Legislature Report
For the Week Ending February 26, 2010
The Vermont General Assembly is in recess this week to allow members to meet with constituents and participate in Town Meeting Day activities in their districts. Legislators return to work on Tuesday, March 9th.
Health care reform discussions were in full swing last week, though, as legislative committees in both chambers wrestled with tough policy questions over health system reform and immediate decisions necessary to develop a state general fund budget for FY2011. Frustration levels ran high last week as few palatable solutions appeared within reach to allow committees to meet their policy goals while also balancing the budget.
The House Health Care Committee drafted an advisory letter to the House Appropriations Committee presenting their recommendations for health care spending. The health committee recommended general themes and priorities for the development of the FY2011 budget, including support for several administration recommendations for cost savings in the Medicaid program. The committee, however, opposed premium increases in the state’s VHAP, SCHIP, Dr. Dynasaur, and drug programs as recommended by the administration. The committee also opposed administration proposals for raising deductibles and co-pays in the Catamount Health program for the uninsured.
A consultant’s report on the administrative efficiency of private insurers offering the Catamount program drew a strong response from the Douglas administration before the House committee on Wednesday. Susan Besio, director of the state’s Medicaid program and health reform efforts, challenged the report’s conclusion that the state Medicaid division could administer Catamount for about $1 million a year less than private insurers BCBSVT and MVP. The report neglected to include a key portion of Medicaid administrative costs in its comparison with private insurers, Besio told the committee, negating most if not all of the estimated $1 million savings. Furthermore, Catamount Health benefits also are significantly different than typical state programs and would require new systems and procedures to administer Catamount as it is currently configured, Besio told the legislators. Committee members were clearly disappointed to hear that a potential cost savings measure might not be there for them to help resolve their budget issue with Catamount. The state fund that supports subsidies for low income Vermonters to purchase catamount coverage is projected to fall $7 million in deficit in 2011 unless some action is taken.
Also last week, the House committee began to prioritize the elements to be included in its omnibus reform bill for this session. Among the preliminary list developed in initial discussions were proposals to expand the Blueprint for Health chronic care initiative statewide, establish a public option for coverage, global budgeting, programs to encourage more primary physicians to practice in Vermont, and measures to establish more uniformity in the insurance system as well as require insurer loss ratios to be no less than 90 percent. The committee hopes to produce a bill by early April.
BCBSVT President and CEO Don George appeared before the House committee on Tuesday to provide a historical overview of the Blues in Vermont and offer his commitment to work with the state as a partner in reform.
The Senate Health and Welfare Committee pushed ahead with deliberations on its effort to create a bill focused on cost containment. The committee expects to address immediate steps to “bend the health care cost curve” closer to that of normal inflation, establish strategies to improve system efficiencies in the mid-term, and also outline a process to address long-term savings. The committee heard comments about their outline of initiatives from interested parties representing reform advocates, administration officials, and representatives from provider organizations. The committee also continued its discussions about restructuring the executive branch of state government to more effectively administer and/oversee a reformed health care system in Vermont.
The Senate Finance Committee revisited a proposal (S.262) to require health insurance coverage for intensive, long-term treatment of autism. The state Health Department described a myriad of the challenges in the treatment of autism and the difficulties insurers would have due to an absence of any standards of care, no real definition of medical necessity for autism treatment, and a lack of provider specialties that could be licensed and credentialed. The committee will take the issue up again when it returns after the break.
There will be no Legislative Report next week. The next edition will be issued on Monday, March 15, 2010.
If you are interested in this week’s Legislative Committee Meeting schedules, agendas, and a listing of other meetings and activities, please visit the Vermont Legislature’s website at http://www.leg.state.vt.us/schedule/schedule2.cfm
Committee meetings are normally updated daily, and are subject to change without notice. If you plan on attending, you may want to call ahead to verify the agenda.
For more information on legislative proposals, visit the Blue Cross and Blue Shield of