Well, hooray, we got us a health care bill. It wasn’t looking like it on Friday night and Saturday morning, but Governor Shumlin and top lawmakers finally inked a deal providing a whole three million dollars more for health care reform.
“I wish there were other things we could include,” said Rep. Bill Lippert, chair of the House Health Care Committee. His Senate counterpart, Claire Ayer, called the bill “pathetic.” And single-payer advocate Dr. Deb Richter told VTDigger: “For perspective, $3 million is what we spend as a state on health care in four hours,”
How’d we wind up with $3 million? Ass-backwardly, of course.
At the eleventh hour, health care reform came in last on lawmakers’ list of reasons to raise taxes, behind closing the budget gap and paying enough for clean water that the EPA might, hopefully, get off our backs. As the Governor pushed for fewer tax hikes and more spending cuts, health care was caught in the wringer.
On Friday night and Saturday morning, there were four big bills hanging fire: taxes, spending, economic development, and health care. Health care was a distant fourth. In fact, hallway chatter had it that health care would fall from the agenda, partly because of revenue shyness and partly because any bill would be so small as to not be worth the trouble.
On Saturday morning and early afternoon, as lawmakers and administration officials tried to reach common ground on revenues, it became clear that health care would have to settle for whatever crumbs fell from the conference table.
The earlier idea of financing health care through a substantial tax on sugary beverages had been watered down (sorry) to simply applying the sales tax to soda — and then that revenue was used to help close the budget gap. Nothing for health care, sorry.
Potential revenue sources had to pass three tests: acceptable to Governor Shumlin, to legislative leaders, AND to the Republican caucus. GOP consent was necessary to suspend the rules and pass a health care bill on Saturday. House Minority Leader Don Turner made it clear that he wouldn’t do so for any taxes on business.
Attention fell to a tobacco tax increase. On that, there had to be a balance between maximizing revenue for health care with retailer concerns, especially in the infamous border regions. That’s how we wound up with a 33-cent increase instead of 50 or 75 cents.
The revenue source settled, leadership told health care conferees that they had $3 million to play with, so make some choices. They did, and the teeny-tiny health care bill passed into law.
It’s been a long, draining, and disappointing six months for health care reform advocates, starting with the November election, which knocked the pins out from under Shumlin. Much of the blame for his near-defeat was placed on the continuing struggles of Vermont Health Connect, which had become (unfairly, inaccurately) synonymous with health care reform.
In one close election, Shumlin went from the Great White Hope of single payer, to a deeply wounded warrior with little political capital to call upon.
A month later, he abandoned single payer, until then his signature issue.
A month after that, he produced a $90 million health care plan. Unfortunately for him and for the cause of reform, he seemingly failed to do his political homework. His proposal for a 0.7% payroll tax was a nonstarter; House Speaker Shap Smith opined that Shumlin had “poisoned the well” by shunting some of the payroll tax revenue to other purposes.
If he’d come out with a clean bill, a lower payroll tax increase with all the revenue going to health care, AND if he’d worked on it with legislative leaders before launching it, he might have gotten somewhere. It still would have been an uphill battle in a tough budget year, but it would have been possible.
In the absence of a feasible plan from Shumlin, it was left to the Legislature to craft a plan. Smith asked the House Health Care Committee, led by the ever-unflappable Bill Lippert, to put together a solid alternative on a more modest revenue base. The panel produced a $52 million package including a 0.3% payroll tax and a two-cents-per-ounce tax on sugary drinks.
The tax package then went to the House Ways and Means Committee, which couldn’t muster majority support for either tax idea. Ways and Means then let Health Care know that it could manage no more than about $20 million in new revenue.
So Lippert’s merry band crafted a new proposal. Then, Ways and Means failed to reach its own revenue target, producing only about $12 million. At this point, I wouldn’t have blamed Lippert if his eyes turned bright green, his muscles burst through his clothing, and he went on a rampage through the Statehouse screaming “HULK SMASH!”
But he didn’t. His placid demeanor was seemingly unaffected, alhough I suspect there’s a well-used punching bag in his basement. Or maybe a hideous portrait in his attic.
The reduced health care bill passed the House. And then the Senate came up with its own revenue ideas and trimmed another $1.2 million from the package.
And then the issue sat, unresolved, until Saturday, when the health care conference committee was given a whole $3 million to play with.
Which brings us to today, and a health care package whittled down from $90 million to $3 million. I’d parade out the old “glass half full, glass half empty” analogy, except in this case it’s more like “The optimist sees the glass as one-thirtieth full; the pessimist sees the glass as twenty-nine-thirtieths empty.”
And where was health care reform’s fierce advocate, Gov. Shumlin, through this dismal process? Frankly, he didn’t seem all that involved until a couple weeks ago, when he suddenly began touting his 0.7% payroll tax idea. He even claimed that it hadn’t even been considered yet, so why not give it a shot now?
Well, because the moment had long ago passed, that’s why.
He didn’t much like any of the alternative revenue sources for health care. Which meant he was basically holding a gun to reform’s head and threatening to shoot it if he didn’t get his payroll tax.
The Legislature’s response? “Go ahead, shoot.”
And so we have a minuscule bill, at the end of a long painful series of expectation-diminishing setbacks.
To adopt the “glass one-thirtieth full” approach for a moment, this was a very difficult budget year. Something did need to be done about Lake Champlain and water quality more generally. We did need to address the education system. We did have a huge budget gap to close.
A lot got done in a number of areas.
But health care isn’t one of them.