Vermont Legislature SmartTranscripts:

[Speaker Jill Krowinski]: Will the house please come to order and members kindly take their seats? Good afternoon. Good afternoon. Members, we will start with three bills which are s one ninety which is an act relating to the Green Mountain Care Board and other topics followed by house bill six sixty which is the opioid settlement bill followed by H757 which is the manufactured homes bill. So S190, H660, H seven fifty seven and then we will see if any other bills have moved, out of committees to take up. So with that, member from Pulteney. On our notice calendar is Senate Bill 190 which is an act relating to the Green Mountain Care Board reference based pricing and studying the creation of a public employee health benefit authority. Can you please offer us a motion to suspend rules to take up senate bill 190 off the notice calendar for immediate consideration?

[Representative Patricia McCoy (Poultney)]: Madam speaker, I make a motion to suspend rules in order to take up off the notice calendar for immediate consideration s one ninety.

[Speaker Jill Krowinski]: The member from Pulte moves that we suspend our rules to take up senate bill one ninety off the notice calendar for immediate consideration. Are you ready for the question? If so, all those in favor please say aye. Aye. All those opposed please say nay. The ayes appear to have it. The ayes do have it and you have suspended rules to take up senate bill one ninety for immediate consideration. Senate bill one ninety is an act relating to the Green Mountain Care Board reference based pricing and studying the creation of a public employee health benefit authority. The bill was referred to the committee on health care which recommends that the house proposed to the senate to amend the bill as printed in today's calendar. The member from Essex, representative Black, will speak for the committee. And then affecting the revenue of the state, the bill was then referred to the committee on ways and means, which recommends that the bill ought to pass in concurrence with the proposal of amendment by the committee on healthcare. The member from Norwich, representative Holcomb will speak for that committee. Then carrying an appropriation, the bill was then referred to the committee on appropriations which recommends that the report of the committee on healthcare be amended as printed in today's calendar. Member from St. Albans Town, representative Dickinson will speak for that committee. Please listen to the second reading of the bill.

[House Reading Clerk (BetsyAnn Wrask)]: S one ninety, an act relating to the Green Mountain Care Board reference based pricing and studying the creation of a public employee health benefit authority.

[Speaker Jill Krowinski]: Member from Essex.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Thank you, madam speaker. Today, I'm presenting s one ninety, which is a strike all amendment, and you can find the bill on page thirty six twelve of today's calendar. It was right about this exact same time last year that I stood here, and I presented s one twenty six. That was a bill that became act 68. One of the most important pieces in act 68 were the sections that required the Green Mountain Care Board to establish reference based pricing for hospitals. To refresh your memory, reference based pricing is a health cost containment model that sets a fixed maximum payment amount for specific medical procedures and services, usually based on a transparent benchmark like Medicare reimbursement rates. Act 68 says, the Green Mountain Care Board shall set rates to be implemented over time beginning with reference based pricing as soon as practicable but not later than hospital fiscal year '27. Hospital fiscal year '27 begins October 1. That is five months from now. We were aggressive in our timeline because we were in a crisis, and we remain in that crisis. In fact, changes on the federal level have made that crisis even worse. This bill, one ninety, ensures that act 68 is being carried out as intended in the time frame that was laid out. This bill will do four things. One, it gives authority to the Green Mountain Care Board to start implementing reference based pricing for fiscal year '27. Number two, it will help reduce insurance cost for those who need it the most. Number three, it will help reduce property taxes. And number four, it's going to help save your hospital. Number one, this bill and the amendment that you will hear later from House Appropriations Committee will allow the Green Mountain Care Board to commence with reference based pricing for 2027 as intended in act 68. The Green Mountain Care Board has been working diligently to finalize rulemaking, but due to the timing on putting out an RFP and bringing in a consultant, it will not be done in time for October. That consultant who has been hired is currently at work, and rulemaking will be finalized in January '27. This bill allows them to proceed with commencement with reference based pricing in a limited scope without rule just for 2027 as we intended in act 68. They are prepared to do this. They are fully capable and eager to get started. They will continue to roll out reference based pricing for the entire commercial market beginning in 2028 after their rulemaking has been completed. I'm calling 2027 reference based pricing a soft opening. Number two, this bill will allow reference based pricing in the qualified health plans or QHPs in 2027. The QHP is divided between the individual market. Those are individuals who have no options for employer sponsored insurance. They're mainly self employed. And then there's the small market, small group market. Those are small businesses who offer health insurance to their employees, but they are not able to seek self insurance. The expiration of the enhanced premium tax credits at the end of twenty twenty five has pushed Vermont's individual marketplace enrollees into impossible choices. The Vermont Department of Vermont Vermont Department of Health Access own enrollment data tells the story. Vermonters have lost over $60,000,000 this year in federal subsidies that began 01/01/2026. Over 5,000 Vermonters have disenrolled entirely from the marketplace for coverage by April 2026. That is five times the rate that was seen at the same point in '25. And of those that did remain, Vermont saw nearly twice as many new bronze plan enrollees as compared to '25. 60% of the new bronze enrollees came from gold plans. These are not new to market shoppers choosing bronze. These are Vermonters who are trading down coverage that they had previously chosen. When Vermonters trade gold for bronze, they don't just lower the premium. What they face is much higher deductibles and out of pocket costs when they actually do need the care. That is not affordable. There have also been no relief for the small group plans, and they have never received subsidies and have borne the greatest burden of all of of ever rising costs, often forcing them to provide high deductible plans to the Vermonters that work for them. Number three, we know that one of the significant cost drivers in education funding is the increase in health care costs for our educators. This bill expands reference based pricing to the Vermont Education Health Insurance or VHI, and this will reduce spending and stabilize increasing health care costs for VIHI. This will help our education fund, and it will contribute to lowering the tax burden that all Vermonters pay for education. Number four, this bill will help hospitals. The financial pressures of Vermont hospitals that are facing is very real, but the diagnosis for that matters. UVMMC's losses since the beginning of this year, as described by their CEO, stem primarily from reduced utilization, not from insufficient commercial rates. The utilize utilization problem will only get worse. It won't get better. And if we allow the QHP market to keep shrinking, when Vermonters can't afford coverage or they downgrade to high deductible Browns plans, they skip care. That means fewer paying patients, more bad debt, and more charity care. The exact conditions that further strain hospital finances. As costs increase, utilization decreases, and revenue falls, It is a death spiral. That is what's hurting all of our Vermont hospitals, not just UVM. Some hospitals may warrant a unique approach, and that is why in act 68, we test the Green Mountain Care Board when establishing reference based pricing to consider the community need when establishing that reference based price. The goal of reference based pricing is not just to rein in spending, but is to make sure that we're putting our money where it matters most. This bill and particularly the amendment that will be offered by house appropriations will allow the Green Mountain Care Board to tailor that approach for each hospital. Keeping Vermonters insured and receiving care is the best thing that we can do for hospital financial sustainability. S-one 190 is pro patient and it is pro hospital. I did wanna describe something else that happens. When the Green Mountain Care Board does their hospital budget orders, they set a revenue, commercial revenue cap. What we see happening now is when hospitals start getting close to that cap or going over that cap, the only way that they can stay under the cap is to decrease access. They stop seeing people. If we do this bill, if we do right reference based pricing, that does not stop what the Green Mountain Care Board does. Your hospitals will have that same revenue cap. They will just not need to deny access to Vermonters because they're afraid of going over their cap. The bill also includes a cup a report that it looks at the effects of hospital outsourcing as it affects the provider tax, and then there's some additional technical language in the bill. And additionally, members may have heard in the news that there's an issue regarding Medicare patients at critical access hospitals that affect how much that their cost sharing is for outpatient services. We're asking critical access hospitals to work with the Green Mountain Care Board for possible solutions and to provide transparency for patients and affordability. I'm gonna now walk you through the bill. Let me get a jerk off. So section one is our reference based pricing section, 18 VSA ninety three seventy six. It requires that the Green Mountain Care Board to use reference based pricing to reduce hospital prices incrementally in order to equal national median prices by 2030. It requires hospitals and health insurers to begin expressing their rates as a percentage of Medicare for items and services in provider contracts starting in January '28. It directs hospitals to provide their publicly reported prices both as a percentage of Medicare rates and in dollars and cents disaggregated by payer and by plan. And it allows hospitals to express rates as a percentage of Medicare based on the actual reimbursement rates the hospital receives from Medicare until the Green Mountain Care Board adopts reference based pricing rule establishing methodology for determining those Medicare rates. It also requires hospitals to use a separate national provider identification on claims filed after October 1 for services that are delivered at each hospital department that is not part of the main hospital. That's a federal requirement. Section two. I'm gonna walk you through section two, and there's a lot of numbers, but I wanna let you know that much of what is in the house appropriations amendment will be changing a lot of this, so don't get too stuck on them. Ninety four fifty one adds a definition of Medicare adjusted base rate for purposes for hospital budgets and hospital budget review. Ninety four fifty five limits the amount that health insurers can pay certain hospitals for services provided to enrollees in qualified health plans and plans provided through the VIHI. It does not affect critical access hospitals or Vermont's single federally designated Medicare dependent hospital. For fiscal year twenty seven, hospital budgets allows the Green Mountain Care Board to direct an amount equal to 3.5% of the affected hospital's total commercial net patient revenue toward reducing reimbursement rates for QHPs and VHI plans by setting the rates as a percentage of Medicare. For fiscal year twenty eight hospital budgets, it allows the Green Mountain Care Board to set up reimbursement cap of 300 for Medicare rates for QHP and VHI. For fiscal year twenty nine hospital budgets, it allows the Green Mountain Care Board to set reimbursement cap at $2.50 for Medicare of Medicare for QHP and VHI. It limits the amount that the insurers can reimburse the hospitals to give the Green Mountain Care Board rate caps for fiscal years '27, '28, and '29. If the Green Mountain Care Board orders a hospital to reduce its commercial reimbursement rates more than what is accomplished through the caps on QHP and VHI, then the hospital must next reduce its commercial reimbursement rates that are more than 500% of Medicare or otherwise the highest in relation to Medicare. That's meant to address the outliers. It directs the Green Mountain Care Board and the Department of Financial Regulation to ensure that the rate caps are appropriately reflected in the premium rates for the QHP and VHI plans. Section three, nine thousand four hundred seven, outpatient prescription drugs. It increases 120% to 130 of average sales price, the cap amounts. Hospitals can charge health insurers for prescription drugs administered in an outpatient setting. That was act 55 from last year, and that also will be removed in the house appropriations amendment. Section four, hospital outsourcing report. It requires the Green Mountain Care Board hospitals to provide information in their fiscal year twenty seven hospital budgets about any clinical services that they outsource to external entities. And by 01/15/2027, the board will report to the general assembly with findings and recommendations on hospital outsourcing and with the agency of human services on the impacts of hospital outsourcing on Vermont's provider tax revenue. Section five is health care bargaining groups. It exempts the Green Mountain Care Board from having to negotiate with provider bargaining groups regarding the board's establishment of reference based pricing. That's a cleaning up existing statute. Section six around appeals to the Green Mountain Cara orders, it eliminates the statutory language requiring the board to adopt administrative appeals procedures and requiring someone aggrieved by the board determination to exhaust those administrative appeals prior to appealing to the Vermont Supreme Court. And, again, that is cleaning up language. Section seven and eight on data infrastructure health system performance tool, It directs the board to develop and maintain a public interactive tool showing information on health system performance, including quality, access, and affordability. Section eight makes the requirement to develop the health system performance tool contingent on the Green Mountain Care Board receiving federal or other funds for this purpose. This particular idea was in the Rural Health Transformation grant that AHS had, and it was approved by CMS for that purpose. So that is why those two sections are in here. Section nine is critical access hospitals, Medicare outpatient cost sharing. It describes a federal requirement that Medicare beneficiaries must pay 20% of charges for outpatient services at critical access hospitals, not 20% of Medicare's allowed amount. And by 09/01/2026, it requires critical access hospitals to identify all outpatient services for which the hospital charges five or more times the Medicare allowed amount for the service. It must post a disclosure on their website and in outpatient departments of the hospital about the federal requirement and that Medicare beneficiaries may be able to get care with less out of pocket costs at a different provider and how to contact the hospital's financial assistance department for more information. It directs the Green Mountain Care Board if it wants to address the issue in fiscal year twenty seven to consider the proposals from the critical access hospitals and other interested stakeholders and ensure that its actions are consistent with ongoing transformation efforts and with the act 48 principles of health care reform. And just to advise, this this process is already happening. The critical access hospitals are working with the board to identify solutions to this. Sections 10 are the effective dates. The date the act would take effect on passage except for the increased cap on hospital charges for outpatient drugs, which would take effect 10/01/2026. Again, that's going to change in the house appropriations amendment. And then there is a new bill title. It is an act relating to reference based pricing and the Green Mountain Care Board. We heard from the chief medical officer at Brattleboro Memorial Hospital, the executive director of the Vermont Medical Society, the director of policy for the Green Mountain Care Board, the executive director of the Green Mountain Care Board, the deputy chief counsel for the Office of Legislative Council, the executive director for Vermont School Boards Association, the chief health care advocate, Vermont Legal Aid, the chair of the Green Mountain Care Board, senior vice president of policy and strategy for Vermont Association of Hospital and Health Systems, the director of legislative and government relation relations for Blue Cross Blue Shield of Vermont, the chief negotiator for the Vermont Educational Employees Health Care Commission, a strategic analyst from the Vermont State Employees Association, the senior vice president of NFP, political director for the national Vermont National Education Association, the commissioner of the Department of Financial Regulation, the deputy director of health systems finances for the Green Mountain Care Board, and the director of legislative affairs for the office of the state treasurer and ledge counsel for the office of legislative council. Madam speaker, I went around my committee room on day number one of this session, and I asked every single committee member what their top priority was. Every one of us listed affordability for Vermonters as our top priority. I believe that this is the most important health care cost control legislation Vermont has considered this year, and I believe that it's vital that we pass this legislation this year. This bill is about affordability. I keep asking the question over and over in committee. What is the definition of economics? Economics is the allocation of scarce resources. S one ninety is simply a reallocation of those scarce resources. We have the highest hospital prices in the entire country. We have the highest insurance premiums in the entire country. We have a QHP market in freefall. We have unsustainable property taxes, and we have a federal government that is actively trying to make things worse, not better. S one ninety is our answer to making sure that we stay on the track laid out in act 68, and we focus these early wins where it is needed the most. And it begins to reallocate those scarce resources back to where they belong. They belong to Vermonters. We have been talking about reference based pricing for years. Act 68 set the deadline, and s one ninety removes the obstacle of rulemaking and makes sure that the Green Mountain Care Board can actually do the work that we ask them to do in the time that we ask them to do it. Your committee on health care approved this strike all amendment on a vote of ten one zero, and we ask for the body's support.

