Is there going to be a health care bill? Like, at all?

The clock is ticking on the 2015 legislative session. We’re less than a month away from the usual adjournment, and a passel of “big bills” is just now crossing from the House to the Senate. These include the tax and budget bills, school reform legislation, the water cleanup bill, and the RESET  renewable energy package.

Conspicuous by its absence from this roll call of heavy lifting: the health care bill. It’s been dramatically downsized, and is still being batted around among three House committees. This week, the Ways and Means Committee barely managed to achieve a majority on a financing package after a lot of hand-wringing and internal disagreement. The Health Care Committee produced a scaled-down version of reforms costing about $20 million per year. But the Appropriations Committee, which has to approve the reform spending, has yet to weigh in. Approps chair Mitzi Johnson says her panel will hear testimony on the bill next week.

If that committee takes any route besides endorsement of Health Care’s bill, there may be a fresh round of back-and-forth between those two panels, just as there was between Health Care and Ways and Means on the revenue package.

And then, sometime next week at the absolute soonest, the health care bill will make its way, bloodied, bruised and limping, to the House floor.

If not “the absolute soonest”? We’re getting awfully close to mid-April.

Frankly, it’d take an uncommon outbreak of consensus in the House and between House and Senate for a health care bill of any kind to achieve passage in this session.

There’s a flood-stage ice jam of legislation forming in the Senate. This morning I watched one committee chair working with his staffer to find time to accommodate long and growing lists of potential witnesses. Can we assemble early some days? Can we schedule Monday meetings, an unusual and undesirable step, especially for lawmakers from distant parts of the state? The thought in my mind was, how can they possibly get all this done?

Breaking that jam and moving major bills will depend on the Senate running uncharacteristically smoothly, with unusually effective leadership (cough*John Campbell*cough) and widespread voluntary ego-suppression in Vermont’s Most Self-Important Deliberative Body.

The health care bill, if it gets to the Senate in some form, will take its place in line behind the other Big Bills. Most importantly, it will be the last of the big revenue bills to hit the Senate, and who knows how much appetite they have for tax increases. There’s a significant cohort of moderate-to-conservative Senate Democrats that can diminish or kill any tax measures, and they may be out for blood after pretty much having to approve new money for Lake Champlain and to fill part of the budget gap.

From what I’ve heard, the Senate’s outlook is even more of a mystery this year than usual, and that’s saying something. Big picture, the odds appear to be against any meaningful health care reform getting through the legislature this year.

Which would be a bad thing in three important ways:

— The bill would reduce the sinfully large Medicaid gap. The Shumlin plan would substantially reduce it; the House Health Care plan would make a series dent, at least for primary care providers.

— The bill, in either form, includes more money for proven cost-saving strategies in Blueprint for Health and the Green Mountain Care Board. Continuing to bend the cost curve is crucial to the long-term success of the reform project.

— And third, for those who insist on the humanitarian angle, is that either bill would ease access for thousands of working poor Vermonters.

Lawmakers and legislative leadership know all this. If they didn’t, the bill wouldn’t have gotten as far as it has in a difficult year. Improving health care is a serious priority — but so are a lot of other things. It’d be a shame if health care fell victim to the legislature’s time crunch, but it wouldn’t exactly be a surprise.

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