"Senate Health & Welfare Reform Bill Outline Presented"

On February 16, the Senate Health & Welfare Committee presented the following outline of proposed or potential pieces of a reform bill this year. Notably, when someone asked about universal coverage, noting the outline seems not to address this major point, the committee replied that the issue of universal coverage was being dealt with in the House Healthcare Committee. Its not clear how meaningful reform will be made without uniting these issues.

The Healthcare is a Human Right policy committee has requested permission to testify about this outline. That testimony is still being prepared. Please contact the Healthcare is a Human Right policy committee if you wish weigh in. Everything below is from the outline from Senate Health & Welfare.

Senate Health & Welfare Committee
2010 Health Reform Bill
Draft Outline

The intent of the bill is to reduce the level and rate of growth of health care costs to a more sustainable level through a combination of actions which both
- have an immediate impact on health care costs in FY11 and FY12
- accelerate the structural transformation of the health care delivery and payment system

I. Immediate cost containment options
a. Process involve BISHCA, VAHHS, VMS and health plans

b. Hospitals
i. Modified hospital budget review with state wide targets for reduced growth for FY11 and FY12
ii. State initiatives to reduce administrative burdens on hospitals to be implemented for FY11

c. Health plans
i. Revised review of premium rate increases
ii. State initiatives for reduced administrative burdens to lower administrative cost and premiums to be implemented for FY11

II. Acceleration of delivery system integration and global budgeting
a. Intent: build on the planned statewide expansion of the Blueprint for Health Enhanced Medical Home and expanded health Information Technology

b. Design: review global budgeting options
i. Geographic scale
1. Statewide
2. Regional
3. Hospital service area based
ii. Scope of services
1. Hospital system
2. Hospital and all physicians
3. Comprehensive: e.g. add mental health, prescription drugs, etc.

c. Global budget methodology:
i. who designs and approves global budget
ii. global payment vs. global budget under fee for service
iii. what is the structure of the provider organization and how does it increase integration of care?
iv. estimated savings
1. one time administrative costs
2. bending cost curve

d. Timeline: staged vs. total conversion
i. pilot operations by ?.
ii. at least half the state using global budgeting by ?
iii. state wide implementation by ?

e. All payer participation
i. Existing multipayer system
1. Medicare: file for Medicare waiver
2. Plan for Medicaid participation from OVHA
3. Require participation of all commercial insurers
ii. Shift to single payer first?

f. Implementation
i. Accountability and funding for design and implementation

III. Plan to restructure the way we fund health care and move away from current employer based, multi-payer system to a single payer or public option plan

a. Intent/charge: assess specific options for restructuring financing of coverage to reduce administrative cost and burden

b. Accountability: Consultant required for design with panel overseeing work

c. Report to Legislature 1/15/11 including
i. Pro's and con's of options
ii. How much money needs to be raised, how it would be raised
iii. Analysis of who would pay more and who would pay less
iv. Payment system: how the money would be spent
v. Estimated savings

d. Funding for consultant

IV. Reorganization of state government to ensure that all health care related work is coordinate (Sen. Kitchel's bill)

a. Intent

b. Design:
i. Creation of Secretary of Health
ii. what agencies/functions are included

c. Effective date


Summary of House Health and Welfare Committee Hearings, Wednesday, February 17th:

Discussion of home health care transportation bills. Several legislators were absent. This session was more a continuation of earlier discussions on bills that have been presented to the committee. The first bill talked about centered around H.658,, home health care transportation bill, sponsored by Representative Susan L. Wizowaty (D-Chittenden), with testimony from Bischa, and Home Health, on how it might be possible to set it up, on how there is a noticeable lack of available transportation in rural areas, and what would or would not be covered by insurance, and how hospitals would be able to handle this if it became law. Just discussion and testimony. No votes taken.

Representative Paul Poirier (I Barre) introduced a resolution (JRH 39), in draft, urging Congress to drop legislation on authorizing the purchase of health insurance across state lines or of health insurance companies to sell here in Vermont. A bill to allow this had been introduced by Rep. Patty Komline (R-Dorset), the minority whip, a couple weeks ago. Testimony from VPIRG and BISCHA supporting the resolution followed about the problems associated with a bill allowing insurance to move across state lines – out of network problems, compliance with Vermont laws, and, most of all consumer protection. Representative Wizowaty made a point of asking about what safeguards there would be for consumer protection if something like this was enacted. The Vermont Health Care Ombusperson, Trinka Kerr, health care ombudsperson, supporting the resolution, testified that if the federal government did this, there would be huge problems with people being out of network. Executive director of VPIRG, suggested that companies in states like Delaware and South Dakota with much less regulation could sell really bad policies to consumers, catering to healthy people and excluding sick people. As far as I could tell most legislators present supported this resolution, as do I. The draft of the resolution is below.

To the House of Representatives:

The Committee on Health Care to which was referred Joint Resolution JRH 39, entitled “Joint Resolution urging Congress not to pursue legislation authorizing individuals to purchase across state lines,” respectfully reports that it has considered the same and recommends that the resolution be amended by striking the first resolved clause in its entirety and inserting in lieu thereof the following:

Resolved by the Senate and House of Representatives:

That the General Assembly urges Congress not to pursue legislation allowing individuals to purchase health insurance across state lines or authorizing health insurance companies to offer insurance to residents of a state if the company is not licensed to do business in that state, and be it further. And by changing the title of the resolution to read “Joint resolution urging Congress not to pursue legislation allowing individuals to purchase health insurance across state lines or authorizing health insurance companies to offer insurance to residents of a state of the company is not licensed to do business in that state.”

Walter Carpenter