[Speaker Jill Krowinski]: And now speaking for the committee on ways and means, member from Norwich.

[Representative Rebecca Holcombe (Norwich)]: Thank you, madam speaker. S one ninety was referred to your house and ways and means committee for review. And section four, as was explained by the member from Essex, addresses you know, it requires the Green Mountain Care Board in collaboration with the agency of human services to report on the extent to which hospital outsourcing affects provider tax revenue, which is a matter of interest to the budget of the state. It also requires the board to recommend any necessary modifications of statutes to ensure appropriate that any that we appropriately reflect expenditures for patient care at Vermont hospitals, which could also affect the provider tax. Section eight, as was explained by the chair, also specifies that the Green Mountain Care Board shall only develop the health care system performance tool described in the bill if the board receives sufficient funding from the federal government or another source for this purpose. But I wanna emphasize the larger overall potential impact. This bill accelerates cost containment work specifically for qualified health benefit plans and for school employees. At a time of great stress in our education budgets, this has significant potential to reduce education spending. To the extent the measures in this bill reduce the cost of care for school employees that may have a positive impact on the cost of employee health care, and this reduces our education property tax burden. This may be the most significant work we do this session to curtail the growth in property taxes. We had the privilege of hearing from the chair of the House Committee on Health Care, the deputy chief counsel of the Office of Legislative Counsel, and the principal fiscal analyst of the Joint Fiscal Office. We thank the health care committee for their work, and the House Ways and Means Committee found the bill favorable on a vote of seven four zero, and we encourage the body to support it.

[Speaker Jill Krowinski]: And now speaking for the committee on appropriations, member from Saint Alvin's Town.

[Representative Eileen Dickinson (St. Albans Town)]: Thank you, madam speaker. The house appropriations committee reviewed s one ninety, an act relating to the Green Mountain Care Board. We did a read through of the bill from the house health care committee that relates to the language for reference based pricing. We also were presented with an amendment that the House Health Care Committee prepared that made some changes to a couple of sections. There is no money in this bill, but House Appropriations Committee had an amendment that would allow the administration to consider submitting a state innovation waiver pursuant to the Patient Protection and Affordable Care Act of 2010. After some discussion, the Appropriations Committee decided to combine the two amendments. Our amendment with the amendment from the house healthcare committee. I now yield to the representative from Essex who will present their instances of amendment.

