By Dave Gram
Forbes, May 3, 2011

MONTPELIER, Vt. (AP) — Vermont Senate negotiators dropped an amendment to bar illegal immigrants from coverage under a new state health care program, delivering a victory Monday evening to human rights activists who had rallied repeatedly at the Statehouse to demand the change.

Instead, the three senators serving on a House-Senate conference committee suggested studying the issues surrounding providing health care to an estimated 1,500 to 2,500 undocumented farmworkers in the state, as well as others in Vermont illegally. Their House counterparts readily agreed to the proposal.

The fight over coverage for illegal immigrants was a late-session storm in otherwise smooth sailing for the centerpiece of Gov. Peter Shumlin’s legislative agenda: a publicly financed, universal health care system that had broad support from Shumlin’s fellow Democrats who control both houses of the General Assembly.

After the Senate last week adopted the amendment proposed by Sens. Randy Brock, R-Franklin, and Richard Sears, D-Bennington, activists with the Health Care is a Human Right Campaign of the Vermont Workers’ Center, who had been providing strong grass-roots support for the health reform measure, turned on the senators.

Brock continued to defend his amendment Monday night, arguing that it is in keeping with federal law, and that if Vermont wants the federal permissions it needs to pursue its envisioned health system reform, it can’t flout federal immigration law.

“It’s clear we need a federal immigration policy that makes sense, and we need a guest worker program,” Brock said. “But it’s also clear that Vermont cannot and should not provide insurance coverage to people who are not here lawfully.”

Brock is not on the conference committee, and the senators who are showed their willingness to jettison his and Sears’ amendment under pressure from the activists.

Sen. Claire Ayer, chairwoman of the Senate Health and Welfare Committee and the leader of the Senate conferees, read from proposed legislative findings that pointed out apparent contradictions in federal law:

“Federal law requires certain health care providers to provide emergency treatment to all individuals, regardless of immigration status. Federal law prohibits coverage of undocumented immigrants through Medicaid and through the Exchange,” a new health insurance marketplace that the Vermont bill calls for setting up, in keeping with the federal health care law passed last year, the proposed findings said.

The Senate proposal called for asking the Green Mountain Care Board, which already is to conduct several other studies to get the state ready for universal health care, to add the immigration issue to its list.

House conferees quickly agreed.

“The human rights perspective certainly is a worthy one,” Rep. Michael Fisher, D-Lincoln, vice chairman of the House Health Care Committee and a member of the conference committee, said in an interview shortly after Monday evening’s session. “There’s also financial issues that warrant our attention, and legal ones.”

http://www.forbes.com/feeds/ap/2011/05/03/business-us-vt-health-care-immigrants_8446801.html

Previously:

Activists decry exclusion of undocumented workers from Vermont’s H.202

By Anne Galloway
Vtdigger.org, May 2, 2011

An undocumented Mexican migrant worker named Javier wouldn’t give his full name or say what county he lives in for fear of deportation. In spite of his apprehensions, however, he stood in front of the Statehouse on Sunday and told a crowd of May Day activists that the health care reform bill they had worked hard to support included a provision that discriminates against undocumented workers. Javier’s remarks were translated by an interpreter.

“This amendment appears to be a discriminatory act to exclude us from the health care proposal,” Javier told the crowd.

Javier, who has farmer’s lung, said he would not be able to receive medical attention if H.202 passes because he would not be able to afford to pay for his care out of pocket. Doctors have suggested that he undergo testing because they suspect he has fibrosis. Javier said the expense makes further diagnosis impossible.

The Vermont Farmworker Solidarity Project and the Vermont Workers Center has organized a lobby day today to pressure lawmakers to reverse the amendment, which they say runs counter to the fundamental principles of health care for all. They are also holding a press conference on the Statehouse steps to make their case to reporters at noon on Monday.

About 1,500 to 2,000 undocumented dairy workers from Mexico are employed by Vermont farmers and they are credited with helping to keep the dairy industry solvent at a time when few Vermonters are willing to work on farms.

