Category Archives: Health Care

Capitol Beat with the Governor 3-27-15

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Gov. Peter Shumlin chats with Vermont Press Bureau chief Neal P. Goswami about the health care package in play in the House, new unemployment numbers and gun legislation that cleared the Senate this week.

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Proposed health care bill could see cut in funding

MONTPELIER — Lawmakers are considering a scaled-back health care bill that strips out a proposed payroll tax.

The House and Ways Committee is looking to fund a proposed health care bill with $20 million in revenue, a far cry from the $52 million in revenue proposed by the House Health Care Committee.

“I think it’s safe to say that the figure we come up with will be less than the figure the Health Care Committee came up with,” said Ways and Means Chairwoman Janet Ancel, D-Calais. “If that’s true, we’re going to ask the Health Care Committee to reorder its priorities to decide how best to spend it.”

Earlier this month, the House Health Care Committee approved a bill that included a 0.3-percent payroll tax, as well as a 2-cents-an-ounce tax on sugar-sweetened beverages, which, together, would generate $52 million in revenue.

The bill itself was borne out of a proposal from Gov. Peter Shumlin, who proposed implementing a 0.7-percent payroll tax to close the gap between how much Medicaid reimburses doctors for services and how much those doctors charge private insurers. Shumlin argues that boosting the amount paid by Medicaid will result in lower premiums for individuals with private insurance.

Shumlin’s proposal came after his decision in December to — either permanently or for the moment — shelve his single-payer health care plan.

“We’ve been looking at the bill that the House Health Care Committee voted out, both looking at the spending part and looking at how the revenue will be raised, and I think there is, just speaking for myself, there are initiatives in the bill that I would like to be able to accomplish,” Ancel said. “Certainly, the investment in the cost sharing, the increased reimbursement for primary care, are things that the heath care bill attempts to put in place. The challenge, always, is how do we raise revenue for it?”

Wednesday afternoon, House Health Care Committee members discussed proposals that would reduce the amount of money to address the so-called “Medicaid shift” that would close the reimbursement rate gap between Medicaid and private insurers.

Rep. George Till, D-Jericho, proposed amending the bill from House Health Care that would do away with the payroll tax altogether, and would impose a 0.75-cents-an-ounce tax on sugar-sweetened drinks. Till also proposed eliminating the exemption for candy from sales tax.

Rep. James Masland, D-Thetford Center, said that reducing the sugar-sweetened beverage tax to 0.5 cents an ounce could still raise $20 million.

Rep. Alison Clarkson, D-Woodstock, said the direction the committee will take on the bill is still very much up in the air.

“There are three questions before this committee: Do we want to spend money on health care? How much do we want to spend? And, if we want to spend money, how do we want to raise it?” said Clarkson, who later said she supported the $20 million figure.

Ancel said that, should her committee decide to reduce the amount of revenue as proposed, it would be up to the House Health Care Committee to decide how that money should be spent.

The House Ways and Means Committee is expected to take up the health care bill Thursday.

Shumlin says fed exchange possible if latest deadlines missed

MONTPELIER — The Shumlin administration will scrap Vermont Health Connect and pursue joining a federally-run health insurance market later this year if technology upgrades needed for the state site are not working by October, Gov. Peter Shumlin announced Friday.

Shumlin, in an interview Friday, said his administration would legislative language to the House Health Care Committee Friday afternoon that will codify the administration’s contingency plan. Shumlin said he expects the state’s contractor, Optum, to complete the so-called change of circumstance function by the end of May, as well as the necessary technology for individuals to enroll in insurance plans through the website by early October.

Should Optum not deliver, the state will begin pursuing a move to a Federally-Supported State-Based Marketplace for the 2017 open enrollment period, Shumlin said. The federal government provides three exchange marketplace options, all of which use the healthcare.gov web platform and federal call center.

But the FSSBM option would allow states to maintain the most authority over health plans, officials said. A bipartisan group put forth a similar idea earlier this year.

Listen to Gov. Peter Shumlin discuss the plan here.

