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H.202 Update 3/20/2011

The House Health Care Committee Passed H.202 late Thursday night on an 8-3 vote.   There were significant changes before passage.  Among other changes were two that I found significant enough to allow me to support the Bill.

First all references to “single payer” were removed and replaced with universal and  unified health care system.   The title of H.202 will become:  An Act Relating to a Universal and Unified Health Care System. This more accurately reflects what H.202 actually does and does not make a promise that we can not keep. 

The second major change is that on April 21, before the end of the current session, there will be a fiscal analysis by the Joint Fiscal Office of both the anticipated costs of the system and an analysis of the anticipated savings given the provisions of H.202.  Many of the cost factors are known.    H.202 sets a floor for benefit coverage at the level of current Catamount Health.  It states Legislative intent to keep cost sharing to 13%.  We know utilization from our all payer claims data base. We know how many new people will be included in the system.  The only real question is how much of the Hsiou savings will be realized given the parameters set forth in H.202.  The JFO analysis will be done before the anticipated end of the session this year.

The taxes that are likely to be used for financing the plan are listed in H.202.  What is not known is the mix of those taxes and more importantly what the Federal contribution will be.  We have no way to accelerate the decisions in Washington, but to know how much of the system will require financing from within the state is central to  telling people how much they will pay. 

Even with these changes H.202 is not the Bill I would prefer.  I would rather start with sound business plan and financial modeling which could be discussed and scrutinized first.  If the projected savings are real, the system should sell itself to the voters, business, and providers.   

I see both tremendous opportunity and tremendous risk here.  The opportunity is to provide health care coverage to all Vermonters.  We can and we must.  The risk is that we could drive both jobs and providers out of Vermont.  In my poll offered to all physicians with an active license in Vermont, presently with over 500 responses, there is an even split of those favoring and those opposing a single payer system. Yet  28% of physicians answer yes to the question : “ Would you be likely to stop practicing in Vermont if a government run single payer was enacted  in Vermont?”.    That would devastate access to health care regardless of insurance coverage.   The idea that physicians will pour into Vermont is pure speculation, based on no data whatsoever.   I believe if we get it right and it actually works as we hope for  4-5 years,  physicians may come to Vermont but physicians are largely a risk adverse group coming  out of school with a large amount of debt averaging around  $200,000.  Physicians will understand that once the system is in place the next time we face a large financial shortfall at the state level, there will only be two ways to reduce costs:  reduce utilization of services or reduce reimbursements.

On the question of jobs, some employers are likely to do better with the new system, others will find it more costly.  Large multistate companies with self insured plans have made it clear that want to continue to offer the plans they offer to employees nationally and will not support a system that forces them to pay a payroll tax in addition.  Even if we could force  them into our system  should we try because they may simply move jobs out of Vermont. 
H.202 will come to the floor Tuesday and if passed move on to the Senate.  We will see what changes are made there and whether I can continue to support the Bill.
george till 3/20/2011