After months of struggle over big questions and mind-numbing minutiae, the leaders in the Vermont House and Senate celebrated a moment of triumph on Tuesday: They came to final agreement on the single-payer health care legislation.
Over the last few days, the six members of the Health Care Conference Committee — three House members and three senators — worked through the details of the final draft of H.202. The tone was congenial as they crossed off their to-do list with remarkable efficiency, despite the necessarily nitpicky nature of the process.
In the end the legislators came up with solutions to what they viewed as the most vexatious problems presented by the Senate draft of the bill — an exemption for members of the military who have access to TRICARE, a federal medical plan and a definition of Vermont resident that made it possible for the state to exclude undocumented residents from the Green Mountain Care system. In both cases, the conferees struck the language and proposed studies to determine whether either issue would require special allowances.
Senate President Pro Tem John Campbell thanked the conferees. “We’ve used the word historic to describe bills that have previously passed,” Campbell said. “I believe for the first time that word is really appropriate as we take a major step toward health care policy that is not only morally correct but fiscally sound.”
Democratic lawmakers who support the bill say the legislation is a visionary framework for a transformation of the existing, fractured $5 billion health care industry into an integrated plan that covers all Vermonters and controls the rising cost of care. It creates a board that will make decisions about the benefits package, reimbursement rates for doctors and hospitals, a financing mechanism and payment reform. The Shumlin administration wrote much of the bill and will begin implementing aspects of the cost containment mandate right away.
Critics say the bill will launch the state on an unsustainable fiscal path in which Vermonters will only have access to even more expensive care that is mandated by the government.
House Speaker Shap Smith told reporters that the bill reflected a careful process in which lawmakers listened to “people with concerns and incorporated their comments.”
He compared Vermont’s new law to the early single-payer effort in Saskatchewan that eventually led to a universal health care system throughout Canada.
“Other parts of the country (the U.S.) are moving backwards while in Vermont we’re moving forward,” Smith said. “Every Vermonter should have access to health care. We will need everyone to chip in as well.” Smith said he envisions a benefits system similar to Catamount in which “everybody’s in, and everybody pays.”
Rep. Mark Larson, D-Burlington, chair of the House Health Care Committee, said health care has become a drag on the state’s economy. The new system, he said, will promote quality health care and contain costs.
“The health care bill is an economic development bill in disguise,” Larson said. “I look forward to proving this can work.” Sen. Claire Ayer, D-Addison, described H.202 as a “sensible, logical” step. When asked if she was apprehensive about the future of the state’s single-payer plan, given the numerous hurdles the state has to overcome to implement the system, Ayer said, “You’d have to be senseless not to be a little nervous. It’s a big job.”
“Sometimes nervousness can lead to paralysis,” Smith said. “In this instance, nervous energy will lead to action and lead to a (health care) system for all Vermonters.”
Shortly after the bill signing, the GOP held a press conference to refute the legislation that they said will negatively impact businesses and a large percentage of the state’s economy.
The Senate passed the conference committee version of the bill largely along party lines after a long digressive declamation on the floor of the Green Room by Sen. Peter Galbraith, D-Windham, who insisted that he was merely trying to fully vet a $5 billion bill. Galbraith grilled Sen. Claire Ayer, D-Addison, about the new provision that calls for a study of what it would cost for the state to provide health care for undocumented residents. He asserted that including the state’s 1,500 to 2,000 Mexican migrant workers in Green Mountain Care would make it more difficult for the state to obtain federal waivers.
The bill now goes to the House; it’s expected to be taken up for final passage on Thursday.
