by Anne Galloway vtdigger.org With 38 bills on Mondayâ s calendar, it was hard to know where the Senate was going to land. Would it be one of the red hot issues that the Green Room has been avoiding for weeks, say the campaign finance bill? Or legislation that would allow child-care employers and workers unionize?
In a familiar pattern, the Senate hedged its bets, ran through a handful of sure-to-pass legislation and then saved the most controversial item for last: the health care exchange bill.
Sen President John Campbell, Lt. Gov. Phil Scott and Secretary of the Senate John Bloomer in discussion. VTD/Josh Larkin
The biggest limiting factor for floor debate was the late hour. Senators started their legislative day at 3 p.m. and by 7 p.m. even the youngest members among the middle-aged denizens were starting to look a little bleary-eyed after the first reading of the health care exchange bill. On second reading, senators engaged in a passionate debate over student athlete concussions caused by contact sports.
Democrats Sen. Claire Ayer and Sen. Ann Cummings carefully picked their way through the complicated parameters of H.559, the legislation that uses the federal Affordable Care Act as a foundation for Gov. Peter Shumlinâ s signature single payer plan.
The purpose of H.559 is to fulfill the requirements of the federal law, while finding a way to funnel the federal money that comes with implementation into a state-run health care program for uninsured and underinsured Vermonters.
The federal government requires states to set up â exchanges,’or online marketplaces that enable consumers to sort through the mazelike variety of insurance options based on the cost and scope of coverage. The exchanges are often compared to travel websites like Expedia or Orbitz.
The federal law includes an individual mandate ‘a requirement that all Americans buy insurance. It also requires insurance companies to provide coverage for patients who have â pre-existing’conditions, or known medical problems.
In Vermont, the â Expedia’system would evaluate three different insurance plan types, based on total actuarial value, that is the total cost to consumers of premiums, co-insurance, copays and deductibles.
The Shumlin administration has taken the exchanges a step further. It wants to require companies with 50 or fewer full-time employees (those working 30 hours or more) to obtain insurance on the exchange by January 2014. State officials also want to eliminate commissions for insurance brokers who earn about $18 million a year for actuarial services for businesses.
Steve Kimbell, commissioner of the Department of Financial Regulation, has said small companies could encourage workers to obtain insurance on their own ‘making them eligible for a federal subsidy for insurance coverage. Federal tax credits are available for a family of four with an income of up to $92,400. Though businesses would incur a $2,000 fine per year per employee, Kimbell has argued the penalty is considerably less expensive than the cost of health insurance premiums.
The support and opposition to the stateâ s health care exchange plan breaks down along party lines. Most Democrats back the governorâ s plan; Republicans oppose it.
Proponents say the exchanges will be the foundation for the governorâ s single-payer plan, also known as Green Mountain Care, and will be designed to lower the rising cost of health care, which now accounts for 20 percent of the gross state product, and nearly 20 percent of the gross national product.
Opponents say the Shumlin administration is exceeding the federal requirements and creating an uncertain environment for business.
Peg Flory. VTD/Josh Larkin
Sen. Peg Flory, R-Rutland, used the Expedia exampleto illustrate her point ‘that the Shumlin administration has put limits on consumer choice by requiring Vermonters to buy health insurance through the exchange.
â I appreciated the comparison to Expedia, but ifI want to buy a flight right now, I can go to CheapFlights.com or a travel agent, but my understanding is under this Iâ m stuck with just Expedia if I have 50 employees or less is that correct?’Flory asked.
â Thatâ s correct,’Cummings said.
â And when I go to Expedia, I have â ¦ tons of tons of airlines to choose from,’Flory said. When I go to this insurance exchange how many insurers do I have to choose from?â
Cummings countered that Vermonters would have access to the same companies they have now, in addition to two federal insurance plans.
Flory asked if the exchange â is so wonderful’why is the state requiring businesses to participate in it, instead of allowing them to buy insurance â off the exchange.â
If companies bought insurance â off the exchange,’Cummings said, they would deny their employees the opportunity to receive federal tax credits. â That is money that would come into this state and help fund the whole health care system,’Cummings said, referring to the Shumlin administrationâ s plan to capture federal dollars for the single-payer system, which officials hope to have in place by 2017.
Sen. Ayer said the only reason to allow companies to circumvent the exchange is to support the existing $18 million commission system for insurance brokers.
Sen. Randy Brock, R-Franklin, said he didnâ t see how the new system, which relies on â navigators,’was going to save more money.
Critics also questioned the viability of the health care exchange proposal in the face of a potential decision from the U.S. Supreme Court that could strike down the â individual mandate,’or the requirement that all Americans buy health insurance. The court heard arguments about the constitutionality of the mandate in March, and many observers say the critical nature of the justices’questionsdoesnâ t bode well for the federal provision. A decision is expected this summer.
