Vermont Initiative for Universal Health Access

The burden of mandated healthcare	Survey finds many uninsured Vermonters remain that way
Legislative committees wrap up hearings, will turn to new bill

Lawmakers told public doesn't understand health care terms
By Ross Sneyd, Associated Press Writer | December 7, 2005

MONTPELIER, Vt. --Lawmakers already know how difficult it is to enact health care reform and a consultant offered them a potential reason why on Wednesday: Not everybody can agree on the terms used in the debate, let alone solutions to skyrocketing costs.

The House Health Care and Senate Health and Welfare committees spent a month this fall traveling the state discussing the issue in public hearings and in focus groups organized by the Snelling Center for Government.

The Snelling Center presented a report summarizing the findings of that "public engagement process" confirming what lawmakers largely already understood.

"The Legislature's task is not to design a new system that is theoretically the best that can be found, but rather through engagement with the public, to find points of common agreement and acceptance to make a better system of health care possible," the Snelling Center said in its summary. "At least in part, success will be due to the process that brings us to a better system, and through that process by the ownership of that system by the people it will serve."

The two committees met in six different communities, holding an evening public hearing in each and spending the day gathering information from various interest groups, including medical professionals, social service workers and labor.

Both from the general public and from the focus discussions with interest groups, the Snelling Center found that there is a sense of urgency for state government to develop a reform initiative that will control costs, preserve access to medical care when it's needed and guarantee that consumers have a choice of what doctors, hospitals and specialists they want to see.

But there is no monolithic consensus in just about anything, even among subgroups such as business or social service workers. They have varying attitudes about what ails the system and what needs to be done to fix it.

And complicating matters is that there are so many buzz words associated with the issue and no one really agrees on what some of the key ones mean or how they should be used.

Take universal access, for example. Lawmakers use that term all the time and generally mean they want to guarantee that when someone wants or needs to see a medical professional, they can.

There are broad interpretations associated with it, though, and one of the biggest things that many members of the public hear when they see the term is that the Legislature is talking about a government-controlled and funded health care system, also known as a single payer.

"Their strong expression of these assumptions offers an important lesson for legislators around why it is important to use exact language and explain terms no matter how straightforward and widely accepted we might think they are," the Snelling Center said.

Center President Jan Eastman said that demonstrated how much still needs to be done before health care reform can move forward. "I think it shows you've done a lot of hard work, but you're not done," Eastman said.

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The burden of mandated healthcare
By Scot Lehigh, Globe Columnist | December 6, 2005

AS MASSACHUSETTS debates how to extend healthcare coverage to the uninsured, one issue that's gotten short shrift is the impact of an employer mandate on a still sluggish state economy.

Amid widespread criticism of its theretofore leisurely pace, the House proposed its modified pay-or-play plan like a bolt from the blue on Oct. 31 and passed it three days later, leaving scant time for anyone to analyze its probable effects.

Under that legislation, any company with more than 10 employees would either have to provide healthcare or pay a 5 to 7 percent payroll tax.

The House adopted its basic approach from the proposal put forward by the advocacy group Health Care for All. John McDonough, the former state representative who leads that group, says the House proposal should help those businesses that already provide healthcare, because they will no longer have to subsidize healthcare costs for employees of companies that do not.

And as for firms that don't offer health coverage? McDonough contends that those employers can offset the new costs by raising prices some. Using Dunkin' Donuts as an analogy, he says that the price of a cup of coffee will simply go up a few pennies.

But that's a problematic paradigm, for several reasons.

For one, the state's principal business associations remain adamantly opposed to the policy prescription House leaders insist will prove salubrious for many of their members. They worry both about future increases if such a payroll levy is established and about putting small firms at a competitive disadvantage by adding more burdens in a state where the costs of doing business are already among the nation's highest.

''There are $350 million in new business taxes in the bill," says Rick Lord, president of Associated Industries of Massachusetts. ''It's not realistic to say that that won't have any effect."

Some dismiss those concerns as mere selfishness. Yet it's important to note that leading liberal economic thinkers also regularly cite the high cost of healthcare as one reason US companies like General Motors have become less competitive vis-a-vis international rivals.

Even if it were the case that all firms could simply hike prices to meet the new costs, this question would arise: If the public (as customer) is to bear the new costs anyway, is price the best mechanism for raising the money for healthcare?

