SmartTranscript of Senate Health and Welfare - 2025-01-31 - 10:00AM

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[Jennifer Carbee ]: And we're live. [Chair Ginny Lyons ]: Alright. So we're back health and welfare again on January thirty first, and we're continuing to go through bills that have been briefly presented this morning. So let's go back. What are we on now? S one? Yeah. Okay. Yeah. You somebody mentioned senator Luzzi. One year, the first day, we went through s one to s eighty five eighty seven. Every one of them senator. [Jennifer Carbee ]: Well, if [Chair Ginny Lyons ]: you won't be around, we're right. Yes. You got [Jennifer Carbee ]: Okay. Alright. So, again, Jennifer Cartwright from the office of legislative council. This is s one. This is an after that, I think, to providing Medicaid equivalent coverage to all Vermonters. This would add a new subchapter in thirteen BSA chapter eighteen, which is the chapter where the forty eight unit by universal healthcare system and the exchange statutes currently are subchapters one and two. This would add a new subchapter three on Medicaid equivalent coverage. And it starts out with section eighteen fifty one that directs the agency of human services to provide hospital, medical, dental, and prescription drug coverage equivalent to covered in the Vermont Medicaid state plan to all Vermont residents regardless of their household income, as follows, and it does kind of age cohorts over time. So to individuals up to twenty six years of age for coverage beginning in twenty twenty nine, to individuals who are, as it says, not less than fifty five years of age and not more than the age of eligibility for federal Medicare the federal Medicare program, which currently is you become eligible at sixty five. So fifty five to sixty four, for coverage beginning in twenty thirty. To individuals who are between forty five and fifty four for coverage beginning in twenty two in twenty thirty one. Individuals who are thirty five to forty four years of age recovering coverage beginning in twenty thirty two. And to individuals who are between twenty six and thirty four, recovered beginning in twenty thirty three, at which time all Vermont residents would be eligible for coverage. Then it requires by September first of this year in section two that the secretary of human services request approval from CMS, Centers for Medicare and Medicaid Services, to amend Vermont's Global Commitment to Health Section eleven fifteen demonstration waiver demonstration to make all Vermont residents eligible for hospital, medical, dental, and prescription drug coverage equivalent to the coverage in Vermont, the Vermont Medicaid state plan regardless of income as set forth in section one. And if CMS does not approve our request, Vermont's request for federal financial participation in providing that coverage, then the coverage would be funded with state only dollars. Section three gets some information about what that would look like. So section three directs the Agency of Human Services in consultation with the Green Mountain Care Board and the Department of Financial Regulation to first estimate the costs of providing that coverage, including the amount of state funds that would be required to support the program through full implementation in two thousand and thirty three, both with and without federal Medicaid dollars, so cost estimates both with and without federal financial participation. Second, estimate the potential cost offsets in the healthcare system and elsewhere in the economy as a result of all Vermont residents having access to Medicaid equivalent coverage. And third, develop and propose a detailed implementation plan for providing that coverage beginning with individuals up to age twenty six in twenty twenty nine and continuing through full implementation in two thousand and thirty three. And that report would be due by January fifteenth of twenty twenty six to various committees, including this committee and finance committee. Section four directs the Department of Taxes by January fifteenth of the following year, twenty twenty seven, in consultation with the Agency of Human Services to provide this committee and other committees, including finance, with options for structuring a payroll tax to generate the revenue necessary to support the state portion of the expansion, both with and without federal Medicaid dollars based on the agency of human services cost estimates and any subsequent, fiscal analysis. And it would have the department's report, which the department of taxes, set forth at least three payroll tax options and include the department's recommendation for which option is the most administratively feasible for employers, employees, and the state. Effective dates, section one, providing that Medicaid equivalent coverage, for all Vermont residents beginning with, [Chair Ginny Lyons ]: up to [Jennifer Carbee ]: eighteen twenty six would take effect on January first twenty twenty nine. The remaining sections take effect on