By Nancy Remsen
Free Press (Burlington, VT)
Originally Published February 15, 2006
MONTPELIER — Dr. Deborah Richter hoisted a megaphone and addressed a group of 50 supporters of universal health care gathered Tuesday outside the Statehouse to protest the health reform plan drafted by the House Health Committee.
“Go back to the drawing board and consider a different bill,” Richter bellowed toward the windows of the state capitol. She and the other demonstrators object to the limited scope of the committee’s reform plan, which calls for expanding state-subsidized health coverage to many of the state’s uninsured and promoting better management of chronic diseases among all Vermonters.
The recently organized Concerned Vermonters for a Universal Health Care System prefers the bill the House Health Committee recommended last year, which set out a roadmap to move all Vermonters to a government-financed health care system. Gov. Jim Douglas derailed the broader reform proposal with a veto last spring.
The House Health Committee expects to wrap up work on its new health reform bill this week.
Richter, who has a family medicine practice in Cambridge, blamed politics for the committee’s scaled-back proposal: House Democrats are trying to accommodate the demands of the Republican governor and avoid another veto in an election year.
“They have crafted a bill he would have no choice but to sign,” she told the crowd.
Inside the Statehouse, however, representatives of the Douglas administration found plenty to criticize in the latest draft of the House Health Committee’s bill.
Joshua Slen, director of the state Office of Vermont Health Access, posed the biggest challenge to the bill when he questioned the way the committee proposed to pay for the new Catamount Health program for the uninsured and the bill’s chronic care initiatives. The cost of the proposal isn’t set because the committee continues to study options that change how many uninsured could be expected to enroll.
The House bill specifies that the new programs would be paid for in part with dollars the state will receive under its new agreement with the federal government for funding Medicaid. This is the funding source Slen questioned.
Under the Global Commitment for Health agreement, the federal government has promised Vermont $4.7 billion over five years for state-subsidized health care. State officials project the Medicaid will require at least $4.2 billion in those years. Slen said the administration has plans for another $300 million, and he wants to hold at least $100 million in reserve in case Medicaid costs are higher than projected. The committee has been considering using $70 million from this fund.
“My recommendation to the governor has been we can’t be in a position that eats into that cushion,” Slen said.
Some committee members weren’t convinced of the administration’s math or Slen’s conclusion that their plan would consume the cushion. They had their own financial experts reviewing the numbers.
A parade of other witnesses, mostly advocates with special interests, offered the committee their comments on the bill.
“You did a good job setting the stage to move forward,” said Richard Davis, executive director of the Campaign for Health and a registered nurse.
He praised the comprehensive health coverage that would be offered to the uninsured and the plan to better manage treatment of people with chronic diseases such diabetes.
Davis questioned the requirement that someone who has insurance now would have to go a year without insurance before becoming eligible for Catamount Health. “I don’t understand that, if you want to promote access.”
Dr. Marvin Malek questioned the committee’s assumptions about how much money might be saved with the bill. “I don’t see administrative savings,” he said, noting that it wasn’t the single-payer system he advocated.
“If you are expecting there will be a lot of savings because of chronic care management, I’m not optimistic,” Malek added. He and others warned the system might not reap financial benefits from revamping chronic care for years.
Richter addressed the committee, too, before joining the noon rally. She told the panel they were repeating the mistake made by lawmakers in the 1990s by recommending repairs rather than reform of a broken health care system.
“Nothing in the bill offers cost relief in the near future,” she said. “It will result in more uninsured. And the bill makes no provisions for the under-insured.”
The committee will consider today how to react to all the comments it heard about the bill.
Vice Chairman Malcolm Severance, R-Colchester, observed late Tuesday, “We heard a lot today we have to listen to very carefully.”
