic pharmacy records died in the final days of the legislative session with the House and the Senate unable to reach a deal on how far law enforcement should be able to go to access information in an online drug database.

Starting early in the session, the Senate Committee on Judiciary began taking testimony on the dangers of prescription drug abuse.

The Shumlin administration pushed for direct access to the Vermont Prescription Monitoring System, an online database that tracks the prescribing and dispensing of controlled substances — the drugs that are most likely to lead to abuses.

The House approved a bill that would allow access to the system with a warrant. The Senate shifted gears, allowing access to a limited report of information. Under that version, police would not need a search warrant.

At the end of the session, the House and Senate were deadlocked. A last-minute press conference by Shumlin calling the House irresponsible for the roadblock for law enforcement failed to persuade both sides to reach a compromise.

Correction: Due to an editing error, the original version of this story said lawmakers passed a bill that would require children under 18 to obtain parental permission in order to use tanning beds. The bill will actually prohibit minors from using tanning beds.

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Lawmakers discuss the prescription drug monitoring bill. Photo by Taylor Dobbs

After two days of deadlocked argument over law enforcement access to a statewide prescription drug database, Senate conferees have left the negotiations.

Friday’s arguments hinged on the fate of the section of the bill that defines law enforcement access to a statewide prescription database. Originally the two sides differed on whether it should allow search with a warrant or lower the threshold of suspicion that law enforcement would have to meet in order to get information from the database.

“The Senate walked away,” said a frustrated Rep. Ann Pugh, D-Chittenden.

Friday morning, the House conferees, led by Pugh, proposed removing the section all together and leaving the rest of the bill intact. The bill would then require pharmacies statewide to request a photo ID and enter prescription drug recipients into the Vermont prescription monitoring system (VPMS). It would also require prescribers to be registered with the database and enter information about prescriptions for Schedule II, III and IV drugs.

The Senate presented two proposals. The first further refined the process law enforcement officers would have to go through in order to access the database without a warrant, taking some of the ambiguity out of a process House conferees worried would amount to unconstitutional search.

The second Senate proposal was much shorter – it called for the conference committee to be dissolved and new conferees chosen by both bodies. As the session enters its final days, such a proposal amounts to a death sentence for the bill.

Pugh urged the Senate conferees to consider the House proposal, saving the provisions of the bill both bodies agreed on. Sen. Kevin Mullin, R-Rutland, felt the committee would be doing an injustice to law enforcement if they passed the bill without that provision.

“I agree with you that we’ve done good work,” he said, “but I’m not going to accept the blame when clearly, the Senate has said to law enforcement ‘what do you need to get the job done?’ They’ve told us, and we’re willing to give it to them. So we will not accept the blame.”

After two meetings Friday, it became clear that neither side was willing to budge on the issue.

Sen. Richard Sears, D-Bennington, said the Senate conferees became frustrated after the Senate altered their proposal multiple times and the House conferees stayed firm.

“We moved four steps, they’ve moved none,” Sears said.

Keith Flynn, Vermont’s commissioner of public safety, was also disappointed with the outcome.

“This wasn’t the silver bullet,” he said, “but if it’s a three-legged chair, this was one of the legs of the chair, and the chair’s not going to stand without the third leg.”

Flynn emphasized the three-part approach: education, rehabilitation and enforcement, and said it would only work if all three parts were fully functional. Flynn said law, which will prevail absent an unlikely compromise by the committee, will not allow effective enforcement.

“At the end of the day, regretfully, we don’t have one of the legs on the chair.”

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Rep. Mike Fisher. VTD/Catherine Hughes

In a landslide, the House voted Thursday to continue allowing parents to use a philosophical exemption to opt out of vaccinating their children.

The conference report will have to pass the Senate again before it becomes law. If the Senate rejects it, the bill will fail, and the philosophical exemption will remain intact.

Requirements such as an annual sign-off by parents recognizing the risk to the community were retained. Schools will be required to produce aggregated immunization rates, and the state will convene a working group on how to protect students with health issues that prevent them from getting vaccinated, including allowing them to enroll in different districts with higher immunization rates.

The 133-6 vote to approve the conference report marked a shift from Wednesday when House Health Care Committee Chair Mike Fisher asked to postpone a vote since he did not have the votes to pass the compromise.

Earlier this session, the Senate voted overwhelmingly to remove the philosophical exemption based, in part, on the state’s below average vaccination rate. The House kept the exemption but added more reporting requirements. Members of the House and Senate worked to iron out an agreement to reconcile their conflicting bills.