A full story will appear in Saturday’s editions of the Barre-Montpelier Times Argus and Rutland Herald.

Capitol Beat with the Governor 3-20-15

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Gov. Peter Shumlin and Chief of Health Care Reform Lawrence Miller discuss the administration’s new self-imposed deadlines for Vermont Health Connect. Failure to deliver working technology will result in the state pursuing a transition to a federal health insurance exchange.

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Toxins debate reignited in Senate

MONTPELIER — A host of industry representatives are pushing back against language inserted into a Senate health care bill late last week that would alter a 1-year-old law that looks to regulate toxic products in commercial products.

The Senate Health and Welfare Committee heard testimony from several people Wednesday looking to scrap the language added to S.139 on Friday. It would make changes to Act 188, which was signed into law last year by Gov. Peter Shumlin following an arduous back-and-forth process that was finalized in the waning hours of the previous biennium.

The law created a reporting mechanism for manufacturers that use certain chemicals in children’s products. Beginning in July of next year manufacturers that use chemicals designated by the state as “chemicals of high concern to children” must disclose information about those chemicals to the Department of Health.

It also created the Chemicals of High Concern to Children Working Group that would make recommendations to the commissioner of health about regulating designated chemicals.

But an amendment to S.139 approved by the committee Friday would make significant changes to the law. It would allow the commissioner of health to add chemicals to the list through rule making based on “credible, scientific evidence,” removing language in the law that calls for “the weight of” such evidence to be considered.

Opponents of the change say it could allow a single study to form the basis for regulating a chemical.

It would also change the authority of the working group. Instead of allowing the commissioner of health to adopt rules regulating the sale or distribution of children’s products containing such chemicals “upon the recommendation” of the working group, the commissioner could act “after consultation” with the group. It diminishes the oversight and purpose of the group, which includes members with varying viewpoints.

The amendment would loosen the standard for allowing the commissioner of health to act by changing the threshold from “children will be exposed” to “there is potential for exposure.”

And it also removes language calling for “a probability” that exposure or frequency of exposure to such chemicals could cause or contribute to adverse health impacts before the commission of health could act.

Several industry representatives, including William Driscoll, vice president of Associated Industries of Vermont, testified Wednesday against the changes.

“We are very concerned about the proposed amendments to that statute, even as it is being implemented,” Driscoll said. “We feel that however well-intentioned, the amendments … are unwarranted and actually undermine the statute.”

Allison Crowley DeMag, a lobbyist representing the American Chemistry Council, said the language undermines the process undertaken last year to craft Act 188. The law that was eventually enacted represented a deal, she said, and the amendment seeking to change it would “undue what was a very collaborative effort last session.”

Allison Crowley DeMag

Allison Crowley DeMag

“At the end of the day, everyone in this room, as far as I know, we all gave some, we all won some, but we all came to a deal. Part of that deal was implementing this working group that represented all different types of interests,” she said.

Crowley DeMag urged the committee and others supporting changes to the law to allow the law to be enacted as passed last year.

“The working group hasn’t even been appointed yet and here we are undoing what I thought was a very collaborative effort last session. I’m just really disappointed in the process,” she said. “If the chemical industry had come out and done something like this I know people would be very, very concerned about it. I think that we should just go forward with what we did last session, whether we liked it or not, and just move ahead with the process as it was outlined last session.”

Representatives of IBM and the Personal Care Products Council also testified against the amendment, while representatives from Seventh Generation and Vermont Conservation Voters testified in favor of the changes.

Sen. Ginny Lyons, D-Chittenden, vice chairwoman of the committee, said she is looking to make changes because of potential legislation in Washington that might undercut the state’s ability to regulate chemicals. Changes under consideration to the federal Toxic Substances Control Act could prevent the state from strengthening its law in the future, she said.

“We heard that the Congress is acting on TSCA to make changes which would hold states exactly where they are with respect to chemical regulation, or preempt us altogether, which I hope wouldn’t happen,” she said.

Lyons also said she is looking to enact language the Senate passed last year that was removed by the House before it became law. Because the session was ending, the two chambers did not go to a conference committee and the Senate had to settle for the House version, she said.

