This January, lawmakers introduced two major pieces of legislation, both of which aimed to improve Vermonters’ ability to access health care.
One bill, H.721, proposed expanding the publicly-funded Medicaid program to cover thousands more Vermonters. The other, H.766, sought to diminish private insurers’ influence over practitioners’ care decisions — a move that lawmakers hoped would reduce paperwork and free up clinicians to see more patients.
Now, at the end of the legislative session, the two bills have met divergent fates.
H.766, which supporters have nicknamed the “provider burden bill,” has drawn broad legislative approval and is soon headed to the governor.
Meanwhile, H.721, the Medicaid expansion bill, has been slowly whittled down to a small section of language in the state’s budget bill.
Rep. Lori Houghton, D-Essex Junction, the chair of the House Health Care Committee, where both bills originated, said the trimming of H.721 was “unfortunate.” But she called the passage of H.766 “a huge win for patients and providers in Vermont.”
If signed by the governor, H.766 will reform the ways commercial insurance companies can handle orders for procedures, tests, drugs and claims from medical practitioners. The goal is to relieve practitioners of some of the bureaucracy and paperwork of dealing with insurers — ultimately freeing them up to see more patients.
The bill would impose prohibitions and limits on when insurance companies can reject orders and claims from clinicians, and would restrict insurers’ ability to impose their own requirements on what practitioners are able to do.
Insurers say those practices actually save money, and that eliminating them will hike Vermonters’ health insurance premiums.
“This bill still has a significant impact on health premiums for members,” said Sara Teachout, a spokesperson for Blue Cross Blue Shield of Vermont, which insures roughly a third of Vermonters. “Our concerns remain extremely high.”
But the bill has received approval from both chambers of the Legislature, surviving a last-minute effort to postpone its provisions. Its next stop is the governor’s desk.
Jason Maulucci, a spokesperson for Gov. Phil Scott, said the governor had not yet decided if he would sign the bill.
“He has some concerns about the uncertainties around cost, but also understands there could be benefits, creating efficiencies and improving patient experiences,” Maulucci said. “So, he will weigh those out once it reaches his desk.”
H.721, the Medicaid expansion bill, has taken a much different path. Democrats announced the introduction of the bill with a Jan.12 press release.
As originally written, the bill would have significantly increased the income thresholds required for Medicaid coverage, allowing thousands more Vermonters to access publicly-funded health insurance.
But over the past four months, amid widespread concern about state finances, lawmakers whittled the legislation down to an expansion of just one program, tucked into the state’s budget.
The still-extant section would expand eligibility for Medicare Savings Programs, which provide subsidies to help low-income Vermonters who are 65 and older pay for Medicare.
That provision works by expanding the income threshold for the state’s Medicare Savings Programs. Currently, the most comprehensive program only covers Vermonters at 100% of the federal poverty limit, meaning their income can’t exceed $1,255 a month for an individual in 2024. The language in Vermont’s budget would increase that limit to 145% of the poverty level, or $1,819 a month for an individual in 2024.
That language will make a material difference in the cost of health care for thousands of Vermonters, according to Mike Fisher, the state’s health care advocate.
“The step that the Legislature took this year is a significant improvement for close to 12,000 Vermonters,” Fisher said, “who are going to gain access to real improvements to their ability to afford premiums in Medicare and out of pocket costs.”
But previous provisions — such as allowing more young people and pregnant Vermonters to get covered by Medicaid, and studying a broader expansion of the program for all ages — fell by the wayside.
The original bill had “a lot of good stuff in there that would help us get to a new vision for health care in Vermont,” Houghton, the chair of the House Health Care Committee, said Thursday.
Nevertheless, “We’re going to keep on looking at access and affordability,” she said. “We still have work to do and we’ll keep doing it.”
