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.
