Tag Archives: House Health Care Committee

Missed it by that much

Anne Donahue had a clever plan.

Notice I say “clever,” not “smart.” The Donahue amendment was a last-ditch attempt to derail H.98, the bill that would end the philosophical exemption for childhood vaccinations.

The amendment would have combined the philosophical and religious exemptions, and put more obstacles in the way of those seeking an exemption: reading educational materials, watching a video, having an in-person consultation with a health care practitioner. Donahue argued that these obstacles would achieve the goal of raising immunization rates without sacrificing parental choice.

It was clever because it played on lawmakers’ fears of taking a definitive stand, fears that are always amplified when there’s a loud and focused opposition.

It wasn’t smart because it would have done nothing to raise immunization rates.

I can say that with confidence because if the House had adopted the amendment, it would have been at odds with the Senate. With the Legislature careening toward adjournment and many pressing issues still unresolved, it’s a virtual certainty that H.98 would have been quietly shelved.

Of course, Donahue had to know that.

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Here’s an interesting fact about vaccines

Earlier this week, we had the honor of hosting a real live ***KENNEDY*** right in our very own Statehouse. Yep, RFK Jr. regaled us with his scare stories about the evils of Thimerosal, a vaccine additive containing (a harmless type of) mercury. It seemed a stretch at the time because (1) the autism/Thimerosal “connection” has been thoroughly debunked, and (2) Thimerosal was eliminated from all but one vaccine years ago, and yet autism rates have continued to climb since then.

But here’s something I didn’t learn until today:

The one vaccine containing Thimerosal is not on Vermont’s list of required vaccines.

That’s right. You don’t need a philosophical exemption to avoid the imaginary taint of Thimerosal. Which means that Kennedy’s argument was completely irrelevant to our current policy debate.

In any event, Kennedy seems to have done his cause no good. There’s no sign he moved the needle (sorry); in fact, he may have turned off some undecideds with his overheated rhetoric. Like, for instance, the editorial board of the Times Argus and Rutland Herald:

Kennedy’s strident language added nothing to the debate. He had discredited himself even before he arrived in Montpelier by furthering the damaging and discredited notion that there is a connection between vaccines and autism. The author of the paper asserting that connection has himself admitted to scientific fraud.

But I think it’s worth noting for the record that Kennedy’s bugbear, Thimerosal, has no bearing at all on the philosophical-exemption issue.

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.

Glass half full, glass half empty

There are two ways of looking at the 2015 legislative session so far. Well, two if you’re on the left-of-center side of the political equation. The right, I suppose, is probably in full Ted Cruz “The World Is On Fire” mode.

You can look at it like Progressive Rep. Chris Pearson during last week’s House budget debate, lamenting big cuts to human services: “There have been program cuts every year since I joined the legislature in 2006.”

The glass is half empty. If you’re a liberal or progressive Vermonter, it seems like we’ve been in constant retreat since Peter Shumlin took office. And it got worse after the November election, with conventional wisdom telling us that Republican gains were due to Democratic overreach, the governor abandoning single-payer health care, and Democrats scurrying to the center.

Then there’s the glass-half-full approach. House Ways and Means Committee chair Janet Ancel noted that this year’s tax bill represented the biggest one-year revenue increase in all her years on the committee. And Health Care Committee chair BIll Lippert had this phlegmatic reaction to the rapid diminution of the health care reform bill:

We knew when we put that together it was robust. That was our job, to articulate priorities and how to get there. But I think in the context of the $35 million that was raised on the floor [in the tax bill], and $8 million for the lake [Champlain], if we were so fortunate as to have $20 million for health care, that’s a pretty big appetite for raising revenue in one year. So I would be pleased to have that much dedicated to health care in a year that’s as financially difficult as this.

And, the unspoken corollary: “I won’t be surprised if we get less than $20 million.”

Which leads back to my previous post, “Peter Shumlin: Defender of Liberalism.” If the House is stripping most or all the funding from health care initiatives, we’ll have to depend on the Governor’s political muscle — if he still has any — to get it back.

Anyway, which way do you see it: glass half full or glass half empty?

The current situation has echoes throughout the five-plus-year tenure of Gov. Shumlin. He’s delivered some good stuff, more than many liberals are willing to admit, while keeping the ship afloat in tough budgetary times. Plus, he’s been swimming against three powerful tides: a sluggish recovery which has yet to benefit the middle or working classes, a tax system that has failed to keep up with our changing economy, and the effort to fully fund public-sector pension plans that were revenue-starved by previous administrations. (Lookin’ at you, Tom Pelham.)