[Speaker Jill Krowinski]: The member from St. Albans Town yields to the member from Essex.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Thank you, member. So I just wanted to say that, this bill has been on a long path. There have been rigorous stakeholder meetings since the beginning of this session. They have included the house and the senate, the administration, the Green Mountain Care Board, the department of financial regulation, members of many, many committees, so many people in the room. One thing that was identified was we wanted to direct savings this year. Everyone agreed. We wanted to work on affordability. It has had many, many machinations. There have been many numbers run, many discussions about how to target these savings, numbers changing, and the bill over time just kept changing and numbers were tweaked. And when it came out of your house committee on health care, We had voted it out, and then there was an identified issue that it wasn't prescriptive enough. And this bill is a bill about reference based pricing. It is not a bill about the legislature inserting themselves into a well established hospital budget review process, and that is what the bill had morphed into. So I presented an amendment, and I had presented that with the committee. I had several committee members who were signed on to that. And then I think house appropriations, because when I presented my amendment to them, they felt like they wanted to include my amendment into that. So that is what you're seeing. So I'm going to just sort of talk about the first and the second and the fourth instance of amendment. So the first instance of amendment, it strikes out section two from the bill in its entirety as recommended by the house committee on health care, and it replaces it with a new section two, but there's only a few main differences. The house educate the house appropriations committee version applies only to hospital fiscal year 2027, and while the house health care version had applied to years '27, '28, and '29. The house appropriation committee version applies to all for all Vermont hospitals,

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: while

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: the house health care version excluded critical access hospitals and Medicare dependent hospitals. The house appropriation version allows the Green Mountain Care Board to direct hospitals commercial reimbursement rate reductions to the qualified health plans and the VHI plans, but it does not specify the percentage of Medicare that the board must use. The house health care version had directed the board to limit the relevant hospital rates for those plans by certain amounts to arrive at a certain percentage of Medicare in '27 and then limit the rates for those plans to 300% in '28 and two hundred and fifty percent in '29. The second instance of amendment from the house appropriations committee, it deletes section three of the bill. In the house health care version, the section would have increased the cap on hospital charges for outpatient prescription drugs enacted in last year's act 55 from the one twenty to the one thirty because we were removing the numbers and there was not need to tweak numbers by readjusting and calculating the important work we had done in act 55. And then the fourth instance of amendment, it just amends the effective date to reflect the deletion of that section three, and the entire bill now takes effect on passage. I just wanna remind everybody, as laid out in statute, the Green Mountain Care Board's charge must follow the principles of health care reform established in act 48. Namely, they must ensure universal access to and coverage for high quality medically necessary health services for all Vermonters. Systemic barriers such as cost must not prevent people from accessing necessary health care. All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting. That is the Green Mountain Care Board's charge, and they take that charge very seriously. And they thread a very fine needle with hospital, hospital sustainability, affordability with insurance rates, and now reference based pricing. The Green Mountain Care Board has the authority to regulate hospital budgets and qualified health plans. The Green Mountain Care Board is experienced and has the expertise required to for this work. This is a process that has been in place for fourteen years, and it is well established. The Green Mountain Care Board has the authority to implement reference based pricing, and the Green Mountain Care Board is experienced and has the expertise required for this work, and they are excited to get moving on this. The amendment simply removes all the prescriptive amounts, and it allows the Green Mountain Care Board to do what they are statutorily required to do, and it just allows them to begin this in fiscal year twenty seven. The amendment makes it very clear that the hospital budget process is under the purview of the Green Mountain Care Board, not the legislature. The title of this bill is Green Mountain Care Board and reference based pricing. It is not Green Mountain Care Board and hospital budget review. I will now yield back to the member from Saint Albans Town for section three.

[Speaker Jill Krowinski]: The member from Essex yields to the member from Saint Albans Town.

[Representative Eileen Dickinson (St. Albans Town)]: Thank you, madam speaker. The appropriations committee has the third instance of amendment section four a, which is new. This is starts on page three six two two and continues to three six two three in today's calendar.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: This

[Representative Eileen Dickinson (St. Albans Town)]: takes language from the 2027 appropriations bill and puts it in this bill that authorizes the administration to submit a waiver thirteen thirty two to establish a program for reinsurance and seek federal pass through funding. We heard from ledge counsel, the joint fiscal office, the chair of the house health care committee, and the Green Mountain Care Board, and the vote was eleven zero zero.

[Speaker Jill Krowinski]: Member from Essex.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Yes. Your, house committee on health care took a straw poll on the, house appropriations committee amendment. And on a vote of seven four zero, we found it favorable.

[Speaker Jill Krowinski]: So the question is, shall the report of the committee on health care be amended as recommended by the committee on appropriations? Are you ready for the question? Member from Kesselton.

[Representative Zachary Harvey (Castleton)]: Thank you, madam speaker. Given the importance of making sure that we get this right, I I think I guess I just wanna start with the fact that health care and affordability are two of the most important issues facing Vermonters at this moment. And because of that, the importance of getting this right is so crucial and so key for all of us in this body. I do have a number of questions I'd like to ask the presenter of the amendment. And so at this point, can I interrogate the member from Essex?

[Speaker Jill Krowinski]: The member from Essex is interrogated. Member, I just there's two sections. Are there the sections for health care or probes?

[Representative Zachary Harvey (Castleton)]: This is this is purely be this is purely on health care, madam speaker.

[Speaker Jill Krowinski]: Okay. Yep. Member from Essex.

[Representative Zachary Harvey (Castleton)]: Thank you, madam speaker. I wanna start with the tiers amendment and noting that there's no reduction cap. I'm wondering what prevents cuts that exceed what hospitals can reasonably absorb?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: I'm sorry, member. I I missed the very I could not hear the the first part of your sentence. Can you repeat the question?

[Representative Zachary Harvey (Castleton)]: Absolutely. If the chair's amendment has no reduction cap, what prevents cuts that exceed what hospitals can reasonably absorb?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: That is the purview of the Green Mountain Care Board. That is what the Green Mountain Care Board does now. That is a long, well established process in rule.

[Representative Zachary Harvey (Castleton)]: I'm thank you, member. I note that the original bill contemplated at least a 3.5% limit tied to the hospital stability. The amendment removes that cap entirely. I'm wondering what specific protections now exist for hospitals, workforce stability, and patient access.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: The same protections that have always applied.

[Representative Zachary Harvey (Castleton)]: So nothing has changed there?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: We have changed nothing of current practice.

[Representative Zachary Harvey (Castleton)]: Thank you, member. Can the reporter point out to us any actual estimate of statewide premium savings of the bill? No. So to be clear, there is no reduction in premiums?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: There will be reductions in premiums, but that amount will not be known until the Green Mountain Care Board completes their budget process and comes down with their budget orders and decides how much of hospital budgets they will incorporate into reducing rates in these plans. So therefore, no. There is no estimate because it's an unknown number now.

[Representative Zachary Harvey (Castleton)]: Do we know the number of Vermonters that are gonna be impacted?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Yes, we do. Let's see, I think I saw just today and of course in the QHP individual market, it's constantly shifting month by month. I think the number I saw today was that there are 22,000 in the individual, 20 actually, may I have a moment to, consult with, joint fiscal who I know has those numbers sitting over with him? And I can tell you exactly.

[Speaker Jill Krowinski]: The house is done in recess. Will the house please come to order and members kindly take their seats? Member from Essex.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Thank you, madam speaker. So many numbers. There's currently approximately 64,000 in the QHP market and 34,000 in the VHI for just about 97,000 total.

[Representative Zachary Harvey (Castleton)]: Thank you very much, member. That's helpful. One of the things that we're constantly talking about in this body is the divide between rural Vermont and Chittenden County and I'm curious if you can discuss the geographic distribution of savings.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: That is an unknown number because the Green Mountain Care Board has not completed their hospital budget review process. That number will be known on October 1.

[Representative Zachary Harvey (Castleton)]: All right. I will look forward to that day. And my last question in this section here is the is it known and I assume not given the line of questioning here, but the total reduction in hospital revenue statewide? It is not. So pivoting to another line of questioning here, I'm wondering why we are legislating broad reimbursement authority before we even know the answers to the most basic fiscal questions on this.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: We gave broad reimbursement authority in Acts 68 of 25.

[Representative Zachary Harvey (Castleton)]: But I'm curious not and I wanna be careful here because I I've asked the question once, but I I do wanna try to get an answer here. Why at this moment we're trying to do this when we can't answer some of the most basic fiscal questions?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: I'm not sure there's an answer to that other than what I've already said is how do you know how can you answer a fiscal question when you do not know what the fiscal number is going to be. But I can guarantee you that when they know that number, they will be able to figure out the fiscal impact really quickly.