passage. Well, this looks like [Chair Ginny Lyons ]: the work that we did with doctor Shao, spending a lot of money for the report on payroll tax options and making it back in with a report that even our the governor or the governor who could support the program for shape. I mean, it it was I agree. It It it was devastating for in particular, politically, for him, but the the report indicated the huge amount of money that needs to be raised for the state to do this independent of the federal government. And there was another study done back in the nineties, and the number came in and the speaker of the house pulled the bill and wouldn't let it go to the floor because single payer for the single state of Vermont is a difficult place to be, unfortunately. It's just very costly in a state that doesn't have the resources to do it. Look at Canada. Yeah. I know. Fifty [Jennifer Carbee ]: percent income tax. [Chair Ginny Lyons ]: I mean, the the idea is so compelling. It is. Yeah. But the numbers are just waiting. Go ahead. Have we Go ahead. No. For one, we're just too small and too old and too expensive. But I wonder if we could do it as a New England coal We've tried to do that with with renewable energy and greenhouse gas reduction goals and This might gas leak cost. Maybe even New Hampshire can talk to us. Well, you know, that's a different that's a different look, but it's something that I think we've talked about before. Michelle, sure. Yeah. Talked about it. We've all talked about how could we get a coalition together to build a program that is cost effective and would work with a number of states. Boston in this mixed happens. Senator Gulick, it's I'm doing I have [Vice Chair Martine Larocque Gulick ]: a lot of caffeine, and I'm not done yet. So I appreciate the look back in putting this into a historical context. I think that's that's valid. At the same time, I think or I don't think I know that we are not in the same, you know, we're not in the same place that we were in years ago in terms of, like, the strength and viability and economic stability of our health care system. So I think maybe it deserves a look in the current environment that we're in, which is really precarious as we all know. I I just I think it's in you know, looking back, isn't necessarily completely I don't wanna say relevant, but [Chair Ginny Lyons ]: it's not accurate at this point. So what we will do is what I'm gonna ask of us is to is to be patient with this one simply because it is it is it is a significant amount of work, and it will require some resources to do all the analysis here. Yeah. That look back is is, you know, is still relevant. It will cost money and who can do it on joint fiscal right now. Yeah. No. They couldn't. This is not theirs. They They could contract out And DIVA can't do it. They can con we so we can just talk about that and how it might happen. And then we'll be looking at as I've said before, we'd be looking at a bill that we can produce in here that might begin to attenuate the real emergency that we have, then also look within a much shorter frame. But so I I I agree. This is I think senator Cummings and I are dreaming agreeing that there's something that would be very wonderful about having this single payer program. And the question is, can we afford to look at it now, and can we afford it overall? But You know, we did we updated the PICUS education report. Right. Maybe we could find out what it would cost to have the the shower report? Shower report updated to today's numbers as he designed the Taiwan system. Yeah. So would you wanna talk with Nolan or joint physical about thinking about that as a shock shift here. Yeah. And we will and I I I'm I'm gonna say that I think the bill is huge. So it's not It went through the worst of the wars in here. Which the committee, I don't think, went home before midnight. No. For six months. It was not a Wow. It was a lot of work that went into it. Yeah. So oh, like, Robin, I think, had a cod here. Oh, Robin. Well, Robin had a cod. We all had cards. Forty eight was one of mine. It was one of my mills. Did you [Jennifer Carbee ]: have a card in here too? No. You had a card. Late night. Yeah. It was. It was. Okay. [Chair Ginny Lyons ]: Robin was the drafter, and you were the nun. [Jennifer Carbee ]: No. I was You were [Chair Ginny Lyons ]: the nun. Was the drafter. [Jennifer Carbee ]: She was the She went to the chief director. Yeah. That's right. [Chair Ginny Lyons ]: She was She was the head chair. She was the director of health care reform in the governor's office. That's right. Yeah. That's good. Yeah. Okay. You're leaving. You'll be back. So some of us do have scars from this. I'll be right back. That's good. You've probably hosted them up this morning. I wanted to have a conversation with you all. It's really more procedural, but then I wanted senator Gulick to hear it because it's pertinent to her interest. So what we'll do is just take a a five minute offline. We don't need
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