“Scribblings” An Occasional Newsletter from the Legislature

by Rep. Thomas Koch, Barre Town

The legislature has reached the point of transacting serious business, but it has also signaled the beginning of the silly season.

Last week, we spent nine hours over two days debating whether an employer should be required to provide 30 minutes of break time for an employee whose work day is at least six consecutive hours. (Duh?) We already have a state law requiring that employees be provided “reasonable opportunities during work periods to eat and to use toilet facilities in order to protect the health and hygiene of the employee.” Now we are invited to prescribe that breaks be a total of 30 minutes in any consecutive six hour period.

Why? Because we heard a handful of stories about employers who would not allow their employees to take a break. The fact that every situation we heard about is already covered by the existing state law or by the federal Americans with Disabilities Act didn’t matter to the majority-the bill passed by a vote of 72-61.

It is interesting to note, as freshman Representative Dustin Degree of St. Albans did, that the bill could have adverse consequences. Whereas the current bill requires that an employee have “reasonable opportunities” to go potty, the new language would make it legal for an employer to deny that opportunity to an employee who had already used his 30 minutes of break time for the day! Of course, that’s what happens when you have an all-knowing legislature that tries to regulate every aspect of life.

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Of far greater consequence is H. 202, the health care bill, which is up for debate on Wednesday and Thursday this week. To be blunt, this bill is a disaster. While it no longer mentions a “single-payer” system (a concession to Rep. George Till of Jericho, a physician, a Democrat, and a member of the Health Care Committee), everyone knows that’s the only thing on the menu.

The bill sets up a five-member “Green Mountain Care Board” that will be charged with a long list of functions leading to the creation of a single-payer system. The board will have a full-time chair and four part-time members; the compensation package for the chair will be $160,000.00, and the package for each of the other members will be in excess of $100,000.00. Each member will be vetted by a specially appointed nominating committee and then appointed by the governor. Each member will have a term of six years, but (to ensure that this train keeps rolling down the tracks no matter who the governor is) the initial term of the chair will be seven years!

The Green Mountain Care Board will have the authority to adopt by rule, without further action by the legislature measures having the force of law to:

–“develop…methodologies for achieving payment reform and containing costs, which may include the creation of health care professional cost-containment targets, global payments, bundled payments, global budgets, risk-adjusted capitated payments, or other health care professionals, or other provider arrangements;”

–review and approve Vermont’s statewide health information technology plan;

–develop and maintain a health care workforce development strategic plan;

–set rates for health care professionals “and make adjustments to the rules on reimbursement methodologies as needed;”

–review and approve recommendations from the commissioner of banking, insurance, securities, and health care administration, within 10 business days of receipt of such recommendations, on any insurance rate increases, hospital budgets, certificates of need, changes in health care delivery, changes in payment methods and amounts, “and other issues at the discretion of the board;”

–review and approve the benefit package for qualified health benefit plans (i.e., what your insurance policy will and will not cover);

–develop and maintain a method for evaluating system-wide performance and quality;

–develop and approve (with only 10 days notice to the legislature) the Green Mountain Care benefit package, including determining the level of any cost-sharing requirements;

–“monitor the extent to which residents of other states move to Vermont for the purpose of receiving health services and the impact of any such migration on Vermont’s health care system and on the state’s economy and recommend to the general assembly…strategies to address any related problems the board identifies.” [Emphasis by underscoring added.]

And there’s more, but that list gives us a pretty good idea of what’s happening. The bill proposes to turn our entire health care system over to a five-member board-appointed, not elected-to undertake centralized planning and administration of a system that affects every man, woman, and child in Vermont. It sets us on an uncharted course into unknown territory, with virtually no way to turn back once we have embarked on this journey. We are left not with answers, but only with a long list of questions. Here are a few.

What will our new “benefit packages” cover?

If my present insurance coverage is better than the benefit package provided in Green Mountain Care, will I be able to keep my present policy?

