Political Overview

This week a feeling of heaviness descended upon the State House with the start of the war. The uncertainly of the war was reflected in the mood and the lack of progress on legislation at the State House. Two major bills, Act 60 reform and certificate of need reform, stalled in committee.

Republican Governor Jim Douglas and the Republican-controlled House clashed over raising the income and consumption taxes to fix Act 60, with the Governor strongly opposed to raising taxes. This disagreement is similar to one nearly ten years ago between a Democratic-controlled House and then Democratic Governor Howard Dean. Moreover, after months of testimony and committee discussion, the House Health and Welfare Committee failed to reach agreement on H.128, the bill that reforms the certificate of need process, before the "crossover" deadline of March 21st (more about this below).

There were, however, a number of less complex bills that did make the "crossover" deadline. As a result, both the House and Senate will likely spend a significant amount of time on the floor next week debating those bills. Crossover typically signals the halfway point of the session. However, until the FY 04 budget bill reaches the House floor for debate, which is not likely to happen until April 1st, the end of the session is nowhere in sight.

Specific issues addressed this week by the General Assembly include:

Certificate of Need (H.128)

There was a coup in the House Health and Welfare Committee on Friday afternoon, March 21st, regarding H.128, the certificate of need bill. The House Health and Welfare Committee spent all week marking up a new 53-page draft of the bill. Bea Grause, President of VAHHS, and Tom Huebner, CEO, Rutland Regional Medical Center, testified regarding the continuing problems with the bill. On Friday afternoon when the committee was about to take a vote, five members of the committee who were unhappy with how complex and over regulatory the bill had become, said that they were going to offer an amendment for the committee's consideration. Those five members are Reps. Tom DePoy, R-Rutland, John Hall, R-Newport, Bill Keogh, D-Burlington, David Sunderland, R-Rutland, and Val Vincent, D-Waterbury. These five members plan to offer their amendment for discussion on Tuesday and Wednesday, March 25-26th. Those five and Rep. Linda Kirker, R-Essex, who was absent but also has expressed concerns about the complexity of the bill, make up a majority of the 11-member committee. It is likely that either the bill or this new amendment will ultimately be voted out of the House Health and Welfare Committee favorably. Significantly, neither the bill nor the amendment contains any provision subjecting hospital board meetings to Vermont's open meeting or public records laws, nor does it contain any mandate for hospital board membership.

Anesthesiologist Assistants (S.144)

The Senate Health and Welfare Committee voted unanimously to advance S.144, the bill that proposes to establish a system for certifying Anesthesiologist Assistants (AAs) in Vermont. The quick movement of the bill was thanks in large part to compelling testimony as to the extreme need for AAs in Vermont from Dr. Michael Tarazi and Donna Madigan, RN of Southwestern Vermont Health Care Corporation, and Dr. James Rathmell and Terence Lynch, Anesthesiologist Assistant, of Fletcher Allen Health Care. Other key supporters are the Medical Society and the Medical Practice Board. The bill moved quickly despite the fact that a lobbyist for the Vermont Association of Nurse Anesthetists pushed for supervision ratios and other requirements that make the bill unworkable for hospitals. The committee rejected this level of detail and instead authorized the Medical Practice Board to set the training and supervision requirements of AAs by rule.

The bill will now likely be referred to the Senate Government Operations Committee. There are a number of housekeeping amendments that need to be made to the bill before it is voted out of the Senate. VAHHS is working on drafting these amendments and is urging the Senate Government Operations Committee to schedule a hearing on the bill as soon as possible. Here is a link to the Senate Calendar for Tuesday, March 25, 2003, with the text of S.144 as approved by the Senate Health and Welfare Committee.

Agency of Human Services Reorganization (H.450)

This week the House Health and Welfare Committee and the House Government Operations Committee voted favorably to jointly introduce H.450, a bill that proposes to restructure the agency of human services. As reported last week, the bill delegates the responsibility to restructure the agency to the secretary of the agency according to broad goals and principles set forth in the bill. The bill also requires that by December 15, 2003, the secretary must present draft legislation and a report on the budgetary impacts and transitional costs of restructuring to the newly established Legislative Oversight Committee on Human Services Restructuring.

The bill was referred to the House Appropriations Committee and the committee took testimony this week on the bill. It is unclear at this time if the committee will put the language in the FY 04 budget bill or pass H.450 as a stand-alone bill. Text of the bill.

FY04 Medicaid Budget

The House Appropriations Committee continued to mark up the FY 04 budget bill this week. The Committee did not discuss the Medicaid budget, either as it relates to hospitals or nursing homes. The primary reason they haven't discussed Medicaid is because the Douglas Administration is concerned about Rep. Patty O'Donnell's proposal to replace the tiered deductibles proposed by the Governor with premiums collected by the state. O'Donnell is very committed to her proposal. As a result, it would be surprising if the Governor can talk O'Donnell out of presenting it to the committee during the upcoming week.

S.25, Child Passenger Safety Seats

The Senate Transportation Committee unanimously voted to advance S.25, a bill that requires booster seats for children up to the age of eight traveling in a motor vehicle, among other things. VAHHS supports this bill. The bill is on the Senate Notice Calendar.