"Scribblings" - An Occasional Newsletter from the Legislature 
By Rep. Thomas F. Koch Barre Town

Absent some real shenanigans in Washington (probably unlikely for practical political reasons) or a new-found working relationship between Democrats and Republicans (even more unlikely), the election of Senator Scott Brown in Massachusetts spells the death of health care reform in Congress.  That death will probably give new life to similar efforts in Montpelier.

The Senate health and welfare committee has already announced that it will be looking not at whether a single-payer system should be adopted, but rather how such a system would work.  And last week, that committee and the House health care committee held a joint public hearing attended by about 300 Vermonters, who expressed their views on health care reform.

Several bills have been introduced.  H. 100 (introduced by Rep. Obuchowski as principal sponsor, together with others) is essentially the same bill that has been introduced every two years for the last dozen years or so and would create a pure single-payer system.  H. 510 (Rep. Poirier) would create a "robust public option" that would be a governmentally operated insurance program designed to compete with existing insurance plans.  H. 512 (Rep. McFaun) would create a "global budget" for hospitals in an effort to control the growth of health care costs.  And the health care and appropriations committees will be considering changes to premiums, co-pays, deductibles, and benefits in the Medicaid and Catamount programs, including suggestions made by Governor Douglas in his budget address this week.

My own opposition to single-payer proposals is well known.  We already have a single-payer system for a large part of our population, and we call it "Medicaid!"  About 173,000 of the 630,000 residents of Vermont participate in some form of the Medicaid program.  Within that group, we have a limited public option system (available to people who meet certain qualifications, and now covering about 11,000 people), and we call it "Catamount Health."  And both of these systems are in financial trouble.

Medicaid seriously underpays providers—in many cases paying them far less than what it actually costs them to care for their patients—resulting in many providers refusing to take any new Medicaid patients.  Medicaid underpaid Vermont hospitals last year to the tune of $110 million.  Of course, the hospitals didn’t just eat this deficit—they shifted it onto private insurance such as Blue Cross and Cigna, thereby raising private premiums by about ten percent!  Now just think what would happen if there were no private insurance companies, and the only payer were a cash-strapped government, running a system that resembles Medicaid, but with nowhere to shift its unpaid bills.  The hospitals would be left with their deficits, and the quality of care would take a nosedive—less modernization, long waiting lines, corners cut, and doctors who leave Vermont for greener pastures!  Does that sound like something we want to adopt?

Catamount Health is a state-supported insurance plan offered by Blue Cross-Blue Shield of Vermont and MVP.  It is less expensive than purely private plans offered by those same companies, largely because its underwriting assumptions are based on a disproportionate share of its insured being young, healthy people.  But the plan has some financial problems for a number of reasons.  In his budget address, the governor proposed adjusting increasing deductibles and limiting some benefits in this program as a partial solution to the financial problems of Catamount. 

Topper McFaun gets kudos for offering the only bill that is truly based on the reality that, instead of just figuring out new ways of paying for ever-increasing costs of health care, we actually need to control those costs.  I disagree with Topper on the particulars of his approach, but it doesn’t matter, because the health committees are more concerned with "leading the nation" than developing practical solutions, and Topper’s bill isn’t going to get anything but cursory consideration.

Now, the saving grace is that both H. 510 and H. 512 would cost untold millions to implement, and the state doesn’t have any money!  So as people beat the drum with slogans such as "health care for all" and "health care is a human right," the reality is that these bills won’t really get serious consideration, because we can’t afford them.  Once the economy recovers and the state has money, my own position is simple: fix Medicaid first!!  Until we demonstrate that we can responsibly run the programs we already have, we have no business replicating them on a larger scale. 

Governor Douglas’ budget address this week was greeted with great caution and reserve, not the firestorm of partisan criticism that we have become accustomed to.  However, one comment that I can’t let pass without some response was made by Sen. Doug Racine, who was quoted as saying that the governor had "targeted Vermont’s most vulnerable’ citizens, who usually have no voice in the state house."

