by Morgan True vtdigger.org The House Health Care Committee is working this week on revisions to a Senate-passed health care reform bill, S.252, which is likely to see significant changes before it hits the House floor.Much of the bill focuses on requirements that the Shumlin administration furnish legislators with information they need to craft laws defining the contours of Green Mountain Care, Vermont’s planned universal health care program.The Vermont Workers’ Center sponsors a Health and Diginity Rally in the Cedar Creek Room of the Vermont Statehouse in Montpelier on opening day of the 2014 legislative session. Photo by Roger Crowley/for VTDigger“We’re trying to identify information points that we don’t have answers for at this point,” said Rep. Chris Pearson, P-Burlington, explaining the overarching goal of the legislation.But there are substantive policy proposals that will impact the implementation of universal health care in both the Senate and House versions of S.252.The Senate bill defines the benefits package for Green Mountain Care as those now covered under the essential health benefits packages for Vermont Health Connect, the state’s health care exchange program.Health care reform advocates say that tying benefits to the lowest tier of coverage under Vermont Health Connect could curtail debate on benefit levels.Act 48, the state’s health care reform law, requires the Green Mountain Care Board to define the benefits package, and advocates want to strictly adhere to that process to ensure an open and public discussion of what services should be covered by the program, said Mary Gerisch, president of the Vermont Workers’ Center, an advocate of universal health care.“Ideally we would want to move away from the idea of a benefits package at all, and Vermonters would just get the health coverage they need through Green Mountain Care,” Gerisch said.The concept of covered services originates from the health insurance industry, Gerisch said, where health care is viewed as a commodity that must yield a profit.One of the goals of a universal health care system, according to Gerisch, should be to move from coverage to care, or providing people the services they need to stay healthy, instead of the services their health plan will pay for.“We also know that the Legislature is interested in defining a benefits package to help them understand how much the program will cost,” Gerisch said.In recognition of that reality, the Workers’ Center partnered with Rep. Kristy Spengler, D-Colchester, to draft language that would set the more generous Vermont State Employees Association health plan’s benefits package as the floor for Green Mountain Care. The actuarial value of the VSEA plan is 94 percent.Reports, contracting and reports on contractingThe Senate version of S.252 sets dates by which the administration must contract for administrative and other services.When the bill was being drafted in the Senate, Robin Lunge, director of Health Care Reform, asked lawmakers not to put deadlines in statute.The exchange between Lunge and members of the Senate underlined a fundamental tension between the administration and the Legislature.Sen. Claire Ayer, D-Addison, said the two sides need to find a balance “between not pushing ourselves to go forward when we’re not ready, but pushing ourselves to be ready.”Proposed changes in the House version would eliminate the deadlines for contracts, and roll progress updates on contracts into broader quarterly reports on health care reform from the administration.Rep. Mike Fisher, D-Lincoln, chairman of the House Health Care Committee, hears testimony at the Statehouse in Montpelier. Photo by Roger Crowley/for VTDiggerThat’s the approach favored by Rep. Mike Fisher, D-Lincoln, and chair of House Health Care.“We all know things don’t go as planned,” Fisher said. “What we need to do is set goals and expectations and build a process where the administration regularly updates us on its progress.”The Senate version of the bill called for the administration to write nine reports on different aspects of health care reform to be submitted over the next two years.Spengler and the Workers’ Center also propose additional transparency measures in the contracting of a third party administrator.Their language would require each bidder to disclose their financial and other interests in Vermont and multi-state health systems reform in order to identify any conflict of interest, Gerisch said.“We need to make sure we know exactly what (the contractor) is going to get out of it,” she said.It also calls for the “social value” of a contract to be considered, how it will impact the economic and social wellbeing of the state and residents.Parity among the payers?One report under consideration in the House would require the administration to study the impact of raising the Medicaid reimbursement rate for providers to the Medicare level.Low Medicaid reimbursement rates compensate providers at roughly half the cost and at a much lower rate than Medicare; providers make up the difference by charging a higher rate to commercial insurers, who then build that back into the premiums they charge.That’s known as cost shifting. Addressing the disparity among payers could reduce commercial premiums in the short term, said Pearson, who authored the proposal.It’s also an important consideration in the transition to Green Mountain Care, he said.If private insurance is no longer a payer in Vermont’s health care system, then providers will no longer be able to recoup Medicaid losses by charging more to commercial insurance.Increasing the Medicaid reimbursement rate would take pressure off the rate Vermont would need to set for Green Mountain Care, said Mark Larson, commissioner of the Department of Vermont Health Access.Vermont’s Medicaid budget is close to $1.2 billion, with 55 cents of every Medicaid dollar coming from the feds. Increasing the Medicaid rate would increase the portion of the state’s health care costs borne by the feds under Green Mountain Care.Raising the reimbursement rate for Medicaid to the higher Medicare rate would cost the state between $44 million and $60 million, Larson said.That’s only for the health services administered by his department, which covers the majority of Medicaid services. The cost estimate would be higher if it included Medicaid costs for the Department of Mental Health and Department of Disabilities, Aging and Independent Living, Larson said.A far more modest, 2 percent increase in Medicaid reimbursement rates included in the governor’s proposed budget, was slashed in the budget recently passed by the House.It’s unclear if lawmakers would be willing to substantially increase the rate to take pressure off private premium payers in the short term, but increasing the rate when the state transitions to Green Mountain Care will be an important consideration.