Vermont moves closer to universal health care

Burlington Free Press

MONTPELIER — After a night and day of debate, the House voted 92-49 Thursday to approve a bill that could set the state on the road to creating a first-in-the-nation consolidated health insurance system that offers coverage to all Vermonters.


“There was universal agreement on the House floor that the current system will bankrupt us. We have a problem. We need to solve it,” House Speaker Shap Smith, D-Morristown, said in explaining the need for the bill.


Democratic Gov. Peter Shumlin, who made health reform a priority for his first term, congratulated Smith for securing passage of the bill, then noted it was the Senate’s turn.


Senate President Pro Tempore John Campbell, D-Windsor, promised the Senate would deliver a bill before the Legislature adjourns.


The vote in the House split along party lines, with all but three Democrats, all five Progressives and two of three independents supporting the legislation while the Republican caucus battled unsuccessfully for its defeat.


Supporters deflected every attempt to weaken the bill.


With the outcome certain Thursday afternoon, House Republicans demanded the governor and Democratic “supermajority” in the Legislature reduce the uncertainty that would result from enactment of the bill.


“All we are asking for is a promise,” Rep. Oliver Olsen, R-Jamaica, said. “We call on the governor and legislative leaders to promise employers and employees they won’t have to pay for coverage they don’t use.”


Olsen said employers who provide medical coverage for their workers through self-insurance plans worry about the financial impact of a change to a universal coverage system. Employers might decide it was too risky to do business in Vermont, Olsen said.


House Health Committee Chairman Mark Larson, D-Burlington, countered, “The assumption that there is predictability in our health-care system now is a fallacy.”


Ringside seat

Peg Franzen sat through weeks of deliberations in the crowded House Health Care committee room, then stayed at the Statehouse until after midnight Wednesday to hear every minute of the House debate on the bill.

The 71-year-old Montpelier resident is president of the Vermont Workers Center, an organization that sponsored a campaign to establish health care as a human right.


She became convinced, after listening people recount health insurance nightmares, that the state has a health care crisis — “a crisis we can’t let continue.”


“We are pretty excited,” she said because the bill recognizes health care as a public good and sets out a plan to provide universal coverage.


“It isn’t everything we want,” Franzen said listing concerns about the upfront costs Vermonters might still be asked to pay for care. “We’ve heard that actually prevents people from going to doctors in a timely manner.”


Also, Franzen noted, “We are concerned it isn’t going to happen quickly.” Many of the changes won’t be implemented until at least 2014.


Franzen acknowledged the bill’s complexity, so she said she understood why lawmakers had dozens of questions that extended the House session until after midnight Wednesday and through much of Thursday.


“Last night it was really amazing — the civility,” Franzen said. “I think that really has to be applauded.”


Another perspective

Andy Higgins of Fletcher was at the Statehouse on Thursday to observe his daughter, a legislative page, but his visit also gave him a chance to listen to debate on the health care bill. He wasn’t impressed.


“My concern is government is taking over another part of my life,” Higgins said after listening to a morning of House deliberations. “I think it is kind of arrogant that they think they can run things more efficiently than the market.


“That is an oxymoron, efficient government,” he said.


Higgins works in investments and life insurance, but has a window into the state’s health care system as an emergency medical technician in Fairfax.


He said he has paid attention to the discussion this winter, starting with a radio interview of William Hsiao, a Harvard economist who led a research team that concluded Vermont could save millions if it adopted a single-payer health care system.

Higgins disagrees with Hsiao’s recommendation.


“Government has to get out of the way and let the market drive it,” he said. “If people want to smoke, not exercise, use drugs, why do I have to pay?”


Higgins said he was resigned to passage of the health reform bill.


“What can I do about it?” he asked, but added, “It is not going to work.”


Thrust and parry

Republican complaints about the bill centered on the power given to a new board and details about Green Mountain Care — which would be a unified, state-coordinated health-insurance program open to all Vermonters — that wouldn’t be known for several years.


Rep. Tom Koch, R-Barre, called the bill an empty shell.


“We as a legislature ought to know what we are doing, not pass the ball so it can be dealt with later,” Koch said.


Supporters painted a different picture.


Rep. Jim Masland, D-Thetford, called the bill a bold experiment and responded to the talk about uncertainties.


“We can’t know all the answers at this time — that is the nature of pioneering work,” Masland said. He chided opponents, saying “It is rather easy when there are some uncertainties to sow suspicion and angst.”


Rep. Eldred French, D-Shrewsbury, summed up conflicting complaints made about the bill.


“We’ve been told this bill goes too fast, too slow, that it does too much or not enough,” French said. “Sounds like it may be close to the mark.”


Before the final vote, Rep. Duncan Kilmartin, R-Newport, offered an amendment to change the selection process for the new board that would undertake much of the planning for and regulation of the new health system. Kilmartin said these decisions were too significant to give to an appointed board.


He proposed instead that voters elect a 16-member board with each member representing a geographic region of the state.


“It is not the hospitals, the physicians, the tax department, it is you and me and our fellow citizens who are the stakeholders,” Kilmartin said. “The citizens would control their destiny, not political appointees.”


Larson, who responded to every challenge of the bill, defended the two-step appointment process for the Green Mountain Care Board. An 11-member nominating committee would be named, with the governor, legislature and interest groups each filling seats. The nominating panel would recommend board candidates to the governor, who would make the officials appointments.


“One thing we have heard most clearly,” Larson said, “is we had to have a board that was independent of political pressure.” He said Kilmartin’s plan would result in a partisan rather than an impartial board.


The Democratic majority exerted its muscle, defeating Kilmartin’s amendment by a vote of 99-42.