Last-ditch efforts to change a health care reform bill in the House failed on the floor Thursday.
For most of the day, state representatives lobbed ideas back and forth over where Vermonters should buy their health insurance starting in 2014.
H. 559, which lays the groundwork for the state’s health benefit exchange, will require individuals and small businesses to purchase health insurance in this online marketplace.
Under the federal Affordable Care Act, participation in health insurance exchanges is voluntary, but the current bill would make it mandatory for some. House Republicans offered two amendments, both of which would have the state put the brakes on that idea.
First, Rep. Oliver Olsen introduced an amendment that would allow people to buy insurance outside the exchange if the commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration found plans offered inside the market cost more than 10 percent of “grandfathered” plans. Plans like the Vermont Education Health Initiative that insures the state’s teachers will be likely grandfathered under the federal health care law.
The issue, Olsen said, is that the state is going down a path it has not been down before and it should learn from its past experiments. Forcing people into the exchange does not sit well with businesses in Vermont, according to the Republican from Jamaica.
“If we lock Vermonters in a lab and allow costs to go up and they don’t have a way to get out, I can’t stomach that,” Olsen said.
The amendment died on the floor with 88 representatives voting against and 45 for.
A nearly identical amendment by Republican Reps. Mark Higley and Greg Clark failed on the floor as well, 80-57.
For more than two hours of debate, Rep. Mike Fisher, chair of the House Committee on Health Care, defended the decision made by his committee to require consumers to buy health insurance on the exchange — a regulated online marketplace akin to a travel website for health insurance.
Fisher repeatedly referred to the requirement that Vermonters buy insurance in the exchange as a consumer protection measure.
“The arguments for an outside-the-exchange marketplace I continue to not understand,” Fisher said. “It mystifies me, and I’ve spent a lot of time thinking about it.”
Fisher said plans inside and outside the exchange will be essentially the same. The difference, he said, is that plans inside the exchange allow individuals to draw down federal tax credits. Having an outside market would mean added administrative costs for the state, which would have to regulate two markets rather than one, Fisher said.
Fisher’s list of benefits for consumers in the exchange failed to convince representatives like Ronald Hubert, a Milton Republican.
Hubert, who runs his own business, balked at the idea of having the state tell him where he and employees need to buy their health insurance.
“It should be my right, not the state’s, to decide whether to buy health insurance in the exchange,” Hubert said.
Clark defended his amendment by saying that the issue is really one of choice, and Vermonters want to make a decision for themselves, particularly when it comes to what some see as an experiment.
“Idea of value comes from the fact that Vermonters would like to make their own decisions,” Clark said. “Vermonters are always willing to be led to the water trough, but, man, they get irritated when their heads are forced into the trough.”
The argument over whether to allow individuals and small groups to buy insurance outside the exchange has lingered as the prominent issue in the debate over this year’s health care reform bill. It represents a stark shift from other states that are making participation in the exchange voluntary.
Other points where the Shumlin administration and leading Democrats proposed changes to the bill, like allowing high deductible bronze plans and requiring larger businesses to buy insurance in the exchange, saw little debate Thursday.
While many House Republicans urged the body to allow greater choice, Progressive Rep. Chris Pearson and Independent Rep. Paul Poirier, both members of the health care committee, urged their fellow representatives to keep their eyes on the prize of universal health care at a fair price. Using the exchange to draw down federal funding will help do that, they said.
In another twist, Gov. Peter Shumlin issued a statement Thursday commending final federal rules that would allow the state to obtain a waiver from certain requirements of the federal Affordable Care Act and implement reforms that deviate from the federal model.
An amendment that would move up the date for financing for Green Mountain Care to before the November election failed as well.