So let’s see:

            Vermont Association for Mental Health
            Vermont Legal Aid
            Community of Vermont Elders
            Vermont Coalition for Disability Rights
            Green Mountain Self-Advocates
            Vermont Parent Child Center Network
            Vermont Council of Developmental and Mental Health Services
            Voices for Vermont’s Children
            Windham Child Care Association
            National Association for the Mentally Ill (NAMI)
            Vermont Center for the Deaf and Hard of Hearing
            Northeast Kingdom Council on Aging
            Lund Family Center
            Vermont Network Against Domestic and Sexual Violence
            Boys & Girls Clubs of America
            Council on Aging for Southeastern Vermont
            Vermont Affordable Housing Coalition
            Housing Vermont
            Vermont Protection and Advocacy
            Vermont CARES
            Peace and Justice Center
            Central Vermont Council on Aging
            AARP
            Vermont Association of Adult Day Services

That’s an incomplete list of organizations that have registered lobbyists in the statehouse—people representing and giving voice to Vermont’s "most vulnerable:" children, the elderly, the homeless, those with low incomes, those with disabilities, people with mental illnesses, and others.  And many of these organizations and lobbyists are funded, directly or indirectly, in whole or in part, with tax dollars.

This is not to say that these people and their organizations should not be represented.  Many, indeed most, of these lobbyists do excellent work and provide valuable information to legislators as we go about our work, and I, for one, appreciate their efforts, even when I do not agree with them on a particular issue.  But to say that Vermont’s "most vulnerable" do not have a voice in the statehouse, as Sen. Racine said, is simply not true.

Nearly one quarter of Vermont’s voters now vote by early or absentee ballot, and with about 1,500 Vermont National Guard members deploying to Afghanistan this year, the number of Vermonters—military and otherwise—who will be eligible to cast absentee ballots from overseas is close to 10,000.  Everything we have done in recent years has encouraged people to exercise their right to vote, and certainly everyone wants to assist our troops to cast their ballots while they are overseas.

A new federal law requires that, unless a state receives a waiver from the federal government, absentee ballots must be sent to military and overseas voters at least 45 days before an election, to allow time for ballots to be mailed back and forth before election day.  With our primary election scheduled for September 14 and our general election set for November 2, there just isn’t enough time to get ballots printed and mailed in time to comply with the federal deadline, so the House Government Operations Committee is considering a bill to move the primary to the fourth Tuesday in August.

There are several reasons why this is a bad idea.  Nobody thinks about voting in August—people are still on vacation.  If they’re not on vacation, many are getting their children ready to go back to school.  August 15 is tax due day in Barre Town and in many other communities, and the town clerk’s office is busy with taxes at the same time that many people would be applying for absentee ballots for the primary.  A number of town clerks traditionally take the last week or two in August for their own vacations.  And the entire process relies on mailing paper ballots back and forth to overseas areas—an obsolete and unreliable process that has a history of producing lost and late ballots.

A better way is to use electronic means.  The Deputy Adjutant General of the Vermont National Guard testified by telephone that the military already has internet technology that allows secure transmission of pay and other personally sensitive information back and forth to places like the front lines of Afghanistan.  We are all familiar with the technology—many of us use it to make credit card purchases and do our banking by internet.  It seems to me it would be far better to use faster, modern, more reliable electronic technology to permit our military and overseas voters to cast absentee ballots than to inconvenience innumerable people by moving the date of the primary in order to hang on to the idea of mailing paper ballots back and forth.

I have offered the Government Operations Committee a couple of versions of amendments to permit overseas voting by secure internet, and the committee has postponed further action on the bill until the first week in February in order to obtain more information.

A second voting-related issue is a constitutional amendment that passed the House this week.  In short, it proposes that if a person will turn 18 by the date of the general election, he or she will be permitted to vote in the primary election as well.

I don’t see what it accomplishes, and I spoke against it.  Any time there is a deadline, someone will get caught in it.  This proposal doesn’t solve the problem of the 18-year voting age (if you call it a problem); it just pushes it around a little, and this is not a sufficiently serious matter to warrant amending our constitution.

The voters will make the final decision on this proposal in November.