The spirit of order and compromise was upon them. The Vermont Senate passed the universal health care reform bill in a 21-8, largely along party lines on Monday, after just five hours in the Green Room. (Kevin Mullin, R-Rutland, voted aye; Bobby Starr, D-North Troy, voted nay.The senators will take up the bill for third reading on Tuesday.
The Dems evinced no intra-party dissension on the controversial legislation on second reading. Most of the naysayers, this time, were of the GOP persuasion. And except for an unanticipated, hour-long oratory from freshman Sen. Joe Benning, R-Caledonia, (reminiscent of declamations from his Republican colleague in the House, Rep. Duncan Kilmartin, R-Newport) the Senate floor work seemed to go off without a hitch.
Senate President Pro Tem John Campbell seemed to breathe a sigh of relief today with the initial passage of one of the most complicated and controversial bills to go through the Legislature — since the last reform effort in 2006. The stress of passing all the money bills in late night sessions last week took its toll — by Thursday, his troops were in mutiny mode. With a little holiday rest, the senators seemed to be in a conciliatory mood on Monday — despite the grumbling over adding a day to their normal Tuesday through Friday schedule.
“I’m proud of my colleagues,” Campbell said. “They rose to the occasion.” Campbell said the Senate’s passage of several amendments from the minority party shows senators’ “tremendous collaborative efforts.”
Sen. Peter Galbraith, D-Windham, praised the pro tem for his willingness to shepherd complicated amendments through the obstacles in the process.
“I thought this was historic (the health care reform bill),” Galbraith said. “When I contemplate the federal scene nothing gets done — that’s why I wanted to be in the Vermont Senate.”
There are a few more bridges to cross, however, before the bill is sent to conference committee and Democratic senators can break out the champagne — namely a total of 11 amendments to be considered, several of which are technical in nature, others that are unfriendly.
In fact, the amendments addressed by lawmakers as the bill went through second reading were the no-brainers. Of the seven that were taken up, five were withdrawn and two were friendly amendments that were approved in advance by the Senate Health and Welfare Committee. One of the amendments includes more detailed conflict of interest requirements for Green Mountain Care board members. The second makes members of the military who have insurance through TRICARE exempt from the Green Mountain Care system.
The amendments are to be taken up on Tuesday, starting with a proposal from Galbraith to form a Vermont Health Insurance Corporation, or public option for insurance. Most of the changes, however, revolve around questions of access (will people move here in droves to take advantage of the state’s single-payer system?), questions of cost (will companies pay more for care than they do now?) and concerns about the financing mechanism which wouldn’t be revealed until 2013, after the next election cycle in 2012. (Sen. Randy Brock, R-Grand Isle/Franklin, wants the Shumlin administration to report on financing plans by Sept. 15, 2012.) A proposal from Sen. Vince Illuzzi would exempt employers with 50 to 100 workers from the exchange.
The debate on the floor was less about the specifics outlined in the amendments, and more about the underlying bill. Republicans raised fundamental philosophical objections to the idea of a single-payer system in which the government administers payment for health care.
Sen. Claire Ayer, D-Addison, opened the debate with a description of a system with inadequate access for Vermonters, a lack of preventive care, no central agency for controlling costs, and a propensity of the state to produce study after study with no results. That description published in the Burlington Free Press, she said, was of Vermont’s medical system — in 1929.
“We certainly can’t be accused of rushing this decision,” Ayer said. Health care is 18 percent of Vermont’s gross state product; more than 200,000 residents are uninsured or underinsured, she said.
Ayer cited a study produced by the Vermont Joint Fiscal Office, Steve Kappel, a health care fiscal analyst, and the Department of Banking, Insurance, Securities and Health Care Administration. “The math works,” Ayer said. “Combined with funds from the Affordable Care Act, cost savings are possible in the health care system. This is a $1 billion opportunity that can’t be missed.”
In an impassioned pitch to her colleagues, Ayer said, “We spend more per capita (for health care) on the planet and we don’t get the best care. This is our opportunity to control costs and improve quality.
“We’re behind the health care eight ball,” Ayer said. “We must reposition ourselves if we want to remain competitive as a state.”
The GOP critics in the Green Room disagreed. Brock urged the senators to reject the bill. He said this legislation “comes down to the nine most dangerous words” that can be uttered: “I’m from the government and I’m here to help.”
Brock blamed the federal and state governments for increasing the cost of health care through regulation, interference and bad policy. He compared the Shumlin administration’s push for “fewer payers” or insurance companies to forcing consumers to go to one “supermarket where the amount of eggs we could buy would be rationed.”
The legislation brings up many fundamental questions that go unanswered for years, Brock said, at the same time the Shumlin administration is advancing a plan. “We’re establishing a structure, a pathway like cattle being herded to the slaughter, walking down a chute that gets narrower as we go. At some point in the chute, we won’t be able to turn around.”
Brock said the Green Mountain Care Board will have too much power because it will be able to make decisions about rates for providers, benefit plans, financing and payment.
Furthermore, Brock argued, why should Vermonters trust lawmakers to move forward on this next iteration of reform when previous efforts have failed? He listed Catamount Health and Medicaid as programs that have been unable to control costs.
Perhaps most troubling to Brock, was the notion that the reporting period would be put off until January 2013 — two months after the next election.
“I sense that in the next election health care is going to be a major issue and it will be something people will want to vote on,” Brock said. “Answers aren’t going to be addressed until after the next election.”