Will Medicare be included in Green Mountain Care?

If I am retired from the military and have Tri-Care insurance coverage, will I be allowed to keep that, or will I have to drop it and pick up Green Mountain Care?

How much will all of this cost?

How will we pay for it? A payroll tax, as suggested by Dr. Hsiao? If so, will people who don’t work have to contribute anything? If yes, will the payment system distinguish between those who have retired, those who are disabled from work, those who are trust fund babies, and others?

How much will our medical professionals be paid? Will it be enough to keep them in Vermont? Will young professionals just out of medical school with hundreds of thousands of dollars of debt be attracted to Vermont as older professionals retire?

What happens if a hospital is on a “global budget” and an epidemic of some illness occurs near the end of a budgeted year and there’s no more money left in the hospital’s budget?

Even if the board can set payment rates for Vermont hospitals, how does it propose to set the rates to be paid to Dartmouth-Hitchcock, where 40% of Vermonters get their care? If a Vermonter has to go to Mass General or Mayo Clinic, will they accept the payment levels provided by Green Mountain Care? What if a Vermonter gets sick while on vacation in New Mexico?

What happens if the “cost containment” measures adopted by the board don’t work, and health care costs continue to escalate?

Since the U.S. Supreme Court has found residency requirements for public benefits to be unconstitutional, what tools are available to deal with the situation if there is a large migration of people into Vermont looking for free care?

What will we do if firms like IBM and GE decide that they don’t want to play Vermont’s go-it-alone game and simply leave the state?

This is a brief glance into the 96 page health care bill. There is much we can and should be doing to fix our health care system-electronic health care records using smart card technology, payment reform to control some abusive tactics currently used by some insurers, tort reform to reduce the incidence of “defensive medicine,” keeping government’s existing promises to pay for Medicaid-related programs, thus reducing the cost shift that raises private premiums, and increasing competition within the health care system-but this bill does none of them effectively. The bill is an empty shell, to be filled in by a small group of bureaucrats.

When I vote on legislation, I try to read the bills and understand what they do. I have read H. 202, and I have spent time trying to understand what it does. And what it does is pass the ball to another player. This is not a responsible way to legislate, and I will be voting NO on H. 202.

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In his budget address in January, Governor Shumlin said he was opposed to any increases in broad-based taxes; unfortunately, he didn’t say he was opposed to raising all taxes. As I write, the Miscellaneous Tax Bill is on the floor for debate. It proposes to raise $28.89 million in various taxes (down nearly $2 million from what the governor asked for.)

In rough detail, the bill raises $11.46M in hospital provider taxes that I wrote about in a previous issue of “Scribblings,” creates a new tax of 0.8% on all claims paid by a health insurance company for $10.72M, increases the tobacco tax by $0.27/pack to raise $3.66M, and raises home health and nursing home provider taxes by $3.05M. These increases are said to be necessary to close the budget gap of $176M for the coming fiscal year.

I believe, however, that the deficit should be closed not by raising new taxes, but by careful reductions in the existing budget. And while I have been critical of some cuts proposed by the governor, such as mental health, student assistance counselors, and the Choices for Care program, I believe that there are other places in the budget where we can still go to restore the improvident cuts, while still not raising taxes. One example is the Housing and Conservation Trust program for purchasing development rights to keep open land from being developed; that’s a nice thing to do when you can afford it, but when money is as tight as it is this year, you have to set priorities, and in my book, drug/alcohol/suicide counselors for our kids come before land acquisition.

Over the past three years, as we experienced the effects of the recession, we failed to cut the budget, relying instead on federal “stimulus” funds that we knew were going to go away. Now that they are gone, we are faced with making cuts that should have been made over the last three years; it’s not easy, but it has to be done, because the simple fact is that Vermont is overextended. Raising more taxes may seem to be the easy answer, but it is not the right answer. The Miscellaneous Tax Bill is one more bill that will be getting my NO vote.