Universal health care means universal, David Karindler, an organizer with the center, said.

“This is the first time such hateful language has been put in legislation,” Karindler said. “We’re all about inclusion in this state. This is the first time exclusion has become part of a bill. This is about undocumented people flocking to the state. Why would they flock to a place with no housing and no jobs?”

The Senate amendment to H.202, the universal health care bill, limits access to the state’s insurance exchange, which goes into effect in 2013, and Green Mountain Care, the single-payer system which could be implemented as early as 2014, to Vermont residents. Under the provision, individuals in the exchange are “reasonably expected to be during the time of enrollment, a citizen or national of the United States or a lawfully present immigrant in the United States as defined by federal law.”

The amendment is based on federal requirements under the Affordable Care Act, which restricts access to the state’s health care exchanges to legal residents of the United States. The Brock-Sears amendment would make it illegal for the state to provide federal funding for care through the exchanges. As it stands now, Medicaid money cannot be used to provide health care for undocumented residents. Legislative lawyers are re-evaluating the legal repercussions of the language in the amendment, according to Senate President Pro Tem John Campbell, D-Windsor.

“I doubt people are going to be moving up here,” Campbell said. Vermont already has more generous Medicaid benefits than those offered by other states and that fact hasn’t led to an influx of people to moving here, he said.

Senate Democrats voted overwhelmingly for the amendment in a 22-8 vote after Sen. Claire Ayer announced that the Senate Health and Welfare Committee had reviewed the amendment and took no position on it. Ayer later voted for the amendment, along with Sen. Tim Ashe, P/D-Burlington, and because they were called on first to vote (the roll call is given in alphabetical order), one observer speculated that this signaled a green light to other Democrats in the chamber. Campbell also voted yes.

James Haslam posted a statement about the vote on the left-leaning blog Green Mountain Daily last week that sparked a fierce debate in which the word “racist” emerged.

Campbell said there was some confusion in the Senate about the amendment. For that reason, he asked Shumlin administration lawyers to review the language and they gave senators the go-ahead.

“It came down a lot of things happening last week,” Campbell said. “This was not something on anyone’s radar until we saw the amendment with the assurance of certain individuals. You put faith and trust in that. If it’s determined to be a mistake, then as far as I’m concerned I’ll take the heat on that go ahead and cha
nge it. I don’t think Dick Sears or Randy Brock are racists or trying to be Arizona-like in their development of the law.”

Campbell described the provision as belt-and-suspenders legislation – essentially a restatement of the federal law.

Activists question why the amendment is necessary if it’s part of the federal law.

Karindler said Sen. Randy Brock, R-Grand Isle-Franklin, went out of his way to redefine what a resident was.

“It was strategic in its divisiveness,” Karindler said. “To suddenly frame things around undocumented workers seemed calculated.”

Peg Franzen, president of the Vermont Workers Center, said she thought the Senate debate on the amendment got confusing.

“We’re hoping people understand what it actually means,” Franzen said. “It actually refers to Green Mountain Care, which would not be set up until 2014 or 2017.”

Freshman Sen. Philip Baruth, D-Chittenden, who voted against the amendment, said it’s unfortunate that the attention is focused on the amendment when Senate Democrats evinced, “hard core serious unity” around support for H.202.

“I’m discouraged that this one stray amendment is now the story as though it’s indicating fractures in Democratic lines,” Baruth said. “It’s a shame. Instead of a victory lap we’re now in a simulated crisis. I don’t think it’s a crisis. It’s a bump and we will fix it. I hope people who voted for this will get a chance to vote for (the amendment) without it. There are people who did yeoman’s work on this bill who are being unfairly demonized in some quarters. It’s a shame all around that a victory lap morphed into something far less positive.”