The first agreement struck by a conference committee would have suspended use of the exemption for certain vaccines if immunization rates dropped below 90 percent. That did not sit well with many representatives, and Fisher asked for more time. After a late-afternoon meeting Wednesday, the conference committee brought out the new report, which did not include the 90-percent trigger for certain vaccines.

“I believed we could claw and scrape our way to a majority vote,” Fisher said. “It just wasn’t worth it. The core of the bill was acceptable, and I thought fairly minor changes would make it acceptable to a wider majority.”

Since 1979 Vermont has allowed parents to opt out of vaccinations for philosophical as well as religious or health reasons. Fisher has worked on the issue for a large part of the legislative session. For him, and other lawmakers, the decision whether to remove that right was a difficult balance between parental rights and public health.

“It really is a good puzzle and a great discussion about where individual rights should begin and end and where community protection and public health begins and ends,” he said.

As a parent, Fisher said, he decided to slow down vaccination schedules for his children. Looking at the issue from a public health standpoint, he said, he veered more toward the idea of requiring more immunizations.

“Most people look at this from the perspective of their child,” he said. “It’s a whole different calculation when you look at the whole population of children in Vermont.”

A group of parents called the Vermont Coalition for Vaccine Choice was a driving force in lobbying to keep the philosophical exemption.

Jennifer Stella, one of the leaders of the group, said she is relatively happy with the newer compromise. More independent research on the health effects of vaccines is needed, she said. The group claims unvaccinated children are not causing health problems, but the side effects of some vaccines are. They plan to continue working on the issue.

While the House-passed version of the conference report was better than the first version, she said there are still some kinks.

For one, requiring parents to sign a statement each year saying they have reviewed material outlining the risks of not vaccinating their children and the risks to others seemed like a jab.

“Parents who use the philosophical exemption truly believe they are making the best possible medical decisions for their children,” she said. “To ask them to sign a statement that is denigrating this approach is definitely unfavorable for parents.”

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Sen. John Campbell. VTD file photo / Josh Larkin

Five of six members of a House-Senate conference committee signed a report Monday that would allow parents to continue to exercise a “philosophical exemption” to opt not to have their children vaccinated for certain diseases.

However, the compromise didn’t seem to make anyone happy.

Vermont is one of a minority of states that allows for the exemption; it also allows exemptions for religious and health reasons.

But earlier this session, the Senate voted overwhelmingly to strip that part of the law, based in large part on the state’s dipping vaccination rates.

Then the House voted overwhelmingly to keep the exemption.

The compromise bill stipulates that if rates for certain immunizations, such as measles, drop below 90 percent, the commissioner of the Department of Health would suspend use of the philosophical exemption for that vaccine.

Rep. George Till, the only medical doctor in the House, signed the report, but he said he did not think it went far enough.

“It’s a very, very small step, and it doesn’t go nearly far enough to protect the kids of Vermont,” he said. “It’s an abdication of our responsibility to our kids. We let a very vocal minority rule to the detriment of Vermonters in general.”

Senate President Pro Tem John Campbell refused to sign the report. He was sitting on the conference committee as a substitute for Sen. Sally Fox.

“I cannot in all good conscience sign a report when I deeply feel we are putting our children at risk,” Campbell said. “When you look at the numbers for me I think you’re going to expose children to diseases that are clearly preventable. Some parents are afraid of potential harm vaccination may cause their child. I find it a little disturbing that we don’t care about the rest of the children.”

Sixty percent of Vermont children 19 to 35 months old are “adequately vaccinated,” according to a 2009 Centers for Disease Control and Prevention survey.

Some parents say the bill compromise goes too far.

Jennifer Stella organized the Vermont Coalition for Vaccine Choice this legislative session. She said the 90-percent threshold in the compromise bill limits parents’ right to use the philosophical exemption.

“It basically says that only 10 percent of Vermonters get to use that right,” she said.

Stella has a petition with more than 1,500 signatures of residents who want to keep the philosophical exemption. She said Gov. Peter Shumlin supports their cause, and she is calling him out to veto the bill.

In an April 18 press conference, Shumlin said he thought the House passed a thoughtful bill.

“I do not believe that, in the end, the government should dictate to parents what inoculations their children should get,” he said.

Dr. Harry Chen, Shumlin’s commissioner of Health, supports removing the philosophical exemption.

