Health reform moves ahead
Toolbox
By JOHN ZICCONI Vermont Press Bureau - Published: April 9, 2005
MONTPELIER — A House committee composed largely of Democrats adopted a health-care reform plan Friday that restructures key parts of state government to lay the groundwork for a publicly financed, universal-care system.
The plan calls for primary and preventative care coverage for all Vermonters by July 2007, publicly funded hospital coverage by October 2007, and universal coverage for other medical needs no later than July 2009.
The proposal was immediately criticized by physicians, hospital officials and insurance executives because it calls for sweeping changes to Vermont's health-care delivery system without saying how much it would cost or what medical procedures would be covered.
Those decisions were put off until next year to allow lawmakers more time to meet with business leaders, health-care officials and residents to understand better what coverage level they desire and how much they are willing to pay.
"This is a big two-step," said Rep. John Tracy, D-Burlington and chairman of the House Health Care Committee. "This summer and fall is the time for people to have that discussion."
Gov. James Douglas, a Republican, did not wait to blast the proposal.
"When Vermonters take a good hard look at what the House Democrats are proposing, they're going to want a second opinion," said Douglas, who believes the plan will increase income taxes by 134 percent and lead to health-care rationing.
"This plan would dramatically raise taxes and put health-care decisions in the hands of politicians and government bureaucrats," Douglas said, "a prospect I fundamentally and unequivocally oppose."
Asked if he would veto the bill if it reached his desk unchanged, Douglas said, "I think I am sending a pretty clear message."
Douglas prefers a much less ambitious approach to health-care reform that focuses more on changes to the insurance industry, rather than creating new government programs.
The House Health Care Committee voted 9-2 in favor of the bill. Two of the panel's four Republicans — Christopher Louras of Rutland City and Joseph Baker of West Rutland — opposed the measure, which must be reviewed by at least one other House committee before advancing to the floor for debate.
The Senate must also approve the proposal.
Sen. James Leddy, D-Chittenden and chairman of the Senate Health and Welfare Committee, declined to offer an opinion because he had not read the bill. But those who represent Vermont physicians, insurance companies and hospitals criticized the measure.
"We cannot live with this," said Beatrice Grause, executive director of the Vermont Association of Hospitals and Health Systems.
Two weeks ago, Grause called an earlier draft of the bill a good first step.
"I'm concerned that the committee's approach uses overregulation," Grause said. "To control cost, health-care delivery has to be engineered. And that requires innovation, not more regulation."
The plan calls for the immediate reorganization of state government to create a Department of Health Care Administration that will oversee health-care regulation, planning and cost control.
Strategies include global budgets for hospitals that are capped at predetermined inflation rates and physician payments that limit the growth of health-care spending.
The goal is to lower Vermont's health-care growth rate from more than 12 percent annually to about 7 percent, committee members said.
The proposal calls for a special panel of House and Senate members to decide annually what medical services the public system will pay for. Private insurance, either personally purchased or supplied by an employer, would pay for services that are not included.
The plan does not spell out what public coverage would cost and which taxes would be used to pay for it, but committee members said a combination of income and a payroll taxes were the likeliest candidates.
The bill calls for a tax study to make exact recommendations. It also calls for an economic impact study to determine the effect raising taxes would have on employers, Vermont's business climate and the state's cost of living.
Physicians and insurance officials criticized the plan for setting implementation dates, promising universal coverage and ordering government reorganization before knowing what these impacts will be.
"Do the studies and find out what they say, then determine your direction," said Leigh Tofferi, spokesman for Blue Cross Blue Shield of Vermont, the state's largest health care insurance company. "There is no information right now that the new system will be an improvement."
House Speaker Gaye Symington, D-Jericho, defended the committee's approach.
"Vermont needs to move forward with this conversation and we can't do that without putting something on the table to react to," Symington said. "They have articulated a vision on where they want to go, outlined steps to get there and are inviting Vermonters to come and tell them what they think."
Baker, the West Rutland Representative who voted against the bill, said he had already heard enough from physicians and others to convince him the proposal was taking the wrong direction.
"What bothered me is I saw fear in some people's faces," Baker said.
"If we are willing to see fear in people's faces, we are doomed to fail."
Contact John Zicconi at john.zicconi@rutlandherald.com.
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