[G]ov. Peter Shumlin’s $86 million health care package is likely to dominate the legislative agenda, but a wellspring of health related bills are bubbling up through the House and Senate as well.
The money for the governor’s proposal would come from a 0.7 percent employer payroll tax, the revenue from which could draw more than double that amount in federal Medicaid match.
More than half of that money would go toward raising Medicaid payments to doctors and hospitals in an attempt to increase beneficiaries’ access to care and reduce private health insurance premiums. Increasing health care providers’ Medicaid income is intended to allow private insurance companies and self-insured employers to negotiate lower rates with providers. That, in turn, is expected to lower premiums.
House Speaker Shap Smith, D-Morristown, said reducing the costs shifted from Medicaid to commercial insurance is a priority and accepted that it would require new revenue. Republicans voiced tepid support for the package, but said the money should come from spending cuts elsewhere, not new taxes.
But a recent report on the incidence of health care spending in Vermont by the Rand Corp. questions the existence of the cost shift and suggests that prices negotiated between hospitals and insurance companies have more to do with market dynamics.
“Cost shifting is often cited by providers to justify large gaps between prices paid by private and public plans. But there is a significant debate in the health economics literature regarding the extent to which cost shifting actually occurs. Theoretically, economists have argued that, in competitive markets, cost shifting would not be possible due to competitive pressures, and that, in noncompetitive markets, providers would use market power to set higher prices regardless of the level of uninsured and low-reimbursement patients in the population,” the report says on page 65.
Shumlin said the increased payments will translate into lower premiums for people with commercial insurance in 2016. He proposed expanding the Green Mountain Care Board’s statutory authority and resources to help shepherd that outcome through its regulatory control of hospital budgets and insurance rates. But the insurance rate setting process will begin in February, before the package could take affect.
Administration officials said they have buy-in from board Chairman Al Gobeille, the hospitals and Blue Cross Blue Shield of Vermont, the state’s largest insurer, and the money will find its way back into people’s pockets.
It will be incumbent on the Legislature, the administration and the board to ensure that happens, otherwise the Medicaid bump could become a giveaway to hospitals.
Lawmakers introduce a flurry of health care bills
Last year a bill to license dental practitioners, who could perform oral health services at a dentist’s discretion, was derailed, but lawmakers in the House and Senate have reintroduced it this year.
Sen. Claire Ayer, D-Addison, will again sponsor the legislation in the upper chamber (S.20). On the House side, Rep. Tony Klein, D-East Montpelier, has introduced a dental practitioner bill as well (H.1).
Despite having the second lowest uninsured rate in the U.S., more than half of Vermont residents don’t have dental insurance, according to a recent study of oral health in the state commissioned by the Green Mountain Care Board. While that’s not out of line with national statistics, Vermont’s covered population isn’t getting the oral health coverage they need either, the report concludes.
“Significant numbers of adults 18-64 have lost all their natural teeth to decay or disease and do not access recommended preventative services,” the report states.
In some areas of the state, as high as 9 percent of the total population have lost all their natural teeth to disease or decay.
Advocates say that the state’s access problem stems from a shortage of dentists, especially in rural areas. The bill requires that dental practitioners be employed by a dentist, thereby allowing a practice to serve more patients.
The Vermont Dental Society opposes licensing dental practitioners and succeeded in blocking the legislation last biennium. They say increasing Medicaid reimbursements for dentists is a better way to solve the problem.
The bill is supported by Voices for Vermont’s Children, the Vermont Public Interest Research Group and the Health Department.
Rep. Paul Poirier, I-Barre City, introduced a bill to increase subsidies for middle-income Vermonters with coverage on the exchange H.24. The bill is financed with a tax on sugar sweetened beverages, a revenue source that’s likely to crop up in other places or be considered as part of a larger tax package.
The advocacy group Alliance for a Healthier Vermont was formed to pass a sugar sweetened beverage tax, which has failed to gain traction in the past. The organization hired former Conservation Law Foundation attorney Anthony Iarrapino to lobby for the tax in the Statehouse.
Other health care bills introduced thus far include:
• S.15 brings back the paid sick leave legislation and would require employers to offer workers a minimum amount of paid sick time.
• S.5, would require hospitals to notify patients placed on observation status. Being placed on observation status can impact whether Medicare covers services.
• H.20 would allow licensed substance abuse counselors in private practice to bill Medicaid.
• H.19 would require health insurance plans to cover hearing aids.
• S.19 would prevent dental insurers from charging fee schedules for services not covered by their plans.
• S.21 would allow Vermonters to purchase insurance across state lines in New York and the other New England states.
• S.8 would adopt the Interstate Medical Licensure Compact, allowing physicians from other participating states to seek and expedited medical licenses in Vermont.