[Representative Zachary Harvey (Castleton)]: I I hope so. And so, madam speaker, I I think it's important just to to double click on this point and for the clarity of all of us here in the body, the healthcare committee and the money committees did not see any analysis including actuarial modeling, utilization analysis, hospital specific impact estimates or even consumer saving projections?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: I'm sorry, was that a question?

[Representative Zachary Harvey (Castleton)]: Yes. Did you consider any of those financial elements in the in the testimony leading up to the bill coming to the floor? And I can repeat those four elements if it's helpful.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: We have considered multiple financial elements over hospital budget guidance, which is just guidance. The Green Mountain Care Board puts out their guidance in March with their recommendations for hospital budgets to come in so that hospitals have a understanding about like where they're trying to work. Those hospital budgets come in in July. Green Mountain Care Board goes through a long rigorous process of review with all of those hospitals and then has final budget orders in August. There have also been numbers thrown around from the Vermont Association of Hospital and Health Systems regarding their promise to, they had actuarial analysis done where they could find savings of approximately $50,000,000 in year one, 50,000,000 in year two. And then there was recently the Mike Smith report, the liaison for the University Vermont Network or I'm sorry, University of Vermont Health. And he's indicating, and I think we've heard from the CEO of that entity that they are committed to possibly finding $100,000,000 per year for the next three years. So yeah, we've had a lot of numbers. Hence why the numbers kept changing and hence why it's not a good idea for the legislature to insert themselves into a process that is unknown at this point.

[Representative Zachary Harvey (Castleton)]: And I I think that's exactly right, member, and that's that's part of my concern is that we do seem to be inserting ourselves in the process here. I think the numbers that you've

[Speaker Jill Krowinski]: outlined Member from Burlington, what is your point of order?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Is that the member who's asking questions address questions through the speaker?

[Speaker Jill Krowinski]: Member from Burlington, I I find your point of order well taken. It is in Mason's set. The conversations needs to be directed to and through the speaker. Member from Castle Town.

[Representative Zachary Harvey (Castleton)]: My apologies, madam speaker. It's a bit awkward being six three and trying to position myself with a seat, but I will do my best to direct the conversation through you to the body. So what I where I was going with this is it is it's interesting and I understand the aspirational nature of the $50,000,000 that was just cited to the body, the $55,000,000 that was just cited to the body, the $100,000,000 that was just cited to the body. But five minutes ago, we didn't know any financial aspects or considerations to this. And I fully appreciate the understanding that the fiscal year madam speaker.

[Speaker Jill Krowinski]: Member from Burlington, is your point of order?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: The point the reason for questioning is to illicit information and not to make an argument.

[Speaker Jill Krowinski]: Can I see the members at the podium please? The House of Kennedy.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Okay. Okay.

[Speaker Jill Krowinski]: Will the house please come to order and members kindly take their seats? Will the house please come to order? Member from Burlington? Member from Burlington, I find your point of order not well taken. The member was providing information in support of his question. However, I do caution the member to keep opinion for debate, not interrogation. With that, member from Essex, floor is yours. Or member from Casa 10.

[Representative Zachary Harvey (Castleton)]: Thank you, madam speaker. I the only other question I have so there's actually there's actually two other questions here, and I thank the member for indulging me. What exactly are hospitals, employers, and Vermonters supposed to plan around here? Because we do not know how much hospitals may lose, how much premiums may change, how many Vermonters may benefit, whether savings will actually materialize, or what happens in future years. So I'm wondering if the member can explain how this legislature is expected to evaluate the long term impact of the bill without any clearly defined fiscal endpoint, implementation framework, or a measurable statewide affordability target.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: The legislature has already made that decision. That is Act 68.

[Representative Zachary Harvey (Castleton)]: Thank you, member. And my last question is I saw on the witness list that Vermont Legal Aid was one of the organizations that testified. Is that correct?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: The Healthcare Advocate is within Vermont Legal Aid.

[Representative Zachary Harvey (Castleton)]: And I'm curious what recommendations they made to the legislation.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: They were part of a vigorous stakeholder group, and they shared positive opinions on the bill.

[Representative Zachary Harvey (Castleton)]: So there was just to make sure I understand, member and and madam speaker, there was no meaningful change recommended by Vermont Legal Aid that was incorporated in the legislation?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Not in the final legislation and not in the, I believe, we're on the amendment. And, actually nope. That's in the underlying strike call. There was there was meaningful meaningful addition in the strike call, but we're on the amendment.

[Representative Zachary Harvey (Castleton)]: Thank you, member, and thank you, madam speaker.

[Speaker Jill Krowinski]: So the question is, shall the report of the committee on health care be amended as recommended by the committee on appropriations? Member from Morgan.

[Representative Leland Morgan (Milton)]: Thank you madam speaker. May I interrogate the presenter of the amendment?

[Speaker Jill Krowinski]: The member from which which section member?

[Representative Leland Morgan (Milton)]: Burlington.

[Speaker Jill Krowinski]: Well, from Essex is interrogated and may yield if it's the other part of the report.

[Representative Leland Morgan (Milton)]: Earlier in your statement, you described reimbursement rate being at 300% of Medicare and following year dropping down to 50% of Medicare. For a critical access hospital that I'm here to represent, our Medicare population is over 70% of the revenue of that hospital. Has there been any indication from

[Representative Lori Houghton (Essex Junction)]: Point of order.

[Speaker Jill Krowinski]: It's Member from Essex Junction, what is your point of order?

[Representative Lori Houghton (Essex Junction)]: I think questions are pertaining to the underlying bill and not the amendment.

[Speaker Jill Krowinski]: Member from Essex Junction, I I find your point of order well taken. The question that is being asked is not in this particular question. It would be in the next vote question. Member from Morgan?

[Representative Leland Morgan (Milton)]: Fine. I'll redirect my question to the next session. Thank you.

[Speaker Jill Krowinski]: Member from Essex? No? Yep. Okay. So the question is, shall the report of the committee on health care be amended as recommended by the committee on appropriations? Are you ready for the question? Member from Manchester.

[Representative Kathleen James (Manchester)]: Madam speaker, about 64,000 Vermonters and businesses buy their health insurance from Vermont Health Connect, our state's affordable care act marketplace. In January, many of us lost the federal tax credits that made these plans more affordable. It was a serious financial hit, and as we've learned today, more than 5,000 Vermonters have dropped their plans since then while many others moved to bronze plans. This means higher deductibles. It means higher out of pocket costs. And that in turn means that people are avoiding getting health care when they need it because they can't afford it. In 2025, I was really glad to vote for act 68, which, is moving Vermont toward a referent a reference based pricing framework. And while that rule making process plays out, s one ninety will move things forward just a little bit faster for two important groups on the marketplace, the QHP plans for individuals and for small businesses as well as for school employees. I think we're all trying to make life a little bit more affordable for Vermonters and to make that happen wherever we can as fast as we can. This bill delivers a pretty clear health care win, and I hope that folks will join me in voting yes.

[Speaker Jill Krowinski]: So the question is, shall the report of the committee on health care be amended as recommended by the committee on appropriations member from Barrytown?

[Representative Gina Galfetti (Barre Town)]: Thank you, madam speaker. May I interrogate the member from Essex?

[Speaker Jill Krowinski]: The member from Essex is interrogated.

[Representative Gina Galfetti (Barre Town)]: Okay. I've just got a couple questions here. Hopefully, there's no point of order coming. I think they're on the amendment. I'm just wondering,

[Speaker Jill Krowinski]: let's see.

[Representative Gina Galfetti (Barre Town)]: How can hospitals kinda responsibly plan for workforce access and services under a bill with no defined financial boundaries? If the chair's amendment applies to 14 hospitals and removes the reduction cap entirely, how are the hospitals supposed to assess the impact on staffing and capital investment, labor negotiations, and access to care?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Thank you, madam speaker. That's not addressed in the amendment, and that is part of as well the Green Mountain Care Board's long standing hospital budget review. Hospitals will know their budgets because they submit their budgets to the board for approval and then they know their budgets so they can do all that planning.

[Representative Gina Galfetti (Barre Town)]: Okay, thank you member. I got a couple more here but I'm going to save them for the underlying bill. Thanks.

[Speaker Jill Krowinski]: So the question is shall the report of the committee on healthcare be amended as recommended by the committee on appropriations? Are you ready for the question? Member from St. Johnsbury.