The issue turned into one of the most contentious of the legislative session. On the one hand, parents whose children allegedly have been injured by vaccines say the exemption allows parents to make an informed decision. Some say the pharmaceutical industry has lobbied successfully to convince society that all children need to be vaccinated for every disease possible.

The established medical community says immunizations are a public health issue and that unvaccinated children can pose a health risk, particularly to children with compromised immune systems.

Because the threshold for suspending the exemption is based on a statewide rate, children in a specific school with a low rate of immunizations could still be at risk.

Rep. Mike Fisher, chair of the House Committee on Health Care, said the immunization debate has been one of the most challenging issues of the year.

“This proves to be one of the most difficult and controversial issues we’ve dealt with,” Fisher said before signing the report. “I’m in part baffled, and in part I understand. It strikes at a core conflict of values. I appreciate the frustrations. We’ve been living in it ourselves. I believe we have taken a modest step at both protecting individual rights and protecting the public.”

The compromise also would require schools and child-care facilities to make publicly available aggregated immunization rates of the student body for each vaccine. Parents using the exemption would need to provide a signed statement each year that they understand the risks to their children and others if they decline the vaccines. The bill would also require the departments of Education and Health to convene a working group to address how to protect children with compromised immune systems. The group will have to study the feasibility of allowing those students to enroll in a school with higher immunization rates.

The House and Senate will both have to vote on the conference committee’s report.

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Sen. Randy Brock, Republican candidate for governor, poses with a "Bear for Brock." Courtesy photo

There’s no surer sign of legislative adjournment than the advent of the campaign season, and as of April 28 — thanks to the first and one of the biggest political parades of the year, the Vermont Maple Festival — the election year is off to a sweet start.

Thousands rallied for the sunny afternoon ritual, and there to wave and entertain were some familiar Montpelier faces — Gov. Peter Shumlin, Secretary of State Jim Condos, Vermont Attorney General Bill Sorrell and his Democratic primary rival, TJ Donovan, plus two candidates for Franklin County Vermont state senate.

Republican Sen. Randy Brock was there too — on his first official campaign event as a candidate for governor — with a Bear for Brock in tow wearing tie-dye t-shirt with the slogan “Give the $21 million back to ratepayers!”

Brock said the slogan hit home with constituents who are upset about whether they’ll get their money back.

“It’s a campaign issue, and frankly it’s a nonpartisan issue,” Brock said. “If you look at various groups and coalitions forming this isn’t a Republican issue, this is an issue that crosses lines like few you see around Vermont. Instead of pitting right against left, it pits right against wrong.”

~Anne Galloway

New bill would require health insurers to be transparent

As of this summer, health insurance companies in Vermont will be required to report the number of denied claims, appeals, and other grievances on BISCHA’s website with other company information.

Insurance companies could face more demands, however, depending on which version of S.200 is signed into law. The version of the bill passed in the Senate on March 29 is fairly bare bones, but the House version, amended this week by Rep. Sarah Copeland-Hanzas, D-Orange, and passed 135-1, adds several more reporting requirements.

These include reporting the salaries of corporate officers and board members, political contributions, and advertising and lobbying expenses. It also adds a new section on pharmacy audits and reimbursements for ambulance services.

Sen. Anthony Pollina, P-Washington, one of the sponsors of S.200, said that he liked the changes made by the House.

“The more reporting, the more we know about insurance companies the better off we’re going to be as consumers,” Pollina said. “Hopefully someday we’re not going to even have a need for insurance companies, but as long as insurance companies are around, it’s important that we have as much information about their behaviour as possible so that people can make decent choices about who they want to do business with.”

VPIRG’s health-care advocate Cassandra Gekas said she was pleased with the bill, particularly the House version. Health insurance has been a campaign issue for the consumer advocacy group.

“I think it was just a huge victory for Vermonters, and I feel really proud of the fact that justice prevailed, that legislators sided on patients instead of on profit,” Gekas said. “And when I think about this in the big picture, health care and health insurance, we’re not talking about widgets,” she said. “From my perspective, Vermonters deserve to know not only how their premium dollars are being spent but also what the business practices are of health insurers.”

However, Sen. Claire Ayer, D-Addison, the chair of Senate Health and Welfare, says many of these additions are unlikely to remain. Ayer intends to call for a conference committee, where the bill will likely get pared back down to the version passed in the Senate.

“Basically in Senate Health and Welfare we stripped [S.200] down because the entire system is going to change in 2014, when we go into the insurance exchange. They’ll have specific and unified reporting requirements and that sort of thing. So to ask an insurance company to change all its forms for one year is just a waste of resources,” Ayer said.

