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Rep. Alyssa Black, D-Essex, on the floor of the House of Representatives at the Statehouse in May 2023. File photo by Glenn Russell\/VTDigger<\/p>\nRep. Alyssa Black, D-Essex, on the floor of the House of Representatives at the Statehouse in May 2023. File photo by Glenn Russell\/VTDigger<\/p>\n
Referential treatment<\/p>\n
As the legislative session races to a close, there is a lot of hurrying up and waiting for bills to reach their final form.\u00a0<\/p>\n
In the healthcare world, one such bill, S.190<\/a>, would fast-track the Green Mountain Care Board\u2019s ability to reduce the amount that two insurance groups pay hospitals for services, starting next fiscal year.<\/p>\n In the House, the bill awaits a final look from the Appropriations Committee before going to the floor. A spokesperson for Gov. Phil Scott said the governor can\u2019t commit to whether he will sign the bill until it has reached his desk, but over the past few days, some in the Statehouse have raised concerns that Republican lawmakers may not support the bill, over concerns it might deprive hospitals of too much revenue or unfairly skirt rulemaking.\u00a0<\/p>\n Last year, the Legislature directed<\/a> the care board to bring down hospital prices through something called reference-based pricing, which aligns the amounts insurers pay hospitals with a percentage of some benchmark, usually Medicare\u2019s rates.<\/p>\n But to do that, the care board has to go through a long rulemaking process that won\u2019t be ready for primetime this year. (Oh, is the October start of the hospital budget year not primetime for you, too?)<\/p>\n So, this bill would give the care board the power to set those benchmark percentages for this coming fiscal year for two health insurance plan groups that are feeling cost pressure most acutely: public school employees (through the Vermont Education Health Initiative<\/a>, or VEHI) and individuals or small businesses who buy insurance from Vermont Health Connect<\/a>. This would go into place before the care board completes its formal rulemaking process, which would apply to what hospitals charge all insurance plans, and would give hospitals, insurers and stakeholders a chance to weigh in.<\/p>\n S.190 took a number of wonky turns to reach this point. Early drafts were much more prescriptive about percentage reductions in revenue the care board should include when it sets hospital budgets this summer.<\/p>\n \u201cI was like, \u2018Wait a minute, we\u2019re the Legislature. We\u2019ve already given this authority to the Green Mountain Care Board. Why is the Legislature inserting themselves in the hospital budget process?\u2019\u201d Rep. Alyssa Black, D-Essex Town, told VTDigger in an interview.\u00a0<\/p>\n Black introduced an amendment last week <\/a>that strips all of this down. Her version now just tells the care board \u201cgo forth and do,\u201d she said.\u00a0<\/p>\n From the start of the session, Vermont\u2019s hospitals have said they are capable of taking $50 million out of their budgets this coming fiscal year and $50 million the following year, balancing keeping costs affordable for patients and staying financially stable, said Devon Green, the vice president of the Vermont Association of Hospitals and Health Systems.\u00a0<\/p>\n Calculations in earlier versions of the bill blew past that $50 million that hospitals say they can absorb this coming year.<\/p>\n The Green Mountain Care Board already has the regulatory authority to set hospital budgets and the authority to set rate increases for insurance plans on the Vermont Health Connect marketplace. S.190 would give the board the ability to more narrowly direct the cost reductions it requires of hospitals \u2014 the board will not only be able to tell hospitals, This is how much you need to cut revenue, but also, These two plans are where you should specifically reduce revenue.\u00a0<\/p>\n \u201cI came to the session at the beginning saying, \u2018Do something in \u201927. Don\u2019t let \u201927 go by without taking a real tangible step in reducing prices,\u2019 and so this bill represents that,\u201d said Mike Fisher, the state healthcare advocate. It\u2019s frustrating that the rulemaking process takes this long, he said, but to him, the bill is a step in the right, more permanent direction.\u00a0\u00a0<\/p>\n In the know<\/p>\n In a largely symbolic move, the Senate voted Tuesday to repeal the Clean Heat Standard, a 2023 law aimed at reducing carbon emissions that come from heating and cooling buildings in Vermont. Senators tacked the language undoing the law onto a bill, H.740<\/a>, that would direct the Agency of Natural Resources to collect data from fuel dealers about the types of fuel they sell and where they sell it.<\/p>\n The 26-4 vote<\/a> doesn\u2019t change much in practice, as lawmakers have been in agreement since last year that work to develop the Clean Heat Standard would not advance during this biennium<\/a>. On the floor Tuesday, Sen. Anne Watson, D\/P-Washington, who chairs the Senate Natural Resources Committee, called removing the 2023 language \u201chousekeeping.\u201d<\/p>\n Still, the vote carries political significance because of the rhetorical role the Clean Heat Standard played in the 2024 elections that ushered in a wave of new Republicans to the House and Senate<\/a>. On Tuesday, Senate President Pro Tem Phil Baruth, D\/P-Chittenden Central, said as much.<\/p>\n \u201cThe Democratic majority \u2014 not the supermajority \u2014 the Democratic majority, post-election, is\u00a0 saying to you, \u2018Here. Here is the repeal you sought,\u2019\u201d Baruth told his colleagues.<\/p>\n The Senate\u2019s changes to H.740 are set to be considered on the House floor Thursday.<\/p>\n \u2014 Shaun Robinson<\/p>\n There has been a \u201crise of hateful, threatening rhetoric\u201d online in recent weeks centered on the push to roll back aspects of Act 181<\/a>, two House leaders said Wednesday.<\/p>\n House Speaker Jill Krowinski, D-Burlington, and Poultney Rep. Pattie McCoy, the chamber\u2019s Republican minority leader, said in a joint statement that they\u2019d seen \u201ctruly reprehensible\u201d social media posts and emails targeting Rep. Amy Sheldon, D-Middlebury, who chairs the House Environment Committee, where this year\u2019s headline changes to the 2024 land use law<\/a> have been hashed out.<\/p>\n \u201cThe Vermont Legislature is a \u2018citizen legislature\u2019 made up of Vermonters who work hard \u2014 on a part-time, seasonal schedule \u2014 to represent the voices and priorities of the people who elect them,\u201d Krowinski and McCoy said. \u201cThese personal, threatening attacks are unacceptable anywhere, and especially in Vermont, where we have a long history of civil debate and respectful dialogue.\u201d<\/p>\n \u2014 Shaun Robinson<\/p>\n On the move<\/p>\n Two committees of conference signed off on compromise versions of healthcare legislation on Wednesday. One is H.660<\/a>, which would direct how, in the upcoming fiscal year, the state should spend its share of settlement money with drug companies over the toll caused by prescription opioids. The other is H.816<\/a>, which would regulate the use of AI in mental health care<\/a>.<\/p>\n The joint committees\u2019 version of both bills will now head back to the full House and Senate for final approval.<\/p>\n \u2014 Shaun Robinson<\/p>\n On the Hill<\/p>\n