“We wanted to approve the language that was passed in the bill last year to ensure that our department of health can do its work,” she said. “This opens a conversation that we were unable to have last year because the bill went right up to the end.”

Driscoll said the there is no need for the state to rush because the changes being considered to the federal law would preempt state actions taken after Jan. 1 of this year. And the federal legislation is not focused on the “procedural matters” addressed in the committee’s new language, he said.

“Arguments that these amendments must be rushed into enactment to avoid federal preemption are without factual basis,” he said.

Others see the issue differently, including VPIRG. Executive Director Paul Burns said there was never a deal in place to pass the law.

Paul Burns

Paul Burns

“Right up until the end the industry lobbyists were opposing it and were opposing the Senate for suspending the rules to take it up. This notion that there was a deal, and certainly a deal that included an understanding that nobody would ever come back to try to change the law, that just doesn’t exist. That’s just a fantasy,” Burns said.

He said the “modest changes” added to S.139 are intended “to make a law that is designed to protect kids from toxic chemicals a little more effective.”

If changes are made to the federal law the state would be prevented from taking any action against chemicals that the federal Environmental Protection Agency considers regulating for a seven year period, Burns said.

“It puts it on list, so seven years later they may decide to regulate or they made decide not to. In all that time we would be prevented from taking any action,” he said.

By acting now, the state may be allowed to continue to regulate chemicals at the state level, depending on what Congress passes, according to Burns.

“That could be grandfathered in … if we could make it happen soon enough,” he said.

There are differences of opinion within the committee’s 5-member ranks. Sen. Dick McCormack, D-Windsor, said he believes the committee’s amendment is “superior to the language that’s in the law.”

However, McCormack also said he believes “a deal is a deal,” and making changes now could hinder future efforts to craft collaborative policy in the future.

“If a deal was made I’m reluctant to just say, ‘Well, it was a bad deal so now we’re going to make a new deal,’” he said. “I’ve got to roll this one around in my mind for a little while.”

Lyons challenged his position.

“So we’d never change a law again? I’m going to push you on that one,” she said.

Lyons said the Senate’s position last year was abandoned because of the time crunch.

“The deal, as it left the Senate, was all consumer products were being regulated. That was a deal I felt very firm about,” she said. “Some of the changes that were made in the House, I think, have been identified here as being problematic.”

First-term Sen. Brian Collamore, R-Rutland, indicated he supports keeping the existing law as is.

“I do think that you had disparate parties brought together. There was concession on both sides, an agreement was reached and Act 188 was passed,” he said. “You haven’t allowed the process to work yet.”

Meanwhile, Sen. Anthony Pollina, P-Washington, indicated his willingness to amend the law. Committee Chairwoman Claire Ayer, D-Addison, was absent Wednesday due to a family emergency.

The committee is expected to make a final decision on whether to seek changes to Act 188 this week.

neal.goswami@timesargus.com

Capitol Beat 3-16-15

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Vermont Press Bureau reporter Josh O’Gorman and bureau chief Neal Goswami discuss guns, a sugar tax, new budget proposals and education in this week’s episode.

Capitol Beat with the Governor 3-13-15

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Gov. Peter Shumlin chats with Vermont Press Bureau Neal P. Goswami about a House Health Care Committee bill, the state budget and gun legislation.

Proposed sugary drink prompts debate

MONTPELIER — Business and health advocates are squaring off over a proposed tax on sugar-sweetened drinks.

Wednesday morning, the House Ways and Means Committee took testimony on a proposal that would add a 2-cent-an-ounce excise tax on beverages with added sugar. Advocates claim the tax would raise as much as $34 million in state revenue while curbing rising obesity rates, while opponents say the tax will hit poor people the hardest and will drive Vermonters over the boarder into New Hampshire to shop.

What was a theoretical discussion in the morning took on more weight in the afternoon, when the House Health Care Committee approved a bill that included the proposed 2-cents-an-ounce tax, and a .3 percent payroll tax, as a way to boost Medicare reimbursements.