Cummings compared this aspect of the stateâ s journey toward health care reform with driving down the road in a pea soup fog, hoping not to hit a bull moose. But not doing anything, in her view, isnâ t an option.
â If the plan is overturned weâ re back to square one on this,’Cummings said. â But we need to remember that two years ago we were talking about how the present system is not sustainable, that the employers are worried about the cost. Weâ ve been in a race to the bottom trying to keep cost affordable.â
Brock, the Republican candidate for governor, strongly urged the Senate to defeat the bill.
â The volume of unknowns and uncertainties â ¦ raises questions about where weâ re going with this bill, and what weâ re getting when we get there,’Brock said.
After the second reading of the bill was passed on a voice vote, Brock proposed that an amendment that would have required the Shumlin administration to disclose the cost of the Green Mountain Care system and to reveal the financing mechanism for the single-payer plan before the November election. The measure was defeated.
H.559 is up for third reading on Tuesday. Expect vigorous debate on amendments, including one from Sens. Vince Illuzzi and Hinda Miller that would put off the exchange implementation date to January 2015.
Senators expended almost as much energy on an unanticipated clause in the health care reform bill that would require coaches to pull student athletes out of a football game or other concussive sport if they had a â reasonable belief’that the student had sustained a head injury.
Sen. Dick Sears, D-Bennington, chair of Senate Judiciary, was miffed that the measure wasnâ t brought to his attention and he insisted that the standard be changed to â actual knowledge.â
Sen. Dick Sears, chair of the Senate Committee on Judiciary. VTD/Alan Panebaker
This proposal led to an outburst from Sen. Kevin Mullin, who in a passionate exchange with Sears, insisted that the provision, based on National Football League language, was necessary to protect students.
â No child should ever have to go back into a game and sustain another injury,’Mullin fumed.
Sears countered that the standard of reasonable belief would have a chilling effect on high school contact sports and would lead to frivolous litigation.
A discussion about litigation phobia, common sense principles and whether schools should replace baseball with wiffleball ensued. Sears withdrew the amendment.
No increase in Vermont Yankee thermal fee
The Senate also passed the environmental fee bill on Monday. It includes a $105,000 annual surcharge on the release of heated water from Vermont Yankee Nuclear Power Plant in Vernon, which is located on the banks of the Connecticut River. The fee is identical to the charge previously assessed on the plant, which is owned by Entergy Corp. The House more than doubled the fee in its proposal.
The bill includes a 50 percent increase in air pollution monitoring fees; a 2 cent per cubic yard charge for extraction of stone, gravel and sand, and an additional 1 cent per cubic yard assessment for removal of more than 1 million cubic yards of material.
Fees for petroleum tanks at gas stations were increased by 50 percent to 250 percent, in order to cover costs associated with oil contamination cleanup. The assessments will range from $75 to $250 a year for tanks.
The Department of Environmental Conservation sought to increase state fees because funding from the Environmental Protection Agency will be significantly reduced over the next three years.
Senate OKs bill raising the school dropout age to 18
In an effort to help students who might otherwise drop out of school at age 16, lawmakers approved a measure that will not only require children to stay in school until age 18, but also creates incentives for dual enrollment programs at local state colleges.
The drop-out age would be gradually implemented over six-month intervals through 2015.
Under the plan, students and parents must receive counseling about alternative education programs. The idea is for teenagers to develop personal learning plans for work and additional training. School officials and guardians would have to sign the withdrawal form.
â Leaving school used to be an act,’said Sen. Ginny Lyons, D-Chittenden. â By putting this in place, we make it a process where kids are asked to evaluate who they are with respect to their career and educational goals.â
The money for the dual enrollment program would come from the $30 million Higher Education Trust Fund.
Senators scrap proposal to curb metal thieves
An attempt to help law enforcement track metal thieves was scrapped on Monday. Lawmakers had hoped to improve record-keeping practices for salvage yards and pawnbrokers, but the bill failed to garner the support of several senators who were concerned about the impact of the proposal on the sale of jewelry. The bill was ordered to lie.
Other business
Secondary mortgage lenders, including Fannie Mae, are requiring homeowners who live on private roads to obtain formal agreements verifying that they share the cost of maintaining the thoroughfares. The Senate gave preliminary approval to a House bill, H.272, that memorializes in statute a Vermont Supreme Court precedent that requires homeowners to share responsibility for private roadways. Cummings said the new law will make it easier for homeowners to obtain financing.
The Senate Appropriations Committee will hold an informational caucus on the budget at noon Tuesday in Room 11 at the Statehouse.
by Anne Galloway vtdigger.orgApril 24, 2012