MONTPELIER, Vt. — The Vermont House on Thursday gave preliminary approval to a bill under which the state would take the next big step on a path to sweeping health insurance reform passed in broad outline last year.
The measure, advanced on an 82-40 vote, would set up a state-managed health insurance marketplace, known as an exchange, in compliance with federal law. But Vermont’s version of the exchange called for under the federal health overhaul passed two years ago would go further than most, and it would be used as a springboard for moving the state toward a government-run single-payer health insurance system by decade’s end.
Backers said the bill would help individuals and families afford health insurance and would give small businesses the option, starting in 2014, of no longer providing employee health insurance. Instead, most workers could buy health insurance through the exchange with federal subsidies.
The measure was expected to come up for final House action on Friday before moving to the Senate.
Rep. Michael Fisher, D-Lincoln and chairman of the House Health Care Committee, said the bill “will greatly expand regular Vermonters’ ability to afford access to care.”
“This bill gives us a new freedom for small businesses to focus on what they do best: to build good products and provide better services in the comfort that their employees will have access to the care that they need,” he said.
The subsidies would be available to people making up to four times the federal poverty level, or about $45,000 a year for an individual and $92,000 for a family of four.
Key Republican amendments were defeated easily in a chamber in which the GOP holds just 48 of 150 seats.
The bill would require anyone working for a company with 50 or fewer employees to get insurance through the exchange beginning in January 2014. In 2016, that would expand to employees of companies with 100 or fewer workers. Republicans objected to that, saying Vermont residents should have freedom of choice, and offered an unsuccessful amendment to remove the provision mandating participation in the exchange.
“Does it not diminish my right to make choices as to how I pay for health care insurance?” asked Rep. Duncan Kilmartin, R-Newport.
Democrats argued that buying through the exchange would be key to receiving the federal subsidies. Backers of the bill also have said that the larger the risk pool — the number of people covered — the easier it will be to manage costs.
Democratic Gov. Peter Shumlin’s administration has been engaged in extensive planning since last year for the launch in 2017 of Green Mountain Care, which would bring as many Vermont residents as possible into a single insurance pool and would seek to lower health care costs by changing the way doctors and hospitals are paid. They would move from a “fee-for-service” system in which the more procedures they perform, the more they get paid, to a set budget for providing health care to a given population.
Republicans also have complained that the administration says it won’t have a plan outlining how much the system will cost and how to pay for it until January, after the November election, in which Shumlin is expected to seek a second two-year term.
The House defeated a GOP amendment to move up the financing report date to Sept. 15.
“Maybe some people know what the cost is, (but) most of us don’t,” said Rep. Greg Clark, R-Vergennes. “We haven’t been told. That is a real injustice to the people of the state of Vermont.”
Lawmakers broke in the early evening for a Statehouse ceremonial room reception for a visiting Canadian dignitary at which beer and wine were served. After they returned, debate grew testy, with numerous points of order raised. In two instances, Speaker Shap Smith, D-Morristown, told complaining Republicans there were not House rules barring the behaviors being complained about.
Kilmartin complained that during one of numerous instances when Smith called lawmakers to the podium to discuss points of order, he was accosted by the state’s insurance commissioner, who was sitting nearby. Kilmartin said the insurance commissioner made “intimidating and offensive” remarks to him, and he asked Smith to clear members of the administration from seats at the front of the chamber, which Smith declined to do.