Daily Archives: March 13, 2015

The Good Ship Two-Tax leaves the harbor

“Yes.”

That’s the one-word answer I got from House Health Care Committee chair Bill Lippert (D-’Burbs). The question? Did he consult with Speaker Shap Smith and Governor Shumlin before proposing a two-tax approach to funding health care?

As you may have heard, Lippert’s committee yesterday passed a health care bill including a .3% payroll tax and a two-cents-per-ounce sugar-sweetened beverage tax. Thus confounding the predictions of low-budget Vermont Political Observers (ahem) who thought the introduction of the lower payroll tax might be the death knell for the beverage tax.

Asked to elaborate on his one-word revelation, Lippert unsurprisingly didn’t offer much:

“…there are different points of view on different parts of the bill. That’s all I can say, really. The Governor’s made clear that he’s a fan of the payroll tax and not a fan of the sugar sweetened beverage tax.”

Of course, in this budgetary environment, the governor’s going to wind up accepting some items he’s “not a fan of.”

On the other hand, the Health Care Committee is a relatively safe harbor for the beverage tax; it approved the tax last time around, only to see it run aground in Ways and Means. So, will it be smooth sailing for the committee’s bill this year?

Nah.

“Sail through? No, it will not sail through. There are waves and shoals and whatever metaphor you want to use. I’m looking forward to it not being a shipwreck.”

At that point, we abandoned the metaphor. Point being, Lippert has no illusions about the permanence of the vessel — oops — he’s built.

He makes a good case for it, from a liberal point of view. Since the Governor reduced his payroll tax plan, the combo tax was an alternative way to fund an array of health care reforms aimed at broadening access, reducing the uninsured, encouraging expansion of primary care offerings, and further bending the cost curve.

The bill would improve available subsidies in the health care exchange for those making between 133% and 300% of the federal poverty level. Even with current subsidies, many of the working poor can’t afford health insurance. Or their coverage has such high out-of-pocket costs that they can’t afford to use it. Kind of defeats the purpose of health insurance, no?

The sugar-sweetened beverage tax, Lippertays, makes sense as a funding source for health care because it “raises revenue, but is also a way to invest in longer-term behavioral changes and better health.”

Of course, he acknowledges diverse opinions about the beverage tax, even on his own committee, and expects more of the same going forward:

I have no illusions that what we propose will be a final product at the end of the session, but it was our responsibility, and I was given the direction, to work with the committee to identify and articulate priorities that could make a difference now and could be investments for the future, even in a time of tight budgetary constraints. We may have exceeded that, but we did our best.

A number of us came into this session saying, we’re not going to be able to move forward on the universal access through single payer, but there is still reason for us to move forward in a significant way in health care.

Moving forward “in a significant way” required more revenue than the Governor’s reduced payroll tax would provide. Problem is, there’s pretty broad disagreement on the relative merits of the payroll tax and the beverage tax — across party lines. At this point, there’s no consensus on how to pay for health care reforms, or how much to pay. The likeliest outcome: a lot of the reform provisions will wind up on the cutting-room floor as legislative compromises eat away at the Health Care Committee’s revenue proposals.

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The vultures descend

Here’s a little item that I find amusing. Maybe you will, too.

At yesterday’s meeting of the House Health Care Committee, Rep. Avram Patt (D-Shap’s District) brought up the subject of those long, confusing Explanation Of Benefits forms (EOBs) we get in the mail every time we see a doctor or have a covered service or procedure done. You know, the ones nobody ever reads?

Well, Avram Patt reads ’em. And he had some questions, mainly centered on the lavish “prices” for services beyond the basics. How are those prices arrived at? Do they reflect the cost of the services rendered? Does anyone — covered or not — ever actually pay that?

He had inquired about some of this with his insurer, and been told that if an uninsured person gets a whopping bill and complains, “it’s immediately negotiated down.” And the original fee? That’s an “algorithm” — a calculated starting point for negotiations.

Short answer, in other words: Nobody ever actually pays that price, and it seems to have nothing to do with cost.

The committee wanted more information on these questions and some others, and decided to seek testimony — mainly from Shumlin administration functionaries.

But lo and behold, I look at the revised committee schedule this morning, and at 11:00 a.m. I see a lobbyist clusterf**k. Lobbyists for MVP Healthcare, CIGNA, and Blue Cross Blue Shield will be lined up, one after the other, to explain those EOBs. Presumably in an industry-friendly, “No no, it really makes sense, please don’t ask us to change” sort of way.

That’s all. I just found it amusing that healthcare industry lobbyists were so quickly available on less than 24 hours’ notice, and all at the same time.