Thursday evening the Senate Finance Committee concluded work on H.559, the ‘Health Care Exchange’ bill. Sen. Randy Brock, R-Frankiln, offered an amendment requiring the release of financial information about Green Mountain Care in September, 2012 rather than January, 2013, so that it will be available to the public before the November elections. This amendment has been strongly supported by Vermonters for Health Care Freedom and many others. The amendment failed on a 5-2 party-line vote. The bill was subsequently approved by the committee. Consideration of the bill by the full Senate may happen as early as Friday (today) but most likely will not happen until next week. No major changes to H.559 were made by the Finance Committee, so the version that goes to the floor will most likely require all individuals and small businesses with 50 or fewer employees to drop their current health care plans and purchase insurance through the new, government-specified and limited health care ‘Exchange’ as of January 1, 2014. Vermont is the only state in the nation seeking to use the Exchange to restrict choice and competition, rather than expand it. Vermonters for Health Care Freedom is asking Vermonters to contact their senators and urge them to vote ‘NO’ on H.559 due to this requirement.
VHCF has prepared an 8-minute video explaining the problems with Vermont’s Exchange which can be viewed here: http://vthealthcarefreedom.org/news
Last week, BISHCA Commissioner Steve Kimbell and Health Care Reform Director Robin Lunge provided legislators with documents ‘rebutting’ claims made by VHCF and others who are critical of these reforms. VHCF prepared a side by side response to these statements and provided it to members of the press and all 30 members of the senate on Tuesday. The statements in dispute circulate around H.559, the ‘Health Care Exchange’ bill. In the response VHCF takes issue with the accuracy of a number of the Administration’s assertions.
The 4-page VHCF response is available at this link http://vthealthcarefreedom.org/sites/default/files/04-17-12%20VHCF%20Rebuttal%20to%20Lunge%20Kimbell%20Fact%20Check.pdf
Townhall.com published a commentary by Dr. Hal Schertz and Dr. Jeffrey English on the perils of rationed care and the unavoidable consequences of mixing politics and medicine. While the commentary is about federal reforms, the piece gets right to the heart of measures being pursued even more aggressively here in Vermont.
Titled, ‘Obamacare: We Need an Earmark to Treat That Disease,’ Schertz and English describe the pressure that is being brought on their practice by government bureaucrats because they ordered an unusually large number of radiology tests last year. The government explained that the notice was a tool to help them ‘adjust their practice patterns.’ It was also explained the information will be made public to drive patients away from ‘over-utilizers.’
Schertz and English explain that their practice has a heavy concentration of MS patients, who require significantly more (and more expensive) diagnostic screening and post-diagnosis radiological monitoring than the average patient. Notwithstanding the government warning, Schertz and English follow the guidelines of the American Academy of Neurology and the Consortium of Multiple Sclerosis Centers with regard to the frequency of ordering scans. They write:
How can physicians protect themselves from the iron fist of the Federal government? Quite simply, by taking care of healthy people. Patients who have expensive, chronic conditions will find it increasingly difficult to locate doctors to care for them. These patients will drive doctors and hospitals out of business because they will be penalized for taking care of people who require more testing or expensive medicine. As an alternative, physicians could order fewer tests and avoid expensive medicine, which would in the case of MS, be detrimental to patient care and lead to increasing patient disability.
In the end, Schertz and English conclude, only those diseases with well-funded and politically savvy advocacy groups will get funding and support through acts of Congress. Anyone suffering from anything else might as well live in Canada.
The full commentary is available here: http://townhall.com/columnists/halscherz/2012/04/18/obamacare_we_need_a_earmark_to_treat_that_disease
The Montreal Gazette reported that wait times for major surgeries are growing again in Quebec province. In 2008 the Canadian Supreme Court ruled that delays for hip and knee surgery in Quebec were unacceptably long. In response, provincial health officials have shifted resources to reduce wait times for both of these procedures and for cataract removal.
Response to the court ruling has apparently come at a cost, however. The Gazette reports that nearly 3,000 Montrealers have been waiting at least half a year for cancer and other major operations. In 2007 the number was about 2,200. And the province has also acted to limit the criticism resulting from such statistics:
“What’s more, the Quebec Health Department has stopped publishing statistics on those who have been waiting for at least nine months, even though there are patients who continue to wait at least a year for some operations like bariatric surgery.