On the other hand, many of Shumlin’s promises have been curtailed or abandoned — most notably single payer health care, the issue that arguably won him the 2010 Democratic primary and hence the governorship. Plus, liberal expectations were inflated, fairly or not, possibly both, by the size of the Democratic majority. Shumlin and legislative Democrats never seemed to realize how much political capital they had; and now, much of it is gone, unspent.

And on the other other hand, it’s not as if the last five years have been without accomplishment. And it’s not as if this legislative session will be a failure if we don’t get significant movement on health care reform.

It’ll just kinda feel like one.

Peter Shumlin, Defender of Liberalism

So this is what we’ve come down to: as the House continues to slash away at health care reform, Governor Shumlin has become its stoutest defender.

Isn’t it ironic, don’tcha think. A little sad, too.

Here’s the situation: the House Health Care Committee originally came up with a $52 million package that would have greatly reduced the Medicaid gap, made health care more accessible to our growing cohort of working poor*, expanded proven measures to enhance delivery while holding down costs, and boosted incentives for badly-needed primary care providers.

*Thanks to our top-heavy economic recovery, which has produced stagnant wages and lots of jobs with unlivable wages while fattening the pockets of the wealthy and corporate.  

The Ways and Means Committee couldn’t agree on any tax scheme to pay for the $52 million — or even part of it. So the ball got bounced back to Health Care with a new diktat: devise a bill that will only cost $20 million a year.

The two committees remain at loggerheads, with each other and within their own ranks. Health Care can’t decide how to downsize its deftly-woven tapestry without the whole thing unraveling, and Ways and Means can’t reach consensus on a tax plan to produce $20 million.

Which almost certainly means the package will be further reduced before it even gets to the full House.

This is where Peter Shumlin, Defender of Liberalism comes in.

“I think that it’s really important that we make real progress here, and you’re not going to make real progress with $10 or $20 million,” the governor said in an interview Friday.

That interview was with the Vermont Press Bureau’s Neal Goswami, who wrote a front-page story in today’s Times Argus about the developing tussle between cautious lawmakers and a determined governor. (The story is paywalled, but you can listen to the interview for free.)

Shumlin rightly points out that a modest health care package would leave “$100 million of federal [matching] money on the table,” and would reduce private insurance rates by closing the Medicaid gap. Penny wise and pound foolish, you might say.

Problem is, the legislature is in penny-pinching mode after approving a tax bill that will raise $33 million in new revenue. Well, that’s the next problem. The first problem is Ways and Means, which has just enough centrist votes to effectively roadblock any of the tax plans outlined by Shumlin or the Health Care Committee.

Hmmm. And who, pray tell, appointed the committee? Oh yeah: Mr. Speaker.

Ways and Means has eleven members. A bill needs at least six votes to pass. But wait, you might be saying, there are seven Democrats on the committee and only three Republicans.

Well yeah, but two of the Democrats are definitely in the party’s centrist wing. Jim Condon is one of the most conservative Dems in the legislature, and Sam Young is definitely a taxation skeptic. The lone independent, ski resort mogul Adam Greshin, might as well be a Republican.

That leaves five relatively liberal votes, and a tough task for committee chair Janet Ancel to find a majority for any tax proposal.

Problem is, the Governor is right: spending more up front would make the system more robust and effective, and bring down costs for private payers. It’d also bring in the aforementioned truckload of federal matching funds.

And oh yes, if you’re interested in the “humanity” angle, it’d make health care accessible to thousands more Vermonters.

Goswami reports that Shumlin “may have to turn his attention to the Senate if he is to rescue his own plans.”

Oh boy. The disorganized, testosterone-and-ego-fueled Senate, with the centrist Cerebus of John Campbell, Dick Mazza and Phil Scott guarding the portal.

Good luck with that, Governor.

.House Health Care gets the brown plate special

Recently, the House Health Care Committee passed a health care bill that raised $52 million in new revenue to pay for an array of reforms, including better Medicaid reimbursement for providers and more premium support for the working poor. It proposed raising the revenue through a payroll tax and a sugar-sweetened beverage tax.

Then it went to the Ways and Means Committee, which couldn’t agree on either tax. Technically they have yet to agree, but they did send guidance to the Health Care Committee that it should craft a plan requiring no more than $20 million a year. Ways and Means is reportedly moving toward a smaller version of the beverage tax to raise that money, although nothing is final.

Well, as one of my childhood heroes, Detroit Lions great Joe Schmidt, says, “Life is a shit sandwich, and every day you take another bite.” When the Health Care Committee reconvened this morning with that guidance in mind, they looked like they’d been served the Brown Plate Special. Glum faces all around. As committee chair BIll Lippert said, tongue slightly in cheek, “We can’t do all that we have to do.”