[Representative R. Scott Campbell (St. Johnsbury)]: Yes, Madam Speaker. The CEO of my local hospital, Critical Access Hospital, Northeastern Vermont Regional Hospital, has been holding monthly meetings with area legislators to talk about the financial challenges at MVRH and also North Country Hospital, which which they are partnering with as much as they can. So I I wanted to check with him about the status of this bill and especially this amendment. And he he was very clear that, this amendment is what makes the bill viable for him and for, regional hospitals like like, NVRH. So I just wanted to let everybody know that this is a critical amendment to this bill and I'd like to urge everybody to support it. Thanks.

[Speaker Jill Krowinski]: The question is, shall the report of the committee on health care be amended as recommended by the committee on appropriations? Are you ready for the question? If so, all those in favor please say aye. Aye. All those opposed please say nay. The ayes appear to have it. The ayes do have it. And you have amended the report of the committee on health care. Now the question is, shall the house propose to the senate to amend the bill as recommended by the committee on health care as amended. Are you ready for the question? Member from Morgan.

[Representative Leland Morgan (Milton)]: Thank you, madam speaker. The the basis of my question is since we're gonna be experiencing a reduction of 50 from the 300 to two fifty, have we been notified or is the Green Mountain Care with been notified of any future increases from the federal government on the reimbursement from Medicare? It's my understanding that it has not been increased for many years. If that happens, this could be very doable. That's my question.

[Speaker Jill Krowinski]: But do you wish to interrogate the member?

[Representative Leland Morgan (Milton)]: From Essex. Correct. The

[Speaker Jill Krowinski]: member from Essex is interrogated?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Well, I I will say that that is that is not the bill has been amended, so there is no two fifty or 300. But I will remind members in Act 68. The Green Mountain Care Board is developing reference based pricing, and we have given them this time to develop reference based pricing so that it is tailor made for each hospital within our state. Part of what the board is tasked with is that the reference set at your critical access hospital may be completely different than it is set at an academic medical center. The board has discretion to set the rates and to set the caps to meet the needs of each individual hospital. It is not I I thank the member for the question because, again, it allows me to stress how important the amendment from the appropriations committee was. Because if we had passed the bill as originally passed out of house health care, what would we what we would have been doing is the legislature would have been prescribing a one size fits all to all the hospitals, and that is not what we do. That was the reason for the amendment. So I thank I the member. I hope I hope that explains that, you know, the the Green Mountain Care Board in their expertise has wide latitude, and they are there to help hospitals, to keep our hospitals sustained. There are hospitals closing all over this country, and Vermont is lucky because we haven't lost one. And in part, that is due to the fact that we have the Green Mountain Care Board ensuring that our hospitals remain sustainable. That is why we are in a statewide strategic plan. That is why we are in in hospital transformation. That is why we are working on hospitals, working together to share services and find efficiencies. That is why we're doing this work. So thank you for highlighting it.

[Representative Leland Morgan (Milton)]: Thank you, madam speaker. I have no further questions.

[Speaker Jill Krowinski]: So the question is, shall the house propose to the senate to amend the bill as recommended by the committee on health care as amended? Member from Barrytown.

[Representative Gina Galfetti (Barre Town)]: Madam speaker, may I interrogate the member from Essex, please?

[Speaker Jill Krowinski]: The member from Essex is interrogated.

[Representative Gina Galfetti (Barre Town)]: I've just got a quick, Michelle question. We all love the May Shells. And the Green Mountain Care Board, what happens if the Green Mountain Care Board decides not to act? Because the bill states many times they may implement reductions. Is it correct that the board could ultimately determine not to impose meaningful reductions at all and kinda leave Vermonters with no savings despite a significant disruption and and uncertainty. Thank you, member.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: If you just give me a minute to just read read the amended bill real quickly. I'm or not the whole bill, but It does say May, and I will say that the reason for the amendment was because the rulemaking process has not been completed, that all this amendment does is it says, notwithstanding the completion of rulemaking, the general assembly says that the Green Mountain Care Board may move forward with reference based pricing in these two markets. That's the reason for the May.

[Representative Gina Galfetti (Barre Town)]: Okay. Thank you, member. And then I just got one more here. If Vermont lowers QHP premiums now through this bill before completing its waiver strategy, could we be reducing the amount of federal support available to help Vermonters with premiums and health care costs in the future?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: I'm not sure what waiver strategy the Department of Financial Regulation has asked that we allow them to go forward with applying for a 1332 waiver. That process is several years long. I believe at the earliest something like that would be completed would be maybe 2028 if we are approved, which is not a sure thing. And it also requires even if we are approved that it would require appropriations from the general assembly. I believe there might be actuarial information that the General Assembly would need to pay for. And then after that, it would then require more statutory guidance from the general assembly to move forward because it would require a huge appropriation. So I mean, I've heard at the earliest 2029, and we have tasked the Green Mountain Care Board with completing reference based pricing across all the insurance markets by fiscal year twenty twenty nine, which will be October '28. And so therefore, moving forward one year early in the QHP market would not have any effect different than what is already happening because it will be completed before any 1332 waiver process would be completed. So, no, we're not concerned about that.

[Representative Gina Galfetti (Barre Town)]: Excellent. Thank you, member. Thank you, madam speaker. The

[Speaker Jill Krowinski]: question is, shall the house propose to the senate to amend the bill as recommended by the committee on health care as amended? Member from Ferrisburg.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Thank you, thank you, madam speaker. I appreciate the the work that the health care committee and and ways, means, and appropriations have done on this bill. This is a really thorny issue, and the the four major categories of of goals that were outlined by the presenter of both the bill and the amendment are are really lofty. I mean, authorizing a RFB, focusing the needs where they're met, focusing on those meeting the needs where they're most critical, reducing property taxes, that's a huge goal, and saving our hospitals. I mean, I don't know if those four circles all intersect. So I recognize this is a this is a tough problem to to solve. But I do have a couple questions that I I was wondering, given those those four goals, if I could inquire of the the presenter of of the what, I guess, now bill.

[Speaker Jill Krowinski]: The member from Essex is interrogated.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: It the the original bill, the way it was stated kinda had a statute of limitations kinda built into it based on the fact that we were at different years working through different levels of of percentages for the Medicare adjusted rate. I'm I'm I'm wondering now, given the amendment, is there I don't see in the amendment. Is there some sunset on this provision? Because we're kinda targeting our our savings toward these two specific groups, the qualified health benefit plans and the the the plans offered to to school employees that kinda leaves everybody else out. And I'm wondering, is there a sunset date on this when when we're gonna allow the plan to focus on everybody?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: We that's act 68, and that process, we had asked for them to do the whole market beginning beginning that they shall begin in hospital 2027. However, as I've explained, due to the length of RFPs and rulemaking, they will not have that completed by hospital fiscal year '27, five months away. However, reference based pricing was act 68 and Green Mountain Care Board will be doing reference based pricing for the entire market until, I believe, in act 68, the reference based price has been set, and then we will move to global hospital budgets. So there is no sunset.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Oh, okay. I think I understand the answer being that it's it's only in fiscal year twenty seven that the board may order the rates for these two specific groups. And after '27, then it goes back to the original act 68 where they're focusing on everybody. Is that my understanding?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: They will be focusing on everyone in fiscal year twenty eight.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Yeah. Okay.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: Again, they will be completed with rulemaking in January '27.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Okay. I think I understand that. Thank you. Thank you for that answer. That helps me. And then and then lastly, the that third goal that was originally announced of reducing property taxes, and I and I know based on a previous member's line of questioning, we really don't know all the numbers, but do we have did we set some kind of a target or some like an average? Realize it's not a one size fits all, so the the savings are gonna vary across all the hospitals and and user groups. But I'm wondering, was there some kind of a target set either for savings or for the property tax reduction?

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: No. There is no target set because the number is unknown because the hospital budget process has not been completed.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Okay. Okay. Thank thank you so much, member. Thank you. Yeah. So, I guess I'm finding it a little challenging to claim that this bill is reducing our property taxes. That's one of its main goals when we have really no idea at all, even if that's a possibility out of all this. But I do appreciate the effort, I do appreciate the fact that at least in 'twenty seven, we're focusing some of the savings on on teachers, which indirectly does kind of affect property taxes through the education funding. So so I get that. And I just I think in number four are the responses.

[Speaker Jill Krowinski]: Are you ready for the question? Member for Pulte.

