by Lindsay Smith
The house committee on healthcare faced a staggering list of discussion topics before they voted on H.559, better known as “the health care bill”. The committee room was standing room only as insurers, insurance brokers, and many others gathered hoping their personal experience would influence the committee. From 9:00am to 4:30pm the committee only took small breaks in order to hear much testimony and discuss these important developments.
Some of the important issues decided were:
Bronze Plans (PASSED)
Members of the committee voted to keep the “bronze plans” available in the Exchange by a vote of 6-5. These are the of the most prevalent plans in Vermont today, and small businesses strongly favored that these options to be included. “Bronze” plans offer “cheap” monthly costs but includes a high deductible. Rep. Leigh Dakin was not in support of this plan because she believes it makes consumers “unwilling and afraid to access healthcare.” Rep. Jim Eckhardt voted in favor of this bill because of the support from the community and small businesses. However, this issue is still under review at the federal level.
Section 125 Plans (PASSED)
The committee granted the duty to provide information about cafeteria plans or premium-only plans to employers under Section 125 of the Internal Revenue Code to “navigators”.
The bill allows health insurers or stand-alone dental insurers (including nonprofit dental service corporation) the ability to offer a plan that provides only limited dental benefits (as long as it meets Internal Revenue Control standards and requirements of the ACA). The committee added language to state that a qualified health benefit plan offered in conjunction with a stand-alone dental plan (providing pediatric dental benefits) would meet these requirements, as long as they maintained ACA standards.
Claim Edit Standards (PASSED)
Blue Cross and Blue Shield of Vermont and the Vermont Medical Society are required to present an annual progress report to the house committee on health care and the senate committees on health and welfare and on finance.
Eliminate Brokers Fees (FAILED)
This controversial provision would have effectively eradicated hundreds of insurance broker jobs in Vermont. After hearing from several licensed brokers on the possibility of wiping out their profession through this legislation, the committee failed to pass the provision — but only on a tie, 5-5 vote.
The brokers presented a convincing case that they were not out to “dupe” consumers, as Robin Lunge, Director of Healthcare Reform, had stated. Instead, they offer a service that educates and saves money for the consumer. Rep. Poirier (D-Barre City) recognized that Barre City’s use of brokers for last year’s insurance coverage was an overwhelming success. “My city manager was overwhelmed the cost savings that you guys were able to work with them on, the employees are really happy, and our rates actually went down.”
Prescribed Foods (PASSED)
Prescribed Foods can now be provided to a health care provider to distribute to his or her patients for free. This practice had previously been reserved to samples of prescribed products, “reasonable quantities” of over-the-counter drugs, and nonprescription medical device and equipment. Medical foods lie somewhere between regular food and regular medicine. A good example is “Ultracare”, a nutritional supplement for children with atopic disorders.
The committee also changed some definitions and deadlines to deal with funding and employer issues:
A “qualified employer” is currently defined as an entity that employs 50 or fewer employees. On January 1, 2016 that number will change to 100 employees and on January 1, 2017 all employers will be included.
In an effort to address future funding concerns, the committee added a clause that makes the health care ombudsman relay costs and plans for funding. By January 15, 2013 the state health care ombudsman must report to the house and senate committees on healthcare “on human services regarding the ombudsman’s current and projected funding and resources needs, suggestions for funding mechanisms to meet those needs, and recommendations on how best to coordinate or consolidate the consumer protection efforts of the ombudsman’s office, the department and the agency.”
Any collective bargaining agreements entered into prior to January 1, 2013 and in effect on January 1, 2014 will not be impaired by the exchange until that coverage terminates.
These last two points essentially mean, the politically powerful teachers’ unions don’t have to participate in the exchange, and Vermonters aren’t going to get to find out any meaningful financial information about this scheme until after the election in 2012.
Rob Roper contributed to this article.