House debate heats up on health care: Reps. craft amendments for floor battle

by Angela Chagnon

Several amendments are scheduled to be offered for H.202 during the bill’s discussion on the Floor of the House this afternoon.

Cynthia Browning’s (D-Arlington) two amendments, the first titled “Immediate Strategic Action Amendment” and the second “Strategic & Sustainable Health Reform Amendment”.

Browning included a written explanation along with the amendments. Regarding her first amendment, she writes, “This amendment first requires that BISHCA immediately develop plans to require insurance companies to standardize forms, authorizations, and other aspects of insurance claims and billing.”

According to Browning, this would result in reduced administrative costs “very much sooner” than 2015, which is the date H.202 sets for it’s ‘savings’ to begin.

“Secondly,” Browning continues, “a zero interest revolving loan fund shall be created to make loans to Vermonters in danger of bankruptcy due to medical debt.” The loan fund would be designed to help reduce the cost shift due to unpaid bills.

“Thirdly, the Department of Vermont Health Access shall develop plans for increasing the enrollment of Vermonters eligible for existing public insurance programs, including the possibility of developing a program for provisional point of service enrollment by uninsured individuals at provider facilities.” She emphasizes again that these changes would have an immediate effect, unlike H.202’s proposals.

The second amendment is described as a “strike all amendment that reorients H.202 so that it contains an approach to health reform that is more reliable and sustainable than the Committee bill. It is no longer leading to an unspecified and uncertain state run insurance program called Green Mountain Care.”

The proposed amendments would leave intact the controversial health care board and the insurance exchange, but Browning says that “the regulatory framework is looser since it is no longer designed to lead into Green Mountain Care.” Browning further says that her approach would prevent the state from having to commit to a healthcare program before finding out if it worked or not. She advises, “It is not wise or cautious to make even a conceptual commitment to such a new entitlement program that would greatly expand the state’s budget and obligations on a permanent basis, across unknown future economic conditions. It is unfair to make a promise to Vermonters that we may not be able to keep.”

Browning continues in this vein, remarking that the current bill “creates great uncertainty for businesses, providers, and insurers, without really doing much for the uninsured and underinsured in whose name the program is being advocated. Conditions of uncertainty are extremely adverse for all decisions about long term economic activity and investments.”

As for the issue of insurance reserves, something that private insurance companies build up from premiums to deal with unexpected cost increases such as the 2009 H1N1 flu epidemic, Browning says, “The Committee [bill] H.202 directs a study of this reserves issue, which shows that they have not figured out one of the most basic aspects of any real insurance program.”

And yet another unforeseen issue: the state’s bond rating. “How can we even contemplate this when we are having difficulty meeting our current obligations?” Browning queries. “Would even the planning for this massive new obligation be seen negatively by the bond rating agencies that track our budgetary behavior, resulting in a downgrading of our bond rating?”

Browning concludes with some wise advice. “[F]irst we should see how the cost containment initiatives work and whether federal tax credits associated with the exchange help underinsured and uninsured Vermonters. Then we could see what additional steps were needed.”

Browning’s amendments bring up some excellent points about H.202’s flaws and slow Vermont’s race to a single-payer system, but they unfortunately don’t take single-payer completely off the table. Even then it is unlikely that Browning’s amendments will pass. Although many good ideas and alternate plans have been submitted to legislators regarding healthcare reform, many legislators continue to allow their ideology to get in the way of common sense.

Other amendments of interest include Ann Donahue’s (R-Northfield), which would require that everyone covered by the proposed Green Mountain Care program have the same level of coverage. This would undoubtedly worry the public employee unions who are counting on being in the top tier of a multi-tiered system.

Oliver Olsen (R-Jamaica) and Heidi Schuermann (R-Stowe) have offered an amendment that would exempt employers with ERISA from paying into the new healthcare system. It is not fair that companies who are doing the responsible thing and providing their employees with quality health insurance be forced to essentially pay twice.