“But there were a few things that we thought were really valuable in assessing health care, that would be useful information to the Green Mountain Care Board: about how we give care and what it’s used for, and what it costs, denial and that sort of thing. Those are things we put in that we thought were useful information.”

Health insurance companies like Blue Cross Blue Shield (BCBS) and MVP Healthcare appear to have taken a neutral stance on the change, saying that they already report on much of the information required in the bill.

Lee Tofferi, a lobbyist for BCBS, said the company was not against reporting claims, provided they could explain the reasons for most of them, like duplicate claims or clerical errors.

“What we want to make sure is that we have the ability when we submit the claims denial basis that we can also illustrate and illuminate more of the reasons for those denials,” Tofferi said. “Because there are interest groups out there that are trying to suggest we are denying claims just to avoid paying claims, when in fact most of the claims we deny are for legitimate reasons.”

~Erin Hale

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Rep. Willem Jewett

Last week the Vermont House unanimously passed bill H. 794, a bill which originated in the House Government Operations Committee to substantially reform search and rescue response across the state. The bill passed to the Senate on a waiver of rules which allowed it to move across the bicameral divide despite having missed the cross-over date.

The Senate Government Operations committee had scheduled a hearing on the bill for Monday, but canceled the hearing without notice to those who had been invited to testify, according to one such witness. The bill was sent to the Senate Rules Committee on Monday and not released to the Senate Government Operations committee until Wednesday night.

Rep. Willem Jewett (D-Addison) had developed the House bill after the hypothermia death of 19-year-old Levi Duclos on a popular hiking trail in the Green Mountain National Forest. State police were notified at 8 p.m. by family members that Duclos was overdue to return from a day hike, but they did not initiate a search operation until mid-morning the following day. The House bill would set interim operational requirements for prompt responses in search and rescue cases, require cooperation with municipal and civilian search and rescue organizations, and establish a study committee to evaluate whether the state’s search and rescue function should remain with state police or pass to Fish & Wildlife wardens or other agencies.

A similar, but less-extensive bill calling for a search-and-rescue summer study committee was presented in the Senate by Vince Illuzzi (R-Essex-Orleans). After hearings in the Senate Economic Development, Housing and General Affairs Committee, the Senate search and rescue proposal was appended to S.169, a bill regarding workers’ compensation liens.

“We used a worker comp bill because by the time the death was known to me, it was too late to introduce new bills,” Illuzzi said.

On April 19, Sen. Diane Snelling (R-Chittenden) objected to the attachment of the search and rescue study committee bill on the point of order that it is not germane to the workers’ compensation lien bill. Snelling advised by email that she does not object to the search and rescue bill, but objects to its inclusion in the workers compensation bill.

Sen. Tim Ashe (D/P-Burlington) moved to suspend the rules to permit consideration of the search and rescue provisions. That motion was not voted on, and the discussion was deferred to a future date. This week, with the question of amendment still pending, Illuzzi offered a further change to the bill, adding a proposal of extensive changes to state emergency services.

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Prescription drugs. Photo by Alissa Walker

The Vermont Senate voted Wednesday to allow police more streamlined access to prescription drug data for law enforcement.

In an 18-11 vote, the Senate shifted course from the House and stripped a requirement that police obtain a warrant before they target drug criminals through the state’s online prescription drug database.

In the Senate version, police would get a report from the Department of Health with basic information about an individual’s prescription history. The access is limited to ongoing investigations and certain scheduled drugs that are prone to abuses.

The House and Senate must reconcile the two versions for the bill to pass.

Sen. Dick Sears, who chairs the Senate Committee on Judiciary, says law enforcement officials need easier access to information to abate the state’s epidemic of opiate abuse.

The House bill requires police to get a warrant before they access personal information on the statewide database of prescription drug records.

Under the Senate Judiciary committee’s proposal, which the Shumlin administration supports, law enforcement officers could request information from the Department of Health that would let them streamline an investigation.

“What our amendment does is help law enforcement connect the dots,” Sears said.

Under a law passed in 1968, police can walk into a pharmacy and ask for individual pharmacy records without a warrant. The judiciary committee’s proposal would allow specially trained drug diversion investigators access to personal information from the Department of Health based on “an investigation with a reasonable, good faith belief that it could lead to the filing of criminal proceedings.”

