Healthcare Is a Human Right Campaign Proposed Amendments to H.202

These recommendations were presented to the House Committee on Health Care as part of the Healthcare Is a Human Right campaign's testimony on February 25, 2011.

Vermont Workers’ Center
Healthcare is a Human Right Campaign
Proposed Amendments to H.202
25 February 2011

Section 2 (a,c,d)(Strategic Plan); Section 4 (1829) (Exchange); Section 9 (Financing)

Formulate a plan for implementing GMC in a way that starts enrolling people at the earliest possible date, prior to - and potentially independent of - the expected receipt of funds from the ACA. Access to care for Vermonters must not be delayed to coincide with, or depend upon, potential federal funding. The state has adopted, in law, the policy to treat healthcare as a public good for all Vermonters, so implementing this state policy must not be made dependent upon federal policy. The healthcare crisis is a human rights crisis, which means the state is obligated to use maximum available resources to restore and protect human rights. In particular, it is imperative that the needs of vulnerable groups, such as low-income Vermonters, are prioritized, and that no Vermonter faces a backsliding in terms of the affordability or comprehensiveness of their access to healthcare (e.g. through increased deductibles or lower benefits resulting from the Catamount/VHAB merger).

Formulate a public financing plan through sources other than the ACA, also in the event that federal funds for setting up and operating an Exchange (including subsidies for low-income people) dry up, or that setting up an exchange is no longer federally mandated. State that in those events, the state shall immediately move to set up GMC.

An alternative roadmap for state-based universal healthcare, independent from federal policy, should start with developing an equitable, public financing mechanism for raising required resources to replace the inequitable and wasteful manner in which private insurance companies raise and distribute resources.

Section 1

Include the statutory language of Act 128 stating that health care is a public good.

In paragraph 1, delete “essential” health services and replace with “comprehensive.”

Additionally, ensure that other sections of the bill guarantee access to comprehensive healthcare, i.e. all healthcare needed based on clinical assessments, rather than “essential” services, to avoid the interpretation of “essential” as bare-bones services guided by financial rather than clinical considerations.

In paragraph 6, delete the reference to Vermonters taking “personal responsibility” for their health, since health protection is a community responsibility largely outside the control of individuals.

In paragraph 8, add a sentence that reads: “Any decisions made regarding the health system shall be guided by the primary goal of improving the health of the people of Vermont.”

Section 2 (b)(Strategic Plan); Section 3 (9371 - Purpose for Health Reform Board)

The bill should prioritize Vermonters’ health and universal access to care over the goal of cost containment. For example, change the purpose of setting up a Health Reform Board, which currently appears to be limited to cost containment. Vermont statute has recognized healthcare as a public good, so the provision of universal access to care must be weighted more heavily than the concept of cost containment.

Section 2 (a,c)(Strategic Plan); Section 4, Subchapter 1 (1801)(Exchange purpose)

Establish that the purpose of this bill is to set up GMC, a public single payer system for Vermont, and that any other implementing actions, such as setting up an exchange, are only intended to facilitate the establishment of GMC through the maximizing of federal funds.

Section 2 (c,d)(Strategic Plan); Section 4, Subchapter 1(1801 (a))(Exchange), Subchapter 2 (1829)(Green Mountain Care)

Explicitly state that the Exchange will be established only until the necessary waiver(s) for GMC are obtained from Administration and that those waivers will be sought immediately in an effort to move the timeline forward, allowing earlier establishment of GMC than projected. For example, under section 1829 of GMC provide that the secretary of administration shall immediately apply for the states’ flexibility waiver (instead of “when available under the ACA”), so that if the federal executive branch is able and willing to grant the waiver sooner than allowed by the ACA, Vermont’s application will already be pending. In this way the waiver can be granted at the soonest possible date if there is an amendment or striking of the ACA that occurs before the ACA time line for waivers.

Explicitly state that if necessary waivers are not obtained in a timely manner, the state of Vermont will identify other avenues for establishing GMC.

Section 3 (9373) (Health Reform Board)

Insert a conflict of interest provision, stating that that the Board representative with expertise in financing healthcare systems shall not have ties to or be affiliated with any insurance company. Additionally, all Board members should be Vermont residents who will participate in the Vermont system.

Increase the representation from the people (referred to as “consumers”) on the Board, and, additionally, include at least one representative from grassroots or community groups. A people’s representative from each of three geographical sections of the state (southern, middle and northern) would be desirable. A healthcare system designed to protect people’s health should ensure adequate representation from the people it is designed to serve - and who should be the owners of the system - instead of emphasizing representation from those planning, operating, and financing the system.

The term “consumer” refers to people whose only role is to buy products in a market-based system. We would prefer you use the term “patient” or “Vermonter”, which more aptly recognizes status as participant and owner of the system.

Section 3 (9374)(Health Reform Board); Section 4, Subchapter 2 (1821)(Green Mountain Care)

Make the Health Reform Board accountable for ensuring compliance with the principles in Section 1.

Also insert a paragraph in the GMC purpose section incorporates the principles through reference, and requires GMC to be governed by and in accordance with the principles section, and further requires that all other parties are governed by and in accordance with those principles.

Section 3 (9374 (d))(Health Reform Board); Section 4, Subchapter 2 (1802 (b)(2)), (1824(b)) (Green Mountain Care); Section 8 ((1)(C))(Integration Plan)

State that the cost-sharing (deductibles, co-pays and co-insurance) under ACA can be eliminated by the Board, and that the Board will work toward immediate removal of deductibles, and other forms of cost-sharing, during the transition period.

State that cost-sharing under GMC will be eliminated, and strike all non-factual references to cost-sharing as “incentives.”

Section 4, Subchapter 2 (1821), (1826 (a))(Green Mountain Care)

Declare that the State of Vermont and the Board will operate GMC as a public good.

Strike paragraph 1826(a) relating to the administration of GMC by insurance carriers or other third parties, or at the very least provide a narrow definition of “certain elements” of administration, so that meets the public goods principle, i.e. guarantees that no private or third party can deny or limit access to care in any form, and is fully accountable for the transparent and efficient managing of public funds and for protecting Vermonters’ health.

Section 4 Subchapter 2 (1823)(Green Mountain Care)

Specify that medical benefits under Workers’ Compensation will be integrated into GMC (as they appear to be in the Exchange (Section (1803 (b) (3))).
Section 4, Subchapter 2 (1824) (a)(Green Mountain Care)
Change the word “essential” to “comprehensive” when it is used to modify the word “benefit plan” in statute, except where it refers to federal law.

Remove the conditionality placed on dental and vision benefits.

Section 4, Subchapter 2 (1828); Section 9(Green Mountain Care)

Specify the financing mechanism for GMC, and explicitly commit the state to ensuring that financing is public and equitable. The principle of equity would require contributions from Vermonters according to their abilities, through income and asset-based progressive taxation. Wealthier people, including those with investment incomes, should contribute in line with their means, as should corporations (in line with profitability). The burden of paying for healthcare must not disproportionately fall onto those who get sick (through cost-sharing) or those who can least afford to pay (through regressive financing).