Rep. Mark Larson, D-Burlington, and chair of the House Health Care Committee, said lawmakers will likely re-examine the amendment as part of a larger review of the legislation during the conference committees, which take place on Monday starting at 10 a.m., 1 p.m. and 4 p.m.

Larson is also dismayed by the turn of events.

“My focus is on trying to create a health care system that works for our state and I don’t want to get into a focus on whether my senate colleagues are racist or not,” Larson said. “I appreciate why people are upset about the amendment and the significance the issue has in terms of whether all people will be covered by Green Mountain Care. I also understand that national immigration policy isn’t very helpful at this point.”

In the past, Vermont used state dollars to cover health care costs for undocumented farm workers, according to Larson. Under federal rules, Medicaid money can’t be used. That policy would carry through under Green Mountain Care, Larson said, because part of the funding for the single-payer system would come from Medicaid. The state would have to come up with an alternative funding source. Currently, farmers, federal health centers and volunteer groups help workers with care, though in some cases health care providers end up shifting the cost to other patients.

http://vtdigger.org/2011/05/02/undocumented-workers-excluded-from-h-202/

By Dave Gram
Greenfield (Ind.) Reporter, May 1, 2011

MONTPELIER, Vt. (AP) — Even now, Dr. Deb Richter is haunted by images of some of the patients she saw at inner-city clinics where she worked in Buffalo, N.Y., during the 1980s.

One young man without health insurance didn’t get the early intervention he needed for diabetes. He went blind, got an infection and died at 21. His sister, who also had lived with juvenile diabetes, delivered a baby three months premature. The baby died. Two years later, the 25-year-old woman suffered a heart attack and died during coronary bypass surgery.

“I had patients who were dying at young ages of preventable diseases,” Richter said.

One common symptom: Lack of health insurance.

The experiences prompted Richter, 55, to become an activist. She joined Physicians for a National Health Program. After moving with her family to Vermont in 1999, she continued to pursue her goal of a publicly financed universal health care system.

Richter watched last week as the Vermont Senate voted 21-9 to pass a bill setting the state on a path toward the universal, unified health care system that, she and other backers say, will take administrative costs and insurance company profits out of health care, cover all Vermonters — including the 45,000 now without health insurance — and save the state money.

“This is a step in the right direction — finally,” Richter said after the Senate vote on legislation previously passed by the House. “This is the first time a state is actually establishing a true health care system, where everyone will be included. It’s going to have a budget. We’re going to have uniform payments, which will help reduce administrative costs.”

Richter came on the Vermont scene not long after an effort to bring about universal health care in the 1990s fizzled, and she quickly began trying to make political contacts.

She found it a lot easier in a state of 620,000 — she met fellow physician Gov. Howard Dean at a chicken dinner in Barre — than in New York, with its population of nearly 20 million, where she couldn’t get a meeting with her state representative.

She traveled around Vermont, giving more than 400 talks to Rotary Clubs, Chambers of Commerce and other groups.

She offered dramatic Statehouse testimony when she and a friend unfolded a list of the addresses of insurance companies and government insurance programs to which her five-doctor medical practice in Cambridge had to send bills.

The list was 190 pages long.

Even some of those who voted against the health care bill that passed last week credit Richter for her persistence.

“She began to advocate for a single-payer system soon after the last effort collapsed (in the 1990s), and oftentimes was a lone voice in the wilderness,” said Sen. Vincent Illuzzi, R-Essex-Orleans.

Those who share Richter’s support for a single-payer system sing her praises.

“The fact that we are as close as we are to passing a single-payer health care bill in Vermont is a tribute to a lot of grassroots work, but Deb Richter is the backbone of that work,” Gov. Peter Shumlin said. “She’s a doctor who practices every day, sees what’s wrong with the system and wants to right it. … She’s tenacious. She’s smart. She’s tough.”

The bill passed by the House and Senate would set up a new clearinghouse for health insurance policies in Vermont called an “exchange,” meeting a requirement that states establish such entities laid out in the federal health reform law passed last year.