The Vermont Green Mountain Care single-payer health care reform is modeled after the Canadian system. The full article can be read here: http://www.montrealgazette.com/news/Wait+times+major+surgery+growing+again/6481140/story.html#ixzz1sSBdc72n
With all the focus here and in the Legislature on H.559, the ‘Exchange’ bill, we thought it would be helpful to illustrate what is wrong with Vermont’s approach by contrasting it with another state. The State of Maine has embraced the Exchange in a way that, if followed here, could provide significant benefits in expanded access and lower cost, as well as substantial secondary benefits for young families and the overall economy. Maine’s reform law is called LD 1333.
Maine and Vermont adopted very similar reforms in the 1990’s in response to concerns for insurance company ‘cherry picking’ and escalating premiums for seniors. ‘Community rating’ requirements leveled premiums across age groups – increasing costs for younger, healthier individuals and lowering them for seniors. ‘Guaranteed issue’ eliminated the practice of ‘cherry picking’ by requiring carriers to take all applicants regardless of pre-existing conditions. The effect of these and other reforms was to give Maine one of the costliest insurance markets in the nation, and to increase the ranks of the uninsured among young healthy individuals who simply cannot afford the premiums.
Then, in 2003, Maine made an attempt at universal insurance coverage called DirigoHealth. Plagued by funding fights in the Legislature, Dirigo never came close to serving the predicted 180,000 Mainers by 2009, and was broadly seen as an expensive failure. Partially as a result, in 2010 Maine voters replaced the Democrat-controlled House and Senate with strong Republican majorities and elected a Tea Party Republican Governor, Paul LePage, who promised repeal of Dirigo.
With the passage of Obamacare, Maine’s new majority leadership thoughtfully considered their options under the required Exchange and also incorporated contingency plans should the Affordable Care Act be struck down by the courts or repealed. In a nutshell, Maine did three things in 2011 that will lower their costs and increase access to insurance.
First, they reformed guaranteed issue, which had reduced the insured pool as younger people dropped insurance with increasing premiums. Maine borrowed an idea from Idaho and created a broad-based government funded reinsurance system called the Guaranteed Access Plan (GAP). GAP covers the cost of care for high-utilization individuals, thereby reducing premiums for everyone.
Second, they reformed the community rating system to allow insurers greater latitude in rating age groups. This means that the premiums charged to younger individuals can more accurately reflect the actual cost of insuring them. Community rating is still required (a condition of the ACA), but the rules are relaxed. By reducing premium costs to healthy individuals, Maine expects more of them to enroll, which will result in increased revenues from a population that demands few services. This, in turn, will help fund services to seniors, mitigating or eliminating premium increases to this group.
Third, Maine has moved to dramatically increase competition in the health insurance market by allowing Mainers to purchase plans across state lines. LD 1333 allows individuals to purchase health insurance plans offered in New Hampshire, Massachusetts, Rhode Island or Connecticut. The ACA will establish national “minimal essential benefits” and consistent rating practices by 2014, and Maine will use this standardization to dramatically increase consumer choice and competition in their market.
The Maine Heritage Policy Center has an excellent article explaining that state’s approach to the Exchange, which is recommend reading for Vermonters seeking a practical alternative to Vermont’s march to government-monopoly single payer health care.
The article is available here: http://www.mainepolicy.org/2011/08/ld-1333-explained-faqs-about-maine%E2%80%99s-new-health-insurance-reform/
The Green Mountain Care Board announced that it has capped budget increases at Vermont’s 14 hospitals at 3.75% for 2013. In 2011 the cap was 4.5% and in 2012 it is 4.0%, both imposed by the Legislature. Services provided through hospitals account for 60% of total health care spending in VT, and 2013 is the first year for which the authority to set caps resides with the GMC Board.
“Keeping a tight rein on the 2013 budgets is an important step in our efforts to build toward a single payer restructuring in the state,” said Anya Rader Walleck, the chair of the Green Mountain Board.”
Read the VT Digger article here: http://vtdigger.org/2012/04/19/hospital-budget-caps-set-by-green-mountain-care-board/?utm_source=rss&utm_medium=rss&utm_campaign=hospital-budget-caps-set-by-green-mountain-care-board