[Representative Patricia McCoy (Poultney)]: Madam speaker, this bill does not offer relief for the majority of employees and employers of both nonprofit and business in the state of Vermont. It does not create any savings. In fact, five out of six Vermonters would see zero benefit. The bill simply makes our systems more expensive and more complicated. We need health care solutions that finally allow us to break free from the single payer architecture. We need to make meaningful reform in health care for everyone and not just advocating for 15% of us. But just like other important challenges, we are here again with half measures that make no real impact, which allows for handpicked winners and losers when all Vermonters need our support. We need real change with added choice and real reform for Vermonters. We cannot continue to dance around the issues when we need significant, systematic change, be it in health care, education, or housing. This bill falls short. I will vote no. And when the vote is taken, I request it be taken by roll.

[Speaker Jill Krowinski]: The member from Poteney request that when the vote is taken, it be taken by roll. Is the member sustained? The member is sustained when the vote is taken it will be taken by roll. The question is shall the house propose to the senate to amend the bill as recommended by the committee on healthcare as amended? Member from Burlington.

[Representative Kate Logan (Burlington)]: Thank you, madam speaker. Madam speaker, Vermont has the highest health care costs in the country. We've this body has studied this in detail and Vermonters have mourned it at kitchen tables across the state, especially this year. Today with s one ninety, we have an opportunity to actually do something about it. This bill is about one fundamental principle. Vermonters should not be charged whatever a hospital decides to charge. There should be a limit, a rational, transparent, publicly accountable limit. And that limit should be tied to something real. S one ninety directs the Green Mountain Care Board to use Medicare rates as the benchmark and to bring commercial hospital prices down to the national median by 2030. This isn't a radical idea. This is just asking Vermont hospitals to charge what hospitals in the rest of the country charge. Right now, some Vermont hospitals are billing commercial insurers at rates that are many multiples of what Medicare pays for the same exact service. Those inflated rates flow directly into the premiums that Vermont families who purchase on the marketplace, small businesses and nonprofits, and school districts pay every single month. And when the school district pays steeply increasing health insurance premiums, Vermont property taxpayers see unmanageable year over year increases. The people who are paying for that choice are the very constituents who have been asking us to make life in Vermont more affordable. S one ninety also addresses something that has gone unexamined for too long. What Medicare beneficiaries at our critical access hospitals face when they go in for outpatient care. S 190 doesn't solve the federal problem, but it stops pretending that the problem doesn't exist. Older Vermonters living in Addison, Caledonia, Essex, Lemoyle, Orange, Orleans, Windsor, and in rural Wyndham County deserve more affordable care, and s nine one ninety helps to lead the way. And critically, this bill requires that when hospital prices come down, insurance premiums come down with them. The Green Mountain Care Board and the Department of Financial Regulation will be watching that alignment publicly every year. No more of the savings going somewhere other than into the pockets of the people who need relief. S one ninety is a start, not a finish. Reference based pricing is a powerful tool, but it is one piece of a larger puzzle. What s one ninety does is to ensure that our system structure, the authority, and the accountability to begin bending the curve in a meaningful way. The Green Mountain Care Board now has the ex now would have the explicit authority that they need to demand price moderation. S one ninety closes the loophole that would have allowed hospitals to negotiate their way around caps through provider bargaining groups, and the bill requires the board to report publicly every year on whether or not price moderation is making a difference in our premiums so Vermonters can see the impact for themselves. Vermont families deserve health care they can afford. This bill takes a serious step towards that. This is the kind of legislation that we are all here for this session. I urge my colleagues to support it.

[Speaker Jill Krowinski]: Are you ready for the question, member from Essex Junction?

[Representative Lori Houghton (Essex Junction)]: Madam speaker, I'm voting yes for affordability for Vermonters and for our hospitals. S one ninety directs the Green Mountain Care Board to do this work. That is their role, and they testified multiple times in the health care committee that they want to do this work. They have the expertise and the statutory requirement to control costs for Vermonters. S one ninety will make premium cost lowers for individuals, small businesses, and will provide cost savings to our education fund, which will have a direct effect to help property taxpayers. S one ninety will also impact Vermonters in all 14 counties. S one ninety will help Vermonters be able to actually use their health insurance, which in turn helps our hospitals. Right now utilization is decreasing because Vermonters have lost or can't afford to use their health insurance. This will lead to increased bad debt and charity for hospitals. S one ninety is the most important health care cost control legislation Vermont has considered in over a decade. I'm voting yes and I urge the body to vote yes.

[Speaker Jill Krowinski]: Are you ready for the question? If so, will the clerk please call the roll?

[House Clerk (BetsyAnn Wrask)]: Arsenault of Williston.

[Speaker Jill Krowinski]: Yes. Two minutes. Will the house please come to order? Will the house please come to order and members kindly take their seats? I would like to remind members that we are in the middle of a roll call vote. Members and guests are prohibited from using computers, phones or any type of electronic device. Please refrain from the passing of notes and conversation during a roll call and when the clerk calls your name please answer in a loud and clear voice so the clerk can accurately record your votes. The question is, shall the house propose to the senate to amend the bill as recommended by the committee on health care as amended? Will the clerk please call the roll continue to call the roll.

[House Clerk (BetsyAnn Wrask)]: Austin of Colchester. Bailey of Hyde Park. Bartholomew of Heartland. Yes. Bartley of Fairfax. No. Berbeco Winooski. Yes. Byrong of Regens. Yes. Bishop of Colchester.

[Representative Doug Bishop (Colchester)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Black of Essex. Bloomley, Burlington?

[Representative Tiffany Bluemle (Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Bos-one Westminster? Yes. Bosch at Clarendon? No. Booneberry City? No. Boyden of Cambridge? Yes. Brady Williston? Branagan of Georgia. No. Bragano, Saint Almistown. No. Brown or Richmond? Yes. Burditt at West Rutland? No. Burkhardt Brattleboro?

[Speaker Jill Krowinski]: Yes.

[House Clerk (BetsyAnn Wrask)]: Burkhardt of South Burlington? Yes. Burrows of West Windsor? Yes. Burditt Cabot? Campbell of Saint Johnsbury?

[Representative R. Scott Campbell (St. Johnsbury)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Canfield of Ray Haven? No. Pierce Duncan of Whitingham? Yes. Casey Montpelier?

[Representative V. L. Coffin IV (Cavendish)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Casey Hubbardton? Chapin East Montpelier? Yes. Charleston Chester? Christie of Hartford? Gina of Burlington?

[Representative Zachary Harvey (Castleton)]: Yes. Exclination.

[House Clerk (BetsyAnn Wrask)]: Coffin and Cavendish? No. Cole of Hartford? Conlon and Cornwall?

[Representative Peter Conlon (Cornwall)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Cooper Panel?

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Corcoran of Bennington?

[Representative V. L. Coffin IV (Cavendish)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Critchlow of Colchester? Yes. Demar of Petersburg? Dickinson of Saint Almondstown? No. Dobrovich at Williamstown? No. Dobrovich Wessex? Dolan of Essex Junction? Yes. Dolgin and Saint Johnsbury? No. Donahue of Northfield? Duke of Burlington?

[Representative Abbey Duke (Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Durfee of Shaftsbury?

[Representative Zachary Harvey (Castleton)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Eastes Of Guilford? Yes. Emma Springfield? Yes. Feltus Glendon? Yes. Go Fete of Berrytown? Garifano of Essex. Goldman of Rockingham. Yes. Goodnight, Brattleboro. Yes. Ghostland in Northfield. No. Granting a Jericho. Yes. Greg Burdington. Yes. Greg Burkhardt Fairfield. Hango Brickshire? No. Harpo Glover? Yes. Harvey Castlepin?

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Is it over the destination?

[House Clerk (BetsyAnn Wrask)]: Hedrick of Burlington?

[Representative Leland Morgan (Milton)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Higley of Lowell? No. Holcomb and Norwich? Yes. Cooper Randolph? Houghton Essex Junction?

[Representative Kate Logan (Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Howard or Rutland City? Yes. Holland or Rutland Town? No. Houghton Hartford? Yes. Hunter Manchester?

[Representative Leland Morgan (Milton)]: Yes.

[House Clerk (BetsyAnn Wrask)]: James of Manchester?

[Representative Kathleen James (Manchester)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Kasenska of Burke. Keyser of Rutland City. No. Kimmel Woodstock. Yes. Kupner Burlington.

[Unknown Representative (Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Corcoranagan. Carris Duncan. Lebron Morgan. No. Mallory Shelburne. Lenona South Burlington. Yes. Lamonta Morristown. Yes. LaRussia Franklin. Lipsky Stowe? Yes. Logan of Burlington?

[Speaker Jill Krowinski]: Yes.

[House Clerk (BetsyAnn Wrask)]: Long and Milton? Yes. Leaders of Lincoln?