But actually, the notion that all small businesses can simply pass the new costs along to customers overlooks the realities of a competitive business environment. Consider a small contracting firm. If that company is competing against people who do the same work as a sidelight or, in border areas, against companies from other states, Bay State firms won't be able to raise prices and remain competitive.

Rather, they will reduce wages. According to MIT economist Jonathan Gruber, that's what has happened with other business mandates. Over time, Gruber says, the healthcare requirement would result in lower relative wages at the newly affected firms.

There will be other effects as well. Enterprises at or near the trigger level of 11 would likely create subcontracting arrangements to avoid the mandate.

The situations are different, but Hawaii, the only state that currently makes healthcare an employer responsibility, has seen its own sort of avoidance, despite its splendid island isolation. Just as an example, a new analysis by the University of Hawaii suggests that some employers use part-time workers to avoid the 20-hour-a-week threshold that triggers the healthcare coverage requirement.

Second, compared to other states, fewer employees are working 20 to 25 hours a week, while more work above 35 hours, suggesting the employer mandate discourages the flexible employment some families crave.

Now, business climate isn't always a top concern in a heavily Democratic Legislature. Yet in a state where the recovery has been anemic, lawmakers need to pay those concerns more heed.

Paul Guzzi, president of the Greater Boston Chamber of Commerce, says the chamber, AIM, the Massachusetts Taxpayers Foundation, and the Massachusetts Business Roundtable will shortly unveil their own proposal to get the state to full coverage in three to five years. Guzzi wouldn't disclose details, but others say the plan is likely to endorse an individual mandate.

With relations between the House and Senate strained and with little progress reportedly being made toward a conference committee compromise, it makes sense for legislative leaders to wait and see just what the business community brings to the table.

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Legislative committees wrap up hearings, will turn to new bill

By Ross Sneyd, Associated Press Writer | November 1, 2005 | AP News Wire

BARRE, Vt. --Legislative health committees wrapped up their "public listening sessions" before a packed audience Tuesday and prepared to turn their attention again to drafting a new reform bill for the upcoming session.

As they have at their previous meetings, the lawmakers heard a wide variety of opinions about what needs to be done to fix what ails the health care system. They ranged from a ringing call for a European-style single-payer system to an equally passionate demand for government to get out of the health care business and let the marketplace correct itself.

Members of the House Health Care Committee and the Senate Health and Welfare Committee spent the day in Barre, meeting over lunch with members of the local chamber of commerce and through the afternoon with a variety of interest groups. They concluded their day listening to the views of the general public in the cafeteria of Spaulding High School.

The committees plan to gather as early as next week to begin sorting through the reams of information they've gathered, but it appears they'll be exploring many of the same approaches that they debated in this year's legislative session.

"We're not throwing out what we did before," said Rep. John Tracy, D-Burlington, chairman of the House committee. "We did a lot of good work."

Gov. James Douglas is working on a new health reform plan of his own, relying on a series of public hearings that he held and a summit last month in Killington. He has talked about working with legislative leaders to pass a bill early next year on the various initiatives on which they agree while debate continues on broader reform.

But the testimony in Barre demonstrated just how difficult it is to accomplish a comprehensive approach to health care. There is little consensus on what needs to be repaired and how to fix it.

Mary Alice Bisbee of Waitsfield spoke of the need to adopt a single-payer system, in which one entity administers and pays for all health care. She said it was the most sensible way of ensuring that everyone can get health care when they need it.

"I'm still wanting a universal system, not just universal access," Bisbee said. "We need to decouple (insurance) from employment."

But Steve Duke of East Calais believes that neither government nor businesses have a place in government. Instead, private citizens should be free to buy whatever health insurance they wish, just as they do for car or home insurance, and the state should back off many of the mandates that it's adopted over recent years.

"These legislators need to reverse what they've done," Duke said. "I believe if these legislators really want to do what's right, they'll get out of the insurance business completely."

The Snelling Center for Government, which helped the two legislative committees organize the listening tour, will spend the next month compiling much of the information that's been collected during the past several weeks.

Among the things that the legislators have learned is that there is a lot of confusion and misinformation about health care among the public.