The investigators would not have access to the database per se, but the Health Department would be required to turn over the name and date of birth of a person suspected of diverting prescription drugs and pharmacies and doctors who prescribed those drugs.

The Vermont American Civil Liberties Union and some lawmakers have attacked this new level of police access to private health records. In 2006, when the state created the online prescription database, it specified that police would not have access to the information.

Sen. Philip Baruth, D-Chittenden, said the bill will undermine citizens’ right to privacy, and it could hurt efforts in 2014 to create an online insurance marketplace that will contain personal health records of thousands of Vermonters. He said allowing police access to the prescription drug monitoring system is disingenuous.

“It breaks a promise we made six years ago that police would not have access to this information,” Baruth said. “I don’t see how with a straight face going to go to Vermonters in two years and say we’ll take care of medical records. We’ll keep them confidential.”

Some senators opposed the bill not because they were worried about what information police might obtain, but because they said they believed the loosening of privacy restrictions skirts the Fourth Amendment of the U.S. Constitution, which protects citizens against unreasonable searches and seizures.

Sen. Virginia Lyons, D-Chittenden, expressed her concerns with the warrantless access to information.

“I’m concerned about the slow, slippery erosion of civil rights as we move away from having warrants as we access information,” Lyons said.

Sears, whose committee has taken testimony on the dangers of prescription drugs throughout the session, said he would like greater access, but the compromise struck by the Shumlin administration walked the fine line of protecting privacy and helping law enforcement deal with the state’s prescription drug abuse problem.

“We believe that we have an epidemic,” he said. “I personally would support greater access.”

Sears said his committee’s proposal was a reasonable compromise. He said allegations that police would have free rein of the database are unfounded.

“There never was any discussion about unfettered access by law enforcement,” he said. “No one that I know of ever said law enforcement should receive unfettered access.”

Senate President Pro Tem John Campbell also supports the judiciary committee’s amendment.

He said he hoped other senators realized the dangers of prescription drugs. The commissioner of the Department of Public Safety said earlier this session that more people died from prescription drug overdoses in Vermont last year than from car accidents and murders combined.

“The thought that we should not make it easy for police officers or law enforcement does not sit well with me and I don’t think it would sit well with siblings or parents of people who have died as a result of drug abuse,” he said.

Campbell is a former police officer.

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Sen. Claire Ayer speaking on the Senate floor. File photo. VTD/Josh Larkin

The Senate passed H.559, the health care exchange bill, Tuesday evening, 20-7.

The legislation allows Vermont to take advantage of federal subsidies and tax credits associated with the federal Affordable Care Act. The Shumlin administration plans to use the exchange as a stepping stone toward financing a single-payer health care system.

The bill requires individuals and employers with 50 or fewer workers to buy insurance through the exchange beginning in January 2014. Vermont is the only state so far to pass a mandate for companies to purchase health care coverage on the exchange. In 2016, the federal law will require all businesses with 100 or fewer workers to become part of the exchange.

Senators who support the bill said the exchange program will benefit small companies that struggle to pay health insurance premiums for workers.

Sen. Claire Ayer, D-Addison, told her colleagues that the federal government will look at 2014 participation rates in determining how much financial support to provide the state in 2015.

“We need the strongest healthiest exchange we can get,” Ayer said. “We need everybody in.”

Several attempts to delay implementation of the exchange failed, as did a proposal on Monday from Randy Brock, the Franklin Republican who is running for governor, to require the Shumlin administration to reveal its financing plans for the proposed single-payer health care system before the November election.

With the exception of three votes, the Senate approved the bill along party lines. (Sens. Vince Illuzzi and Kevin Mullin voted for the exchange; Sen. Bob Hartwell voted against it.)

Sen. Diane Snelling, a moderate Republican from Chittenden County, explained why she opposed H.559.

“I hoped by this time to be able to support the movement toward health care reform,” Snelling said as she explained her vote. “I am still deeply troubled by the process while there are many worthy changes in the bill it became too complicated and was broadened too far.”

Senators proposed a number of amendments to H.559, which evaluates the quality and cost of health insurance plans.

Here is a sampling:

Pollina Amendment

Sen. Anthony Pollina, D/P-Washington, proposed an amendment to H. 559, which would bolster insurance payments for mental health treatment. The Senate Finance Committee proposed to delay legislation on mental health coverage until next session, pending a report from the commissioner of financial regulation as to where to draw the line between primary and specialty mental health services. Pollina’s amendment gives the commissioner until October 1, 2013, to adopt rules establishing such guidelines, additionally proposing a section that would prevent health insurance plans from requiring higher co-payments for mental health services than for general medical care. The proposed changes would apply to new or renewed plans in 2014 and extend to all plans by 2015.