It also would set up a new Green Mountain Care Board to set parameters for what health benefits would be offered. The administration would be responsible for coming up with a way to pay for the new system by January of 2013. A legislative consultant recommended a new payroll tax shared by workers and employers.

Not everyone agrees the bill goes far enough. Physicians for a National Health Program, the group Richter joined 22 years ago, said the bill stops well short of its goal of single-payer health care because it would still allow multiple insurers to operate in the state.

“The Vermont plan promises a public program open to all residents of the state in 2017, but even then it would allow a continuing role for private insurance,” the group said in a statement. “This would negate many of the administrative savings that could be attained by a true single-payer program, and opens the way for the continuation of multi-tiered care.”

Richter, though, says the bill puts Vermont on a path to real progress. “They want to get to the top of the mountain in one step. I’m willing to take smaller steps. … We just disagree.”

Richter said she has learned an important lesson during her years of advocacy. She began by seeing health care as a moral issue, but came later to believe that the way to get people to change their minds about it was to get to them through their wallets, rather than their hearts.

James Haslam, coordinator of the Health Care Is A Human Right campaign at the Vermont Workers’ Center, called Richter “awesome.” He said the work of Richter and her group Vermont Health Care for All and that of the Workers’ Center were complementary.

Richter’s strength is “particularly bringing voice on this issue to providers, to other doctors and also to the business community. She’s incredibly gifted at reaching them and going to where they’re at. We’ve been more focused on ordinary Vermonters and working-class folks,” Haslam said.

Richter said she strives for a practical approach that will appeal to all audiences. The health care system is like the fire department, she says — something people don’t want to use, but want in place, just in case.

Most people’s first impulse is to say, “You don’t want to pay for Joe,” and his hospitalization, Richter said. “But Joe’s in the bed you’re going to be in tomorrow. That’s why we have to have health care as a public good.”

http://www.greenfieldreporter.com/view/story/f5a45f862d644e4e8749aebde9ca954f/VT–Health-Care-Crusader/

Dr. Francis Pasley
Letters, Burlington Free Press, May 2, 2011

I am a medical doctor, semi-retired living in Vermont and having a limited practice. Prior to moving to Vermont two and a half years ago I practiced full time, dividing my practice between the Detroit area in Michigan and Windsor, Ontario, an hour drive from Detroit. Thus I have a substantial personal knowledge of medical practice in the USA and Canada.

I have been distressed to hear opinions by Vermont medical professionals and local conservatives about the poor care available in Canada, especially long waiting times for care, and the negative feelings of physicians who have moved here from Canada about the experiences they have had practicing medicine in Canada, suggesting no one would stay there by choice.

I moved to Vermont for family reasons and not to leave practice in Ontario, Canada. Indeed if I were younger I would far rather return to practice in Canada. Caring for patients without having to worry about their ability to afford medical care far outweighed any negatives. I knew doctors who chose to practice in Canada rather than the United States for the same reason. Some who trained in the U.S. and elected to locate in Canada.

In my opinion the waiting list issue is manufactured by people who wish to discredit a system that cares well for everyone with some minor inconveniences rather than one that denies care to millions while admittedly providing exceptional care to those well able to afford it. For those with urgent needs and serious medical problems, in my experience the care in Canada is equally exceptional and prompt.

The issues relating to medical care in every country are enormous and to raise concerns about waiting or the personal preferences of a few physicians trivializes it. We must rather decide what sort of society we wish to live in, what level of support we owe to all in our society, to whom we choose to deny adequate nutrition or healing efforts so that the privileged will be denied nothing or whether we choose to provide basic adequate sustenance to all. Hopefully we will choose the latter and then face the difficult task of defining what represents basic adequate sustenance.

Dr. Francis Pasley of Williston is a member of Physicians for a National Health Program.

http://www.burlingtonfreepress.com/article/20110501/OPINION02/105010333/My-Turn-Canadian-health-care-misstated