The House Health Care Committee began work Tuesday on health care reform legislation that passed the Senate last week.
Sen. Tim Ashe, D/P-Chittenden, the bill’s primary architect, appeared before the committee to explain its intent.
The bill, S.252, pulls together a wide array of provisions related to Vermont’s health care reform agenda, setting some elements in statute and calling for further study of others.
“It’s really an attempt to take some modest but appropriate steps to help position us to make decisions perhaps next year,” Ashe said.
The Senate’s goal was to pass a bill that if signed into law would be acceptable as written, he said. The upper chamber was careful not bite off more than it could chew, Ashe said, and he hopes the House will identify other areas where action might be appropriate.
Some members of the House Health Care Committee said Ashe’s bill passes the buck on key financing questions.
A provision in S.252 defines how federal employees and members of the military will interact with Green Mountain Care, the state’s planned universal health care program.
Both groups have federally sponsored health coverage, and one challenge for Vermont’s policymakers is how to deal with populations that will likely continue to receive their primary coverage outside Green Mountain Care.
Rep. George Till, D-Jericho, wanted to know why the bill does not address other larger populations that will also likely continue to receive primary coverage elsewhere, such as Vermonters on Medicare or those whose employer offers self-insured health plans.
“Are you anticipating that we’ll tackle those other two? I’m just wondering why you guys were silent on the big groups and just picked off this little group,” Till asked.
“Well, I think because it was the easiest group to look at,” Ashe responded. “No really, in truth, we weren’t positioning ourselves to have a Senate strategy versus a House strategy, but rather to hand off our best thinking to date.”
Ashe intimated that the Senate would continue to work on the bill, and possibly look to incorporate additions when the bill goes to a conference committee of the two chambers.
The Senate bill also contains a provision requiring the administration to study and present all options for integrating Medicare into Green Mountain Care by the end of the year.
Health coverage for Vermonters who are federal employees or members of the military “shall be deemed, by virtue of their participation in those plans, covered by Green Mountain Care,” and whatever they pay for that coverage will be considered their financial contribution to the state program.
The legislation calls on the administration to present the Legislature with options for a supplemental benefits package if there are “significant gaps” between the coverage offered through federal health plans and what’s offered by Green Mountain Care.
Robin Lunge, Vermont’s director of health care reform, said that language is problematic.
“Our preference is to remain with the construct created in Act 48, which is that all Vermonters have Green Mountain Care because they’re Vermonters,” Lunge said.
Creating a different set of rules for certain populations will complicate enrollment in the program, she said, whereas a residency-based program would be easier to administer.
In addition, TRICARE, which provides civilian health benefits to active duty military and veterans, isn’t always portable, meaning Vermonters who rely on it sometimes can’t access coverage out of state.
“An easier, more simplified approach would be to just ensure that all Vermonters have their Green Mountain Care card,” Lunge said.
Federal employees may not use it day-to-day but if they lose their job or leave federal service, then Green Mountain Care would still cover them.
But that raises a larger question, said Rep. Chris Pearson, P-Burlington, of how – and how much – populations that won’t receive primary coverage through Green Mountain Care should pay into the program.
Lunge said the administration is exploring whether the program will necessitate a different financing plan for people who receive secondary coverage from Green Mountain Care
S.252 also sets deadlines for the state to contract with third party administrators of the program.
Lunge and the governor have made it clear the administration wants to avoid statutory deadlines – or any deadlines really – for when elements of the program need to fall in place.
The nature of government procurement for large-scale projects is such that adhering to set timelines could jeopardize the process, Lunge said, citing the state’s recent struggles with the Vermont Health Connect website as an example of how contracting on deadline can go awry.
Rep. Mike Fisher, D-Lincoln, the committee’s chair, said he understands the challenges the state faces as well as the Senate’s desire to keep the transition to a universal health care program on track and suggested he might look for a compromise.
Fisher asked his colleagues on House Health Care to begin formulating changes and additions that they would like to see in the bill.
The committee will continue to take testimony throughout the week. S.252 is likely to pass through other committees, including Ways and Means, before it goes to the House floor for a vote.