Dr. Barbara Frankowski,M.D., professor of pediatrics at University of Vermont Medical School, discussed trends in sugary drink consumption, saying consumption in the United States has risen 500 percent during the past 50 years.

Frankowski and other medial professionals argue that the rise in sugary drink consumption is a driver in childhood obesity rates, which in Vermont have risen from 11 percent in 1990 to 25 percent today. Frankowski noted that in the ‘90s, children began consuming more sugary drinks than milk.

“Children who become overweight tend to remain overweight for the rest of their lives,” Frankowski said.

Jane Kolodinsky, a professor of economics at UVM, argued that, with the exception of the Irish Potato Famine from 1845 to 1851, an increase in price will always lead to a decline in consumption and said the proposed tax would lead to people drinking fewer sugary drinks.

“An excise tax will work,” Kolodinsky said. “It will reduce demand.”
Opponents argued that an excise tax, which is not visible to the consumer in the store, will drive consumers to shop elsewhere, including over the border in New Hampshire.

“My customers will not see this tax on their price register receipt,” said Pam Trag,co-owner of Quality Market in Barre. “What they’ll think is, ‘Wow, your prices have really gone up and we’re going to shop somewhere else.’”

Rep. James Condon, D-Colchester, suggested that retailers would not apply the tax directly to the sugary drinks, but would spread the added cost over all of their products. Kevin Dietty, who has lobbied on behalf of the beverage industry for 29 years, said small stores, which have fewer products to spread the tax across, would feel the impact the most.

Jim Harrison, president of the Vermont Retail & Grocers Association, argued that the tax would be regressive.

“It penalizes people with the least money,” Harrison said.

“We cannot tax people into eating brussel sprouts,” Harrison continued. “Where do you draw the line? Do you tax all products with sugar? Do we tax salt? Do we believe, that through taxation, Montpelier knows what is best for us?”

Rep. Alison Clarkson, D-Woodstock, responded to Harrison’s remarks. She noted the public health costs of obesity, which nationwide topped $150 billion in 2014, half of which was paid for by public insurance programs, according to Frank Chaloupka, Professor of Economics, University of Illinois at Chicago.

“Montpelier is paying a wad for obesity right now,” Clarkson said. “Montpelier is concerned about the cost of obesity because it costs us all.”

Senate fends off effort to repeal aid-in-dying law

MONTPELIER — The Senate gave preliminary approval Wednesday to legislation that prevents safeguards in the state’s aid-in-dying law from expiring after fending off a spirited attempt to repeal the 2013 law that allows terminal patients to obtain lethal medication to end their lives.

Under the current law, patients who want to obtain lethal medication must be a Vermont resident and have a terminal diagnosis with a prognosis, according to two doctors, of less than six months to live. A doctor must also find that the patient has the capacity to make the decision to obtain the medication voluntarily. And, the patient must make two oral requests at least 15 days apart followed by a written request with two witnesses attesting that the request was made voluntarily.

But those steps, based on a landmark Oregon law, are set to expire in July 2016 if the law is not amended. That’s because two former senators who did not seek re-election last year — Peter Galbraith of Windham County and Bob Hartwell of Bennington County — insisted those safeguards sunset in exchange for supporting the law.

Sen. Claire Ayer

Sen. Claire Ayer

Senate Health and Welfare Committee Chairwoman Claire Ayer, D-Addison, is spearheading the effort to amend the law to ensure those provisions remain. Legislation to do that hit the Senate floor Wednesday and was approved on a voice vote.

“It was our opinion, based on testimony, that safeguards need to be in place,” she said.

Ayer said Attorney General William Sorrell informed her committee that there have been no investigations of abuse or coercion, which the safeguards aim to prevent, because of the law. And the Department of Health reported that the law is working as intended, she said.

Ayer also said family members of patients who have utilized the law — six patients have initiated the process and at least three have taken the lethal medication — support retaining the safeguards.

The safeguards do not expire until next year, but Ayer said she wants the Senate to act now.

“We don’t want to risk it getting caught up … in the end of the biennium swirl next year,” she said.

