Two major healthcare access bills face different fates at the Vermont Statehouse

Last January, lawmakers introduced two major pieces of legislation, both aimed at improving Vermonters’ ability to access health care.

One bill, H.721, proposed expanding the state-funded Medicaid program to cover thousands more Vermonters. The other, H.766, sought to diminish the influence of private insurers over practitioners’ care decisions — a measure that lawmakers hoped would reduce paperwork and allow clinicians to see more patients.

However, at the end of the legislature, the two bills experienced divergent destinies.

H.766, which its supporters have dubbed the “provider burden bill,” has received broad legislative approval and will soon be submitted to the governor.

Meanwhile, H.721, the Medicaid expansion bill, was slowly whittled down to a small portion of the state budget bill’s text.

Rep. Lori Houghton, D-Essex Junction, chairwoman of the House Health Care Committee, where both bills originated, said the rollback of H.721 was “unfortunate.” But she called the passage of H.766 “a big victory for Vermont patients and providers.”

If signed by the governor, H.766 will reform how commercial insurance companies can process orders for procedures, tests, medications, and physician claims. The goal is to relieve practitioners of some of the bureaucracy and paperwork associated with dealing with insurers, allowing them to see more patients.

The bill would impose bans and limits on when insurance companies can reject clinicians’ prescriptions and claims, and limit insurers’ ability to impose their own requirements on what practitioners are able to do.

Insurers say these practices actually save money and eliminating them will cause Vermonters’ health insurance premiums to increase.

“This bill still has a significant impact on members’ health premiums,” said Sara Teachout, a spokeswoman for Blue Cross Blue Shield of Vermont, which insures about a third of Vermonters. “Our concerns remain extremely serious.”

But the bill received approval from both houses of the Legislature, surviving a last-minute attempt to delay its provisions. His next stop is the governor’s office.

Jason Maulucci, a spokesman for Gov. Phil Scott, said the governor has not yet decided whether he will sign the bill.

“He is concerned about the uncertainties surrounding costs, but also understands that there could be benefits, creating efficiencies and improving the patient experience,” Maulucci said. “So he will evaluate them once they arrive at his office.”

H.721, the Medicaid expansion bill, took a much different route. Democrats announced the bill in a press release on January 12.

As originally written, the bill would have significantly increased the income thresholds required for Medicaid coverage, allowing thousands more Vermonters to access state-funded health insurance. State.

But over the past four months, amid widespread concern about state finances, lawmakers have narrowed the legislation to expanding a single program, folded into the state budget.

The still-existing section would expand eligibility for Medicare Savings Programs, which provide grants to help low-income Vermonters ages 65 and older pay for Medicare.

This provision works by increasing the income threshold for state Medicare savings programs. Currently, the most comprehensive program only covers Vermonters at 100% of the federal poverty level, meaning their income cannot exceed $1,255 per month for an individual in 2024. The budget language of the Vermont would increase that limit to 145 percent of the poverty level. , or $1,819 per month for an individual in 2024.

This language will make a material difference in the cost of health care for thousands of Vermonters, according to state health care advocate Mike Fisher.

“The action taken by the Legislature this year represents a significant improvement for nearly 12,000 Vermonters,” Fisher said, “who will have access to real improvements in their ability to pay Medicare premiums and pay their bills. poached.”

But previous provisions — such as allowing more young and pregnant Vermonters to be covered by Medicaid and exploring a broader expansion of the program for all ages — were scrapped.

The original bill contained “a lot of good things that would help us achieve a new vision for health care in Vermont,” Houghton, chairman of the House Health Care Committee, said Thursday.

Still, “we’re going to continue to look at the issue of access and affordability,” she said. “We still have work to do and we will continue to do it.”

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