"What we have found out is a lot of us know a lot about health care and a lot of what we know isn't true," said Sen. James Leddy, D-Chittenden, chairman the Senate Health and Welfare Committee.

So, he said, the committees would have to try to combat the myths and find a politically acceptable compromise. He told the crowd of more than 100 that they could help.

"We hope you'll sell the people of the state on the need for health reform," he said.

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Survey finds many uninsured Vermonters remain that way
October 26, 2005 | By John Zicconi Vermont Press Bureau | Rutland Herald

MONTPELIER — When Vermonters lose their health coverage they often remain uninsured for years — a fact that seems to have even those with health plans worried and looking to lawmakers to make significant changes to the state's health care system.

That was one of the prominent findings of a recent telephone survey conducted by AARP Vermont, a lobbying organization that is spending liberally to pressure Gov. James Douglas and the Legislature to reform the state's health system so it provides universal coverage.

"People want security that they will have health care that they can afford," said John Luehrs, AARP's national coordinator for health. "One reason I think they want health care for all is because all could include them in the future."

AARP in June contacted 1,000 Vermonters age 18 year and older, asking dozens of questions about health care and medical insurance.

The answers confirmed many things policy makers already knew, such as the largest percentage of Vermont's estimated 65,000 uninsured are between the ages of 18 and 34.

But the survey also disclosed something no one knew: More than half of uninsured Vermonters have been without health coverage for two years, and 40 percent have been uninsured for five or more years.

"That is actually stunning and alarming," said Senate President Pro Tem Peter Welch, D-Windsor.

"We know that employer-sponsored health insurance is declining, the Medicaid rolls are growing and the ranks of the uninsured are increasing," Welch said. "But the depth of the problem is more serious than I realized."

Legislative leaders said the survey will add to what is a growing "sense of urgency" among lawmakers that they must make health care not only more accessible but also more affordable.

"When people lose insurance it is gone for a long time," said House Speaker Gaye Symington, D-Jericho. "That creates a sense of insecurity even for those that have insurance. So this debate is not just about the uninsured."

Nearly 80 percent of those who took the AARP's 20-minute survey said it was "very important" or "extremely important" that Vermont reduce its number of uninsured, and more than 80 percent said it was either very or extremely important that health care is made affordable to all.

AARP officials said the survey cost more than $15,000.

The organization now plans to spend some $45,000 in the coming weeks to promote its results — all 120,000 Vermont AARP members will soon receive a mailing — and pressure policy makers to enact reforms that include universal coverage.

"Vermonters want everybody covered," said Gregory Marchildon, state director of AARP Vermont. "We are reminding people of the cause and asking them to join us in finding a solution to fixing the problem."

Marchildon said the survey shows people not only want universal coverage, but are willing to pay for it.

Although the survey concluded that about 75 percent of Vermonters worry about paying more for insurance, it also said the same percentage believe that everyone — employees, employers and the government — should contribute to the cost of providing "basic" health coverage for everyone.

The survey, however, did not define basic health coverage or ask people how much they are willing to pay, said Jason Gibbs, spokesman for Gov. Douglas.

"One question that was not polled is how do we provide universal coverage in a way that does not overburden already overtaxed working Vermonters and curtail our state's ability to support good paying jobs," Gibbs said.

"There are differences of opinion" on how to best do that, he said.

Marchildon said policy makers must forge a consensus.

"It is the job of state government, employers and citizens to talk about what can work," he said. "What Vermonters are saying is they want people covered and … they want a system that is fair end equitable to everyone."

Results of the survey, which has a 3.1 percent margin of error, can be found online at www.aarp.org/vt. Look under announcements. Other highlights include:

About 88 percent of Vermonters have health insurance, one of the highest rates in the country, but coverage varies depending on age and economic status. About 24 percent of those age 18-34 are uninsured, as are 22 percent of those with household incomes below $30,000. Some 17 percent of part-time workers lack insurance.

For those without insurance, 64 percent said they are uninsured because they cannot afford coverage, 12 percent said their employer did not offer coverage and 9 percent said they were not covered because they did not need insurance.

Nearly 60 percent said they were more likely to vote for a candidate who supports a health care system that provides the same basic coverage to all Vermonters.

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Vermont Initiative for Universal Health Access

EMAIL: wsavt@wsavt.com