Voting in favor of keeping the safeguards is not a vote in favor of the law, but “a vote to protect the interests of your constituents.”

Sen. Kevin Mullin, R-Rutland, made a motion to postpone action on the bill until January 2016 to allow lawmakers more time to consider the law’s impact. That motion was rejected on a voice vote.

“This is a painful issue,” Senate Majority Leader Philip Baruth, D-Chittenden, said. “The pain is not eased in any way by delaying what we’ve set out to do.”

The debate Wednesday was much shorter than the debate in 2013 when the underlying law passed by a thin margin. But there was still passionate debate.

Sen. Norm McAllister, R-Franklin, who sponsored an amendment Wednesday to repeal the 2013 law, said his wife died a year-and-a-half ago of a painful disease that “eats you alive.” But his wife relied on available palliative care, McAllister said.

“There were days that were very bad, but we worked through those,” he said. “I had to deal with that.”

His amendment failed by a 12 to 18 roll call vote.

McAllister said government should not be involved in how and when people die.

“Seeing what the palliative care is in this state and the comfort they give you and the support they give the families, I don’t think this bill is necessary and I think it sends a real bad message that we’re letting government involved in decisions that need to be personal,” he said.

McAllister also said many doctors in his district are opposed to the law.

Ayer conceded that some doctors are opposed to the law, but they are not forced to write prescriptions if they are opposed, she said.

“A lot of health care providers have a problem with it, that’s why it’s completely voluntary,” Ayer said.

Sen. Dick McCormack, D-Windsor, said the 2013 law created a right for Vermonters and repealing the law would be “an extreme act and it ought to be done with the utmost caution.”

“The amendment to repeal the bill undoes an existing right. That is a weighty and unusual step for the Legislature,” he said. “It’s done, but it’s done in extreme circumstances.”

Rutland County Republican Sen. Peg Flory said the state should not be sending a message to residents that it is OK to end your own life.

Sen. Peg Flory

Sen. Peg Flory

“I think it’s bad policy when the state tells people that it should be a viable alternative, that some lives you ought to consider ending,” she said.

Flory sponsored another amendment that would prevent doctors who prescribe medications to patients for symptom relief of terminal illness that are then used by a patient to end their lives from facing any criminal or civil liability or professional disciplinary action. It also sought to repeal the aid-in-dying law. It failed on a 10 to 20 roll call vote.

Lynne Cleveland Vitzthum, who represents the Vermont Center for Independent Living, has played a leading role in the effort to repeal the law. Vitzthum, who has a son with disabilities, said Wednesday following the votes that she expects future challenges to the law.

“It’s certainly not settled for the future. As I’ve said before, this issue is never going to go away,” she said.

The legislation is up for final approval in the Senate Thursday before heading to the House.

neal.goswami@timesargus.com

Video: City Room with Steve Pappas

Barre-Montpelier Times Argus Editor Steve Pappas discusses a proposed payroll tax with Gov. Peter Shumlin and Chief of Health Care Reform Lawrence Miller.

City Room with Steve Pappas: Gov. Peter Shumlin & Lawrence Miller, Cost Shift on Health Reform from Central Vermont Television on Vimeo.

Vermont health chief: Exchange cost pushes $200 million

MONTPELIER, Vt. (AP) — Vermont’s health care reform chief says the cost of the Vermont Health Connect health insurance exchange is projected to grow to nearly $200 million, and he says a key part of the system won’t be functional for the foreseeable future.

Lawrence Miller’s comments to the House Appropriations Committee on Tuesday drew tough questions from committee members. Some noted the money being spent on the exchange is made up of federal, rather than state dollars, but questioned the system’s long-term sustainability.

The system still isn’t able to enroll employees of small businesses whose employers pay for health coverage. Meanwhile, its duties are scheduled to expand to include medium-sized businesses, those with between 50 and 100 employees.

Capitol Beat 3-9-15

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Barre-Montpelier Times Argus Editor Steve Pappas sits down with Vermont Press Bureau chief Neal P. Goswami to talk about town meeting, Gov. Peter Shumlin’s troubles selling his payroll tax plan, a renewed aid-in-dying debate and AHS Secretary Hal Cohen.

