After a withering debate that stretched into the early morning hours Thursday, the House gave preliminary approval to the health-care reform bill.
A couple of Democrats – Rep. Cynthia Browning of Arlington and Rep. Timothy Corcoran of Bennington – broke ranks. But the 89-47 margin (14 lawmakers were absent) largely reflected the partisan divide over a bill that lays the groundwork for a publicly financed, universal system of care by sometime after 2014.
The debate often played out like a courtroom cross examination as Republicans peppered Rep. Mark Larson, chairman of the House Committee on Health Care, with scores of questions about the bill, namely: How much will it cost? And who’s going to pay?
“One of the things any human being is afraid of is change, without knowing what it means,” said Rep. Peter Fagan, a Rutland Republican. “Asking questions is very important.”
Larson’s inability to answer them, members of the minority caucus said, expose fundamental flaws in the health-care bill.
Larson though said Vermont knows enough about its current health-care system to know that drastic changes are needed. A rigorous analysis by a renown Harvard economist, Larson said, indicates Vermont could shave nearly $600 million annually from health-care costs under a single-payer system that delivers universal care.
He said he sympathizes with Republicans’ desire to have firmer projections on costs and financing. But he said the Legislature needs more time.
“We need specific information in order to develop an accurate financing plan,” Larson said. “We could speculate, but if we’re going to enact something into law, we need to do due diligence to make sure it’s right.”
House Republicans aren’t the only ones slinging arrows at H.202. In a widely distributed opinion piece, Lt. Gov. Phil Scott says the businesses with which he’s spoken have all voiced similar concerns.
“The bill makes no mention of how much this new system will cost, and I’m not comfortable agreeing to ‘buy’ something without knowing the price,” Scott said. “… With the health care bill as proposed, I feel as though we’re ordering a new car without knowing whether it’s a Yugo or a Rolls Royce, whether we can actually afford it, or whether we’ll even get what we need.”
In an open letter to legislators, Bea Grause, executive director of the Vermont Association of Hospitals and Health Systems, says her organizations, which represent all but one of the state’s hospitals, hasn’t taken an official position on the bill.
But administrators and doctors, she said, need answers to key questions before they can support the measure.
“For example, our members are concerned about the lack of essential detail on how Vermont’s new system will be financed and how providers will be paid,” Grause wrote.
The bill states that payments to medical professionals “must enable health care professionals to provide, on a solvent basis, effective and efficient health services that are in the public interest.”
Grause said hospitals support that concept.
“But given the State’s continued inability to adequately fund Medicaid,” she wrote, “we are very concerned with how fair and sustainable funding will be raised for a statewide health care system.”
The system envisioned in H.202, Larson said, can't be worse than what Vermont has now. Health-care costs have doubled over the past decade and will exceed $5 billion this year – nearly 20 percent of the state’s gross domestic product. Despite the massive infusion of resources into that industry, Larson said, 48,000 Vermonters lack insurance, and another 160,000, according to state data, are under-insured.
“We know the price tag of our current system,” Larson said. “And if we offered the system we have now, we would vote it down instantly.”
The bill is expected to win final approval on the House floor later this afternoon, after which lawmaker will take up the next big item – the budget.