My health care committee continues to plow through challenging issues as we head into the last week before the town meeting week break. I joined in a press conference last week after we heard testimony from a consulting group that has worked for the administration for the past three years. The issue: Vermont Health Connect, the state’s stubbornly rebellious system for people signing up for health care through the health care exchange.
The CEO of Gartner Consulting testified that his firm told the Shumlin administration back in 2013 that it was trying to do far too much at once by creating an exchange that would handle private insurance and Medicaid from day one. Boy, were they ever right – but the administration didn’t listen. This is yet another piece of “new news” coming to us years after the fact.
As a legislature, we hold responsibility for oversight. But we are a citizen legislator, and have to rely heavily on expertise from others. I’m no computer expert, but just in looking at the world around us, whether banking or shopping or business, it seems inconceivable that it could be as complex as everyone is claiming to get a working system for signing up and paying for health insurance.
Yet I have been reluctant to support the call to ditch the entire Vermont system and take on the new costs connected to joining the federal system instead.
We’ve invested more than $200 million in it. Do we throw all that out, if we are truly in the home stretch of getting it to work correctly? Or do we stop digging ourselves even deeper into a hole that is a money pit, throwing good money after bad?
The Gartner consultant said we need to stop pouring money into trying to fix our current system, but that we should not jump to something new without having an independent analysis of the best long-term, sustainable system. We should continue to “limp along” with the existing system for several more months, without making large new investments trying to fix it, while doing an analysis of the “investment value” of what we already have and the costs of turning to other options. Some choices might allow us to use some of what we have already invested in, while also aligning with another system.
This makes sense. It is the same recommendation made earlier this year by Blue Cross Blue Shield of Vermont, which has had to pick up the pieces of many of the major failures of the current system.
What does not make sense is to have the Shumlin administration do that analysis, as his staff suggested!
At our press conference, both Senate and House members joined Lt. Gov. Phil Scott in proposing that we move ahead as quickly as possible with this analysis, but to place it under the authority of the Green Mountain Care Board instead of the administration.
I will be pushing for language in the current budget to make this happen.
We sent a bill to the House floor this week to have the Green Mountain Care Board identify all of the quality measures that require reporting from primary care doctors, and to develop a plan to reduce the burden while still monitoring quality.
We have both state and federal programs that demand data to assess whether they are effective or not, and obviously, it is vital that we not putting money into programs without assessing whether they work. On the other hand, we should be able to align some of these different measures so that we get the information we need with our doctors having to spend more time on filling out different reports than time with patients.
We are working on a bill to set state standards to protect consumers under the new “Accountable Care Organizations” that are now part of our health care system under federal Medicare. They will become an even bigger part if we develop a model where all the major payers (Medicare, Medicaid, and private insurers) agree to pay ACOs the same way, per patient instead of per individual service.
An ACO is a group of doctors and providers that contract for joint responsibility for patient care. We will likely end up with a single ACO in Vermont, given our size. Because they are expected to work to save on costs, there is good reason to worry about whether quality and access to care will be reduced.
We need stringent standards to require ACOs to deliver appropriate care and to have independent appeal mechanisms for anyone who feels necessary care is being denied.
A vexing problem we are confronting is ambulance service payments under Medicaid. The state sets these rates, and we current pay far below the costs of the service. The increase in the number of persons on Medicaid under Obamacare has meant that local ambulance services are losing even more money.
Who makes up the difference? You, in your property taxes. Ambulance services are generally town-run (in contrast to other health care), so the cost shift for underpayment goes straight to town budgets.
This is a problem across health care, where the costs are covered by private insurance reimbursements (and higher rates for private payers), but it is worse for our local rescue crews because it has been much longer since they saw any rate increases.
They only solution is to increase Medicaid payments, and there’s the rub. We already have a gap of tens of millions of dollars in the state budget, mostly caused by increases in the Medicaid budget. We are continuing to look into this, but haven’t found a way out yet.
In the House last week we passed the mandatory paid sick leave bill that will require all employers to eventually provide at least five days of sick leave per year. On its face, this seems appropriate, but the devil is always in the details.
The bill includes even tiny businesses trying to get off the ground with only a few employees; it covers employees who work even less than half-time (18 hours per week). “Sick leave” includes taking an extended family member for a doctor’s appointment, staying home with a child on a snow day, or going to court for a family abuse hearing.
These are all good things, but are a lot to place as a burden on the cost of doing business in Vermont, especially at a time when our economy is so fragile. We need to do everything to protect small businesses if we want to protect the jobs they supply.
Some have pointed out that some employers will simply be forced to reduce salaries to cover the overall cost of hiring added staff to cover those out on a sick day. That won’t really help anyone.
As a result of these issues, I did not support this bill.
Importing ivory has been illegal in the United States for decades, but an illegal market thrives on poaching of elephants. One way to help fight this is for states to make the sale of ivory illegal within their boundaries, and the House passed a bill this week to have Vermont join a number of other states in this ban. The bill now goes to the Senate.
Discussion on the House floor included one light-hearted comment, when a Republican got up to speak in support of the bill by reminding others that the elephant is the symbol of the Republican party.
“We need to protect the elephant population,” he said as he looked across the chambers at other members of the minority party. “We clearly need more here.”
Thanks for the honor of representing you! You can contact me or Rep. Patti Lewis by email (firstname.lastname@example.org for me; email@example.com for Patti) or by leaving a message at the statehouse at 828-2228. We welcome your feedback and input.