Capitol Beat with the Governor 2-20-15

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Gov. Peter Shumlin and Vermont Press Bureau chief Neal P. Goswami discuss his effort to obtain an “all-payer waiver,” efforts to find savings in labor cuts and the Vermont Veterans Home.

New poll touts support for removing philosophical exemption

MONTPELIER — A new poll commissioned by a pro-vaccine group shows that 68 percent of Vermonters do not believe parents should be able to opt out of vaccinating their children through the philosophical exemption in state law.

The poll, commissioned by Every Child By Two, a national nonprofit group that advocates for vaccinations, also found that 73 percent of Vermonters support efforts to change the law. The poll of 880 Vermonters was conducted by Gravis Marketing on Feb. 9 and 10. It has a 3 percent margin of error.

Every Child By Two Executive Director Amy Pisani said the results of the poll “are a clear indication that Vermont needs to take swift action to ensure that all of its kids are protected from dangerous and preventable diseases.”

“When nearly three-fourths of the residents in a state believe there should not be a philosophical exemption for vaccines, it’s time to change the law,” she said.image015

The poll could spur action on legislation introduced by Republican Sen. Kevin Mullin of Rutland, which seeks to remove the philosophical exemption. The state also allows for medical and religious exemptions, but the philosophical exemption accounts for most of the exemptions in Vermont.

Mullin proposed similar legislation in 2012. It cleared the Senate but the House, faced with strong opposition from a coalition of people advocating for parents’ rights, did not advance the measure.

Data from the Vermont Department of Health has shown that the percentage of unvaccinated children has risen in recent years.

image018Gov. Peter Shumlin has said he believes all Vermont children should be vaccinated, but he does not favor changing the state’s exemption law to eliminate the philosophical exemption. The poll found that 70 percent of Vermonters do not favor the governor’s position.

The Vermont Coalition for Vaccine Choice and other anti-vaccine groups are again expected to wage a strong campaign against Mullin’s legislation. But this year, the Vermont NEA, the state’s largest union that represents teachers across the state, has decided to come out in favor of the bill.

Read the poll questions and data below:

Big health care change is still in the air

MONTPELIER — The quest for a single-payer health care system was sidelined, at least for now, by Gov. Peter Shumlin, late last year. But another effort to dramatically transform the state’s health care system remains very much alive.

Shumlin, a third-term Democrat, shelved his own long-sought proposal for a publicly financed health care system in December, saying it was too expensive at this time. But he is continuing to push for a parallel goal to change the way health care services are paid for in Vermont.

His administration is seeking an all-payer waiver from the federal government that will eliminate the current fee-for-service payment model that pays providers for each procedure.

In Vermont, like all states except for Maryland, government health programs like Medicaid and Medicare pay vastly different amounts than private insurance does for medical procedures. Shumlin hopes to obtain a waiver from the federal government that will allow the state to set the same rates for all insurance plans within individual health systems.

It’s a monumental undertaking that is at the opening stages.

“We’re at the beginning,” said Lawrence Miller, chief of health care reform. “We’ve had conversations with CMS (the Centers for Medicare and Medicaid Services). We’re really just beginning the formal process.”

Miller said the current health system rewards providers for performing more procedures. But the procedures are not always in line with the best health outcomes for patients.

“They’ve got to have a certain amount of service to get a certain amount of fee. Otherwise they can’t keep the lights on,” Miller said.

“So much of health care, the way we deliver it, is a fixed cost,” he said. “You’ve got a building. You’ve got people in so many hours a week. The fact that you’ve got 35 versus 40 patients in a week doesn’t really change your costs. It has a major impact on your revenue.”

If Vermont obtains the waiver from the CMS, all insurance plans will pay the same amount and providers will be have an incentive to work collectively to have the best health outcome that is not paid for based on the number of tests and procedures performed, Miller said.

“They’ve got a real combined interest to drive to best outcomes for people and avoidance of acute care, because then, overall, it does save money,” he said.

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