[Representative Karen Lueders (Lincoln)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Luno of Saint Albans City. No. Maguire of Rutland City. Malay Pittsburgh. Mark out of Coventry. Madeline Thetford. McKenna M. Peoria. Yes. McCoy Pulte. No. McGillibr Report. Yes. Nicholas of Milton. Yes. Mollie of Callis. Meniere, South Burlington. Yes. Morgan Ela Milton. Morgan Emma Milton. No. Morris Springfield.

[Speaker Jill Krowinski]: Yes.

[House Clerk (BetsyAnn Wrask)]: Orcia Bennington. More of Weston. Yes. Roeke Putney.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Nelson, a derby. No. Nelson, Brandon. No. Niagara Bennington. North Of Pittsburgh. Moise of Wilkett. Yes. New Jersey South Burlington.

[Representative Kate Nugent (South Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: O'Brien and Tunbridge. OD Burlington. Oliver Sheldon. Olson of Starksboro. Yes. Page in Newport City. No. Parsons Newberry. Pezzo of Colchester.

[Speaker Jill Krowinski]: Yes.

[House Clerk (BetsyAnn Wrask)]: Pits on all the Dorset. Patra Heinzberg?

[Representative Kate Logan (Burlington)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Powers Waterford? No. Priestly Bradford? Yes. Bridget Burditt Pollack? No. Quinby of Winden? No. Richardson of Burlington? Secwitz Randolph?

[Speaker Jill Krowinski]: Yes.

[House Clerk (BetsyAnn Wrask)]: Shy Middlebury? Yes. Scully Burlington? Yes. Sheldon of Middlebury? Yes. Spooky of Dover? Yes. Susie of Berrytown? No. Southworth Of Walden? No. Square Of Underhill? Yes. Steady Milton? No. Waterbury. Yes. Stone Of Burlington. Yes. Sweeney Shelburn.

[Representative Michael "Mike" Tagliavia (Ferrisburgh)]: Yes.

[House Clerk (BetsyAnn Wrask)]: Pegla V. Crinch. No. Taylor Mendon. Tomlinson. Torrey Mortown. Yes. Walker Swanton. Was it Zachary City? Yes. Waters Evans Charlotte? Yes. Wells Of Bradenton? White Of Weightfield? Yes. Oh, White Of Bethel? Yes. Winter Of Ludlow? Woodwaterberry? Yes. Yacavoni, Morristown? Yes. Burditt Cabot Casey Hubbardton, Christie Partford, Cola Partford, Dodge of Essex, Galfano Essex, Cooper Randolph, Lallie Schauburn, McGuire of Rutland City, Malia Pittsford, Morgan Ela Milton, Nigro Bennington, O'Brien of Tunbridge, Parsons in Newbury, Prince and Old Dorset, Rachel Center Burlington, Walker Swan, Rosa Brownington, Winter of Ludlow.

[Speaker Jill Krowinski]: For purpose of explanation, member from Essex.

[Representative Alyssa Black (Essex) — Chair, House Committee on Health Care]: I have spent this biennium as the chair of house health care, laser focused on one thing, ensuring that Ramaners have access to high quality health care that they can actually afford. I am proud to vote yes on s one ninety. I have heard Vermonters, and I have done my part.

[Speaker Jill Krowinski]: Member from Westminster.

[Representative Michelle Bos-Lun (Westminster)]: Thank you, madam speaker. H one ninety provides policies that will control the cost of health care in Vermont. These will lower hospital costs and premiums, making health care in our state more affordable for all Vermonters when they need it closer to home.

[Speaker Jill Krowinski]: Member from Burlington.

[Representative Brian Cina (Burlington)]: I vote yes to control cost and to preserve access to care in every corner of Vermont. The failure of a privatized for profit insurance driven system can be resolved by fulfilling the promise of act 48. Health care is a human right.

[Speaker Jill Krowinski]: Member from Castleton.

[Representative Zachary Harvey (Castleton)]: The statutory purpose of the Green Mountain Care Board is to reduce the rate of growth and expenditures for all payers. S one ninety fails to do that, putting it at odds with the very purpose of the Green Mountain Care Board.

[Speaker Jill Krowinski]: Member from Burlington.

[Unknown Representative (Burlington)]: Other rural states like Montana have saved tens of millions of dollars with reference based pricing without affecting access. I'm delighted we are taking this proven straightforward step to finally start reducing health care costs for Vermonters.

[Speaker Jill Krowinski]: Member for Morgan.

[Representative Leland Morgan (Milton)]: I voted no, and I've been a provider of health care forever. And now I'm a consumer of health care, so I am concerned about the cost. I'm concerned mostly about the Medicaid population in our area that we're serving. There are no assurances that reference based pricing as described to us today have any guardrails. We are not being provided with enough financial information, just a hypothetical promise of sustainable dollars. We need more information. Thank you.

[Speaker Jill Krowinski]: Member from Milton.

[Representative V. L. Coffin IV (Cavendish)]: Madam speaker, this bill does not help as many people as we'd like, but I voted yes because helping some of the people is better than none. The real answer is to open up our markets to other health care providers and spur competition. I hope we can pass legislation to make that easier.

[Speaker Jill Krowinski]: The other member from Milton.

[Representative Brenda Steady (Milton)]: Madam speaker, I have concerns about getting Vermonters hopes up when we have never haven't heard any actual savings from this bill. How many Vermonters that would actually benefit? And if and I'm not sure how this would work. If hospitals took a loss, would that mean people like me that might not benefit from this bill would get my prices raised and cost me more, and my husband and I are retired? So with all these unknown answers and questions and I have to do what's best for Vermonters, and that's why I voted no.

[Speaker Jill Krowinski]: Member from Wakefield.

[Representative Dara Torre (Moretown/Waitsfield)]: Madam speaker, s one ninety takes the first step towards reference based pricing in Vermont. Every health care professional I have spoken with about our health care crisis has said that we must adopt reference based pricing to bring costs under control. This bill begins by addressing the cost of health care for teachers, individuals, small businesses. Teacher health care costs are up no less than 25% in the last few years. This bill addresses educator health care costs, which were the largest contributor to property tax increases. This bill addresses affordability for all Vermonters and I am proud to support it.

[Speaker Jill Krowinski]: Member from Morristown.

[Representative David Yacovone (Morristown)]: Madam speaker, it's been said before, if you always do what you always did, you'll always get what you always got. And I am tired of getting the highest health insurance rates in the world. I stand proudly today in taking a step toward affordability for Vermonters.

[Speaker Jill Krowinski]: Members, please listen to the results of your vote. Those voting yes, 87. Those voting no, 44. The ayes have it and you have proposed to the Senate to amend the bill. Now the question is shall the bill be read a third time? Are you ready for that question? So all those in favor please say aye. All those opposed, please say nay. The ayes appear to have it. The ayes do have it and third reading is ordered. Member from can you please offer us a motion to suspend rules to place senate bill 190 in all remaining stages of passage?

[Representative Patricia McCoy (Poultney)]: Madam speaker, I make a motion to suspend rules in order to place s one nine seven in all remaining stages of passage.

[Speaker Jill Krowinski]: The member from Pultely moves that we suspend our rules to place senate bill one ninety in all remaining stages of passage. Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. Aye. The ayes appear to have it. The ayes do have it and you have placed Senate Bill 190 in all remaining stages of passage. Please listen to the third reading of the bill.

[Representative R. Scott Campbell (St. Johnsbury)]: S one ninety, an act relating to the Green Mountain Care Board reference based pricing and studying the creation of a public employee health benefit authority.

[Speaker Jill Krowinski]: The question is shall the bill pass in concurrence with proposal of amendment? Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. Aye. The ayes appear to have it. The ayes do have it and you have passed the bill in concurrence with proposal of amendment. Member from Pulte, can you please offer us a motion to suspend our rules to message our action on senate bill one ninety to the senate forthwith?

[Representative Patricia McCoy (Poultney)]: Madam speaker, I make a motion to suspend rules in order to message our actions on s one nine zero to the senate forthwith.

[Speaker Jill Krowinski]: Member from Feltney moves that we suspend our rules to message our action on senate bill one ninety to the senate forthwith. Are you ready for the question? If so, all those in favor, please say aye. Aye. All those opposed, please say nay. Aye. The ayes appear to have it. The ayes do have it, and you have suspended our rules message our action on senate bill 190 to the senate forthwith. Members at 03:09 today, the clerk emailed you all the committee of conference report on house bill six sixty which is an act relating to fiscal year 2027 opioid abatement special fund appropriations. The report is also posted on the house overview webpage and paper copies are available at the main table. Member from can you please offer us a motion to suspend rules to take up house bill six sixty for immediate consideration pending its entry on the notice calendar.

