House Passes Healthcare Bill

Republican amendments for transparency and flexibility fail

by Lindsay Smith

Debate over healthcare kept legislators working way past business hours this Thursday night. H.559 (the healthcare bill) passed out of the house committee on healthcare last week with a vote of 8-2. It then made its way to the house floor where it was met by several strong Republican amendments. The principle issues: should Vermonters be forced into the federally mandated healthcare exchange or be allowed to participate voluntarily, and do Vermonters have a right to know how much healthcare reform is going to cost, how its going to be paid for, and by whom before the next election.

The Mandate

Rep. Mark Higley (R-Lowell) proposed an amendment that would eliminate any mandate to participate in the exchange. Federal rules make entrance into the exchange optional, but H.559 dictates that small businesses with 50 or fewer employees, participation will be compulsory as of January, 2014. Higley’s amendment stated:

Beginning January 1, 2014, the commissioner of banking, insurance, securities, and health care administration may require qualified health benefit plans to be sold to individuals and small groups through the Vermont health benefit exchange, provided that the commissioner shall also allow qualified and nonqualified plans that comply with the required provision of the Affordable Care Act to be sold to individuals and small groups outside the exchange.

Arguing in favor of his own amendment, Higley expressed the concern of many Vermonters: “We don’t even know the benefit package that will be included in the package at this time.” How can it possibly be fair to force someone to buy a product that hasn’t even been defined? “If the exchange is what groups and individuals [who support H.559] believe it is what will best serve their needs they will certainly flock to the exchange.”

Legislators supporting the amendment maintained their belief that Vermonters should be allowed to choose their own healthcare. Rep. Robert Lewis (R-Derby) pointed out all the everyday choices that Vermonters control. He emphasized the responsibility that goes hand-in-hand with making important choices. When it comes to healthcare he says, “Its my choice, your choice, its our peoples choice”.

Rep. Michael Fisher (D-Lincoln), the chair of the house committee on healthcare, opposed Higley’s amendment. Fisher stated that allowing people to chose to remain outside the exchange was a “mystifying” concept. He described his disbelief by saying, “I can’t see any potential value that can be gained outside the exchange.” Fisher did not elaborate on this but instead deflected to the “feel good” feeling he has been pushing all along: “Inside the exchange I think there is a lot of value. I think there’s a whole level of consumer protection that Vermonters will benefit greatly from if you care about affordability if you want to make sure that people can maintain their insurance even when they lose their jobs. Inside the exchange is pretty darn important.”

The amendment failed with a vote of 57 yes and 80 no. (See how they voted). Ten Democrats and one Independent joined a unified Republican Caucus in supporting the Amendment.

After the passage of the overall bill, the Vermont Chapter of National Federation of Independent Businesses put out a statement, “Although we thank the 57 supporters of Rep. Mark Higley’s amendment; failure by members of the Vermont House of Representatives to amend the bill was a missed opportunity to send small businesses in Vermont, who account for more than 95% of all businesses, a message that they are as important as big businesses.”

Transparency (and fiscal sanity)

Rep. Peter Fagan (R-Rutland) proposed an amendment that would make financing information regarding healthcare reform available before the next election. “I’m asking for a reporting date for the cost financing system for the exchange and for Green Mountain Healthcare be moved from 15 January 2013 up to 15 September 2012,” said Fagan. He made the point that when a responsible person decides to buy a car there are many steps to that process. One important step is to know the cost and financing options. Without that step, the process is incomplete.

Rep. Oliver Olsen (R-Jamaica) pointed out that Vermont would have to have a funding plan for the exchange in place by 2015. In 2014 the exchange will be federally funded but is the legal responsibility of Vermont to have a sustainable funding source in place for every year after that.

Asked what it might be, Fisher had no answer. “There has been some conversation but largely we are looking forward to a well developed report… in January of 2013,” said Fisher, admitting that he didn’t have enough information available to provide a responsible plan.

Without knowledge of cost, the House Healthcare Committee allowed the bill to go to the floor. Knowledge of funding is historically one of the most important factors to be decided upon before a bill leaves committee. Fisher, and the others who voted the bill out of committee, without any knowledge of finances, have signed their names to an unfinished product.

This amendment was rejected by the majority with a final vote of 49 yes and 86 no. (See how they voted) Five Democrats and one Independent joined Republicans in supporting the Fagan Amendment. One Republican, Topper McFaun of Barre Town, voted with the Demcrats in opposing it.

In explaining their votes, Rep. Tom Burditt (R-West Rutland) made a good point when he said, “It is a political move to move the finance date to September. It was also a political move not to! I support this amendment because it put the finance issues of health care reform in front of the people – where it should be!”

Making a typical argument for the Democratic side, Rep. French (D-Shrewsbury) lectured, “If someone asked for the cost of a 6,000ft² house to be built, you might be wise to wait until the architect had finished the plans and all contractors had weighted in before answering.” Of course, no architect would start drawing plans for a house until she had at least some idea of how much money the builder had to spend.

The amendments proposed sought to provide Vermonters with the choice and information they are begging from their leaders. As representatives in the house, they represent constituents with real concerns about healthcare. There is an uncertainty surrounding the entire process that makes Vermonters fearful. Having a choice of whether or not to participate and knowing how much this reform will cost could help ease that fear.

In a comment that described how taxpayers are reacting to healthcare reform, Rep. Gregory Clark (R-Vergennes) explained that the opportunity to choose could “probably could only be understood clearly by people that are Vermonters.” He elaborated by saying “the idea of value… comes from the fact that Vermonters like to make their own decisions. Vermonters are always willing to be led to the water trough, but man they get irritated when their heads get forces into the trough. They are asking me to drink at their leisure.”