The Senate passed the amendment on a voice vote.

Mullin Amendment

Sen. Kevin Mullin, R-Rutland, proposed an amendment that would make it easier for prescribers to get prior authorization from insurers for medications that require such pre-approval. The final version of the amendment requires insurers to respond to urgent prior authorization requests within 48 hours and non-urgent requests within 120 hours. The language proposed by the Senate Finance committee allowed two business days for urgent requests and seven business days for non-urgent requests. That amendment passed.

Mullin also sought to limit insurers to five prior authorization request forms. Currently, insurers like Blue Cross/Blue Shield and MVP Health Care have about 100 forms, representatives said. Having numerous forms, they said, allows them to get specific information regarding the drug in question, making the process more efficient. Mullin said this system makes it difficult for prescribers to navigate the system to get prior authorization. That amendment was ultimately struck down in committee.

Sears Amendment

Sen. Richard Sears, D-Bennington, proposed to remove three sections of H.559, including a section on sports injuries. The section became a subject of heated debate on Monday, when Sears insisted the language be changed to state that coaches must have “actual knowledge” of a head injury in order to be legally required to pull student athletes from a game.

The wording was changed to “an objectively reasonable belief under the circumstances.” The Senate approved the new language.

Illuzzi-Miller Amendment

Sens. Vince Illuzzi, R-Essex-Orleans, and Hinda Miller, D-Chittenden, proposed to delay implementation of the health care exchange by one year to January 2015.

The Senate defeated the proposal by a narrow margin, 15-12.

Illuzzi Amendment

Illuzzi failed to persuade his colleagues to adopt a proposal to ensure brokers are “reasonably compensated” along with a provision that would have given the Secretary of the Administration the ability to modify the implementation planning for the health insurance exchange bill should the U.S. Supreme Court strike down the individual mandate requirement in the Affordable Care Act.

Editor’s note: Taylor Dobbs contributed to this report.

CORRECTIONS: Sen. Illuzzi was listed as a D/P. He is a D/R. Sen. Kevin Mullin voted for H.559; he was originally left off the list of supporters.

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Rep. George Till. File photo by Josh Larkin

Lawmakers are seeking a compromise that would protect public health and possibly maintain a philosophical exemption for parents who choose not to have their children immunized.

In a conference committee this week, House and Senate members are working to reconcile one bill that would remove the exemption altogether (the Senate’s) and another that would leave the option intact (the House’s).

On Monday, members of the Senate, who voted overwhelmingly to remove the philosophical exemption, offered a compromise that would require parents who opt out of any immunizations to provide schools with a notarized statement that they have received “evidence-based” information from a health care provider about the dangers of not immunizing children.

The Senate proposal would also direct the state commissioner of health to disallow exemptions for certain vaccines if the immunization rates fall below thresholds set by the Centers for Disease Control and Prevention.

On Tuesday, House members offered a proposal with fewer hurdles. Both plans would require schools and health care facilities to disclose aggregated immunization rates.

A coalition of parents lobbied tirelessly this session to keep the exception. Vermont is one of 20 states that allows for a philosophical exemption in addition to religious and medical exemptions. According to state and federal health officials, the state also has one of the highest exemption rates in the country.

Many in the medical community, including Dr. Harry Chen, commissioner of the Department of Health, say leaving the exemption in place could lead to an increase Vermont’s already high rate of unvaccinated children.

Rep. George Till, an obstetrician who supports eliminating the exemption, said many physicians don’t like the Senate doctor sign-off requirement.

“It belittles what they’re already doing in the form of education,” he said.

Till said some pediatricians see the sign-off provision, a compromise the Shumlin administration recommended earlier in the session, as tacit approval of allowing unvaccinated children, who could potentially spread disease, to attend school.

The other issue, he said, is “if you sign a paper against medical advice, it changes the relationship between the doctor and the family.”

Jennifer Stella heads a coalition of parents who want to keep the exemption.

She said the Senate proposal puts too many restrictions on the philosophical opt-out.

“There’s a certain time where you have to examine is this really a right anymore is it a right with so many conditions on it that it’s no longer a right that can be exercised?” she said.

The conference committee meets again Wednesday at 11 a.m.

If the two houses don’t reach a compromise by the end of the session, the bill will die, and the philosophical exemption will remain.

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