Committee members had no clear idea how to proceed. There were widely varying ideas. Anytime a specific cut of any size was suggested, sound and reasonable objections were voiced.

When they looked at the overall picture, some members wanted to make big cuts here and hold harmless there; but they all had different heres and theres.

At the end of a necessarily brief discussion (before the House convened for the day), Lippert thanked everyone for their input and said he would try to put together a proposal for futther discussion. And he noted that the committee would need to adopt some kind of bill by the end of the day tomorrow. He didn’t sound very happy.

Whatever Health Care comes up with, it’s likely to face the ax down the road. It’s still unclear whether Ways and Means can pass the reduced beverage tax, to say nothing of its fate in the full House and Senate. If I were a betting man, I’d say any new health care initiatives are going to be whittled down to nothing, or nearly so.

Our Leaders will plead fiscal responsibility in tough times, and perhaps start looking for a bone to throw to disaffected liberals.

For health care expansion and SSBT, a long road ahead

Last week brought some relatively cheery news for fans of better access to health care and of the sugar-sweetened beverage tax. The House Health Care Committee passed a fairly wide-ranging bill that would help close the Medicaid gap, provide more assistance to working-class Vermonters seeking health insurance and encourage more primary care providers, among other things. To pay for all that, the Committee opted for a two-pronged approach: the revised 0.3% payroll tax proposed by Gov. Shumlin, plus the two-cents-per-ounce tax on sugar-sweetened beverages.

A good package, a nice bill. But is it a meaningful step, or simply a McGuffin? When you read between the lines of Committee chair Bill Lippert’s statement, and see the slightly shopworn look on his face, well, you start thinking the latter.

I have no illusions that what we propose will be a final product at the end of the session, but it was our responsibility… 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.

Glass half full, or glass half empty? I hear a guy resigning himself to the inevitable disembowelment of his bill.

Enough inference. The next stop is the Ways and Means Committee, where opinion is split on the SSBT and there’s widespread opposition to the payroll tax. After that, well, there’s a lot of room for pessimism.

There’s little appetite for raising taxes in Montpelier — or should I say “raising more taxes,” since tax increases will almost certainly be part of a budget-balancing deal. (Front runner: Ways and Means chair Janet Ancel’s plan to cap itemized deductions at 2.5 times the standard deduction.) There’s also the EPA-mandated Lake Champlain cleanup that needs funding. In this climate, it’ll be hard to justify funding the health care package as well.

Regarding the SSBT specifically, Governor Shumlin and House Speaker Shap Smith don’t like it. Really, there aren’t many real fans; some just see it as the least bad option. Most lawmakers seem allergic to the payroll tax, even in reduced form. But let’s say, just for the heck of it, that the Health Care Committee’s bill passes the House. What awaits in the Senate, that notorious den of centrism where liberal House bills go to die?

“I wouldn’t predict what a vote today would be,” says Senate Finance Committee chair Tim Ashe (more D and less P with each passing day). “I’d say they both start in difficult places in terms of a Senate vote. Individual committees may be more or less favorable, but in the whole Senate, both would struggle to pass at this time.”

Gulp. Well, I guess I shouldn’t be surprised. So I guess that leaves us with no money for enhancing our partially-fixed health care system?

“That’s an open question,” says Ashe. “There are the resources to pay for new initiatives or increased support for existing initiatives can come from existing sources or new revenues.”

Oh really? You’ve found a pot of money somewhere?

“I’ll mention just one resource. …This year, Vermonters without insurance are going to ship about six million bucks to the federal government in a penalty. Next year that money goes up to 12 to 14 because the penalty basically doubles.

“So 23,000 Vermonters will be shipping all that money to Washington, and they will get nothing for it. Question is, is there a way to help them NOT send the money to Washington and get nothing for it, but to keep the dollars here and give them something for it? I don’t know what the answer to that is, [but] it makes you scratch your head and say, ‘Well, jeez, wouldn’t it be easier if they just had insurance here?'”

Nice to see the Senator thinking outside the box, BUT… he himself admits he doesn’t know the answer to that. And even if we could somehow funnel the penalty money into health insurance, we’re talking “about six million bucks” this year and 12 mill the year after that. That’s a far cry from the Health Care Committee’s $70 million a year.

Six million, or even 12, isn’t going to buy you a whole lot of improvement. The Medicaid gap would remain painfully wide, and good-quality insurance would remain out of reach for many working Vermonters.

But that’s the kind of year we’ve got. Best to ratchet down expectations.

Of course, we’re now looking at budget gaps in the $50 million range for each of the following two years. Substantial health care reform keeps receding further over the horizon. And universal access? Rapidly approaching pipe dream territory.