Referential treatment
As the legislative session races to a close, there is a lot of hurrying up and waiting for bills to reach their final form.
In the healthcare world, one such bill, S.190, would fast-track the Green Mountain Care Board’s ability to reduce the amount that two insurance groups pay hospitals for services, starting next fiscal year.
In the House, the bill awaits a final look from the Appropriations Committee before going to the floor. A spokesperson for Gov. Phil Scott said the governor can’t commit to whether he will sign the bill until it has reached his desk, but over the past few days, some in the Statehouse have raised concerns that Republican lawmakers may not support the bill, over concerns it might deprive hospitals of too much revenue or unfairly skirt rulemaking.
Last year, the Legislature directed the care board to bring down hospital prices through something called reference-based pricing, which aligns the amounts insurers pay hospitals with a percentage of some benchmark, usually Medicare’s rates.
But to do that, the care board has to go through a long rulemaking process that won’t be ready for primetime this year. (Oh, is the October start of the hospital budget year not primetime for you, too?)
So, this bill would give the care board the power to set those benchmark percentages for this coming fiscal year for two health insurance plan groups that are feeling cost pressure most acutely: public school employees (through the Vermont Education Health Initiative, or VEHI) and individuals or small businesses who buy insurance from Vermont Health Connect. This would go into place before the care board completes its formal rulemaking process, which would apply to what hospitals charge all insurance plans, and would give hospitals, insurers and stakeholders a chance to weigh in.
S.190 took a number of wonky turns to reach this point. Early drafts were much more prescriptive about percentage reductions in revenue the care board should include when it sets hospital budgets this summer.
“I was like, ‘Wait a minute, we’re the Legislature. We’ve already given this authority to the Green Mountain Care Board. Why is the Legislature inserting themselves in the hospital budget process?’” Rep. Alyssa Black, D-Essex Town, told VTDigger in an interview.
Black introduced an amendment last week that strips all of this down. Her version now just tells the care board “go forth and do,” she said.
From the start of the session, Vermont’s hospitals have said they are capable of taking $50 million out of their budgets this coming fiscal year and $50 million the following year, balancing keeping costs affordable for patients and staying financially stable, said Devon Green, the vice president of the Vermont Association of Hospitals and Health Systems.
Calculations in earlier versions of the bill blew past that $50 million that hospitals say they can absorb this coming year.
The Green Mountain Care Board already has the regulatory authority to set hospital budgets and the authority to set rate increases for insurance plans on the Vermont Health Connect marketplace. S.190 would give the board the ability to more narrowly direct the cost reductions it requires of hospitals — the board will not only be able to tell hospitals, This is how much you need to cut revenue, but also, These two plans are where you should specifically reduce revenue.
“I came to the session at the beginning saying, ‘Do something in ’27. Don’t let ’27 go by without taking a real tangible step in reducing prices,’ and so this bill represents that,” said Mike Fisher, the state healthcare advocate. It’s frustrating that the rulemaking process takes this long, he said, but to him, the bill is a step in the right, more permanent direction.
In the know
In a largely symbolic move, the Senate voted Tuesday to repeal the Clean Heat Standard, a 2023 law aimed at reducing carbon emissions that come from heating and cooling buildings in Vermont. Senators tacked the language undoing the law onto a bill, H.740, that would direct the Agency of Natural Resources to collect data from fuel dealers about the types of fuel they sell and where they sell it.
The 26-4 vote doesn’t change much in practice, as lawmakers have been in agreement since last year that work to develop the Clean Heat Standard would not advance during this biennium. On the floor Tuesday, Sen. Anne Watson, D/P-Washington, who chairs the Senate Natural Resources Committee, called removing the 2023 language “housekeeping.”
Still, the vote carries political significance because of the rhetorical role the Clean Heat Standard played in the 2024 elections that ushered in a wave of new Republicans to the House and Senate. On Tuesday, Senate President Pro Tem Phil Baruth, D/P-Chittenden Central, said as much.
“The Democratic majority — not the supermajority — the Democratic majority, post-election, is saying to you, ‘Here. Here is the repeal you sought,’” Baruth told his colleagues.
The Senate’s changes to H.740 are set to be considered on the House floor Thursday.
— Shaun Robinson
There has been a “rise of hateful, threatening rhetoric” online in recent weeks centered on the push to roll back aspects of Act 181, two House leaders said Wednesday.
House Speaker Jill Krowinski, D-Burlington, and Poultney Rep. Pattie McCoy, the chamber’s Republican minority leader, said in a joint statement that they’d seen “truly reprehensible” social media posts and emails targeting Rep. Amy Sheldon, D-Middlebury, who chairs the House Environment Committee, where this year’s headline changes to the 2024 land use law have been hashed out.
“The Vermont Legislature is a ‘citizen legislature’ made up of Vermonters who work hard — on a part-time, seasonal schedule — to represent the voices and priorities of the people who elect them,” Krowinski and McCoy said. “These personal, threatening attacks are unacceptable anywhere, and especially in Vermont, where we have a long history of civil debate and respectful dialogue.”
— Shaun Robinson
On the move
Two committees of conference signed off on compromise versions of healthcare legislation on Wednesday. One is H.660, which would direct how, in the upcoming fiscal year, the state should spend its share of settlement money with drug companies over the toll caused by prescription opioids. The other is H.816, which would regulate the use of AI in mental health care.
The joint committees’ version of both bills will now head back to the full House and Senate for final approval.
— Shaun Robinson
On the Hill
U.S. Sen. Peter Welch, D-Vt., said acting U.S. Attorney General Todd Blanche “should resign immediately” after the Justice Department on Tuesday quietly granted President Trump, Trump’s family and Trump’s businesses immunity from ongoing federal tax investigations.
In a press release, Welch called the agreement “a get-out-of-jail-free card” from which Blanche — who was Trump’s personal lawyer before getting appointed to lead the justice department — should have recused himself. Instead, Blanche signed off on the measure personally.
“This is corruption through and through,” Welch said.
— Shaun Robinson