[Representative Patricia McCoy (Poultney)]: Madam speaker, I make a motion to suspend rules in order to to take up for immediate consideration pending its entry on the notice calendar h six six zero.

[Speaker Jill Krowinski]: The member from Pulte moves that we suspend our rules to take up House Bill six sixty for immediate consideration pending its entry on the notice calendar. Are you ready for the question? If so, all those in favor please say aye. Aye. Aye. All those opposed please say nay. The ayes appear to have it. The ayes do have it and you have suspended rules to take up House Bill six sixty for immediate consideration. House Bill six sixty is an act relating to fiscal year twenty twenty seven opioid abatement special fund appropriations. The bill was referred to a committee of conference on the disagreeing votes of the two chambers. The committee of conference has met and considered the same and recommends that the house adopt its report which is printed in today's calendar. Member from Waterbury.

[Representative Theresa Wood (Waterbury)]: Thank you, madam speaker. The, members of the house, conference committee and the senate conference committee, agreed unanimously to this report of the conference as you so noted was distributed to members at 03:09 this afternoon. I will also point members to a very helpful spreadsheet on my committee's website if you are interested in following along. The primary disagreements were between the amounts appropriated to what areas and so I'm going to just briefly review those for you now, including what really what this bill does. And just to remind members that this is a separate appropriation because it's a special fund, and so these monies are not included in the budget. They are in a special fund. And so, the House and Senate both had agreed to monies for outreach and engagement staff for preferred substance use providers, as well as money for recovery residences and ongoing operational funding syringe service programs and peer recovery services. We also provided resources for substance use services at emergency shelters And the next item is an item where we had a point of disagreement. And in the House version, we did not have funding for recovery The Senate version had 800,000 for recovery centers. And in the Committee of Conference, we agreed on $500,000 Another area of disagreement was in the Opioid Recovery Employment Program. Those are specialized vocational rehabilitation counselors who work with individuals with substance use disorder in the governor's budget. That was included in the base budget for the Department of Disabilities Aging and Independent Living in the higher ability division, And that is $875,000. It had previously last year been funded from the opioid settlement fund. And we are again this year funding it in the opioid settlement fund. And that's $875,000. We agreed to that in conference committee. There was $1,100,000 appropriated in the Senate version for the Overdose Prevention Center in Burlington. The House did not have that in its passage of age six sixty. And your House Committee on Human Services took further testimony on this issue and found that our position was the position that we wanted to stick with and we were successful in doing that. And so 1,100,000 was removed from age six sixty. That those the Overdose Prevention Center has a grant with the Department of Health that will take them all the way through FY '20 So there was no need to appropriate funds for that purpose in age six sixty. Another area of disagreement was between the amount of or the language, not really the amount of money. We had both appropriated $1,200,000 for recovery services, residential recovery services, and the Senate had divided that up between recovery residences, which are a peer supported model, and recovery treatment, which is a medical service at level 3.1 of the American Society of Addiction Medicine. The Department of Health really would appreciate additional flexibility in that, and we wanted to adopt language that included serving unserved and underserved areas of the state. So, the dollar amount did not change, we just, you will see language that says that we will essentially fund both of those, but give the Department of Health some flexibility about how that will be done. In the House version, we had four prevention programs that were funded out of the Opioid Abatement Special Fund, and in the Senate version, they moved that to the Substance Misuse Prevention Fund, which is actually where we preferred to have those taken. So we definitely agreed with that. And so Madam Speaker, at end of our conference committee, we agreed on a unanimous vote and hope that the body supports that.

[Speaker Jill Krowinski]: The question is, shall the house adopt the report of the committee of conference on its part? Member from Cavendish.

[Representative V. L. Coffin IV (Cavendish)]: Madam speaker, may I interrogate the presenter of the committee of conference report?

[Speaker Jill Krowinski]: The member from Waterbury is interrogated.

[Representative V. L. Coffin IV (Cavendish)]: Thank you, madam speaker. I'm looking for a little clarification here. I thought I heard it said that we are not giving $1,100,000 to the city of Burlington for an overdose prevention center. Is that correct? Or are we?

[Representative Theresa Wood (Waterbury)]: We are not appropriating in age six sixty one point one million dollars.

[Representative V. L. Coffin IV (Cavendish)]: Okay. I'm looking at the Committee of Conference report, age six sixty. And Section two, legislative intent, overdose prevention center. I'm seeing a figure in there of $1,100,000 for the Department of Health for the purpose of awarding a grant to the city of Burlington for the work of the Overdose Prevention Center. Is that section two part of this committee of conference report? I'm just curious, unless I'm reading it wrong.

[Representative Theresa Wood (Waterbury)]: Member, the we are talking section two and that section two identifies that if the overdose prevention center has located site and has found that suitable that they could apply through the Budget Adjustment Act for action by the General Assembly. This bill does not appropriate 1,100,000, but it identifies a process by which the center could seek 1.1 up to 1,100,000 next year during the budget adjustment process.

[Representative V. L. Coffin IV (Cavendish)]: Thank you, member. And where would that money come from again?

[Representative Theresa Wood (Waterbury)]: If that was approved, that would come through the Opioid Abatement Settlement Fund.

[Representative V. L. Coffin IV (Cavendish)]: Madam Speaker, was there any discussion of how much Burlington has spent of the 1.1 they were off they had optioned to last year?

[Representative Theresa Wood (Waterbury)]: Yes, Madam Speaker. The Vermont Department of Health has entered into a development grant with the city of Burlington that has allocated $2,200,000 and of that approximately $300,000 has been spent. It is why that the house position was that no further money in this bill was required at this time.

[Representative V. L. Coffin IV (Cavendish)]: So if that money is already earmarked, my question would be why are we earmarking more of it to say that we will fund this and continue to fund it. That's my question is how are we continuing to fund it if that money is sitting there?

[Representative Theresa Wood (Waterbury)]: The development of an overdose prevention center requires considerable amount of work at the local level in terms of community meetings and development work. A site has not yet been located. When a site is located, there will be expenses associated with fit up of that site and leasing or possible purchasing of that location. And the resources there there are four programs within the overdose prevention the overdose abatement settlement fund that had previously been established in statute as receiving annual funding as long as the funds exist in this special fund and this was one of those four.

[Representative V. L. Coffin IV (Cavendish)]: Thank you. That's all the questions I have. Now for some commentary, if I may, madam speaker. We've had approximately a twenty five percent decrease in overdoses since over the last year. That's without this so called overdose prevention center, which by just reading its intent is an enabling center. When we look at the statistics, Without the Overdose Prevention Center, we are lowering the amount of overdoses by getting people actual training. Even reserving and giving the option for $1,100,000 where a teenager, where a 12 year old, a 13 year old can go in and get promised a clean room to use drugs, to use illegal drugs. And all they have to do is keep a record of, oh, well, we gave them a referral somewhere. They don't have to do anything. This does nothing to encourage the lack of drug use. When I read about the intents, Part of it is a smoking room. But don't worry, we'll make sure that the smoke doesn't get to the rest of the building. We'll make sure there's clean, sterile rooms for them to use illegal drugs. This is enabling young people to continue to use illegal drugs. There's nothing. I voted for six sixty when it left this this chamber because it had no funding for a drug drug enabling center. This encourages young people to continue to use. It does nothing to stop them from using. Real treatment centers, 1.1 more million more dollars to real beds. How many hundreds of thousands do we have just providing needles to addicts? But yet, our citizens with diabetes have to pay for them. This is a misuse of funds. If this is for opioid abatement, it should be to stop people from using drugs, to help them not use drugs. So that they can continue and actually have a life instead of being addicted and counting on the system to take care of them, where they would actually learn to take care of themselves. To grow up to be. And I say grow up because yet, there yes, there are people my age as addicted, that are addicted still, that are still using. By getting clean, you grow up. Yes, you have to face reality. Giving them some place to slip away from reality just so they can do it safely. Adulting is hard. We shouldn't try to distract our youth from it. This is an abomination, not a compromise, but helping to poison our citizens. I would ask this body to vote no on this because this is not a compromise. At best, we're compromising with other people's lives instead of getting them real help. Thank you, madam speaker.

[Speaker Jill Krowinski]: So the question is, shall the house adopt the report of the committee conference on its part? Are you ready for the question? Member from Burlington.

[Representative Brian Cina (Burlington)]: Madam speaker, I'd first like to apologize for all the people in Vermont who were subjected to that hateful speech.

[Representative Zachary Harvey (Castleton)]: You're struggling out there Point Point of

[Speaker Jill Krowinski]: And member from Lowe, what is your point of order?

[Representative Mark Higley (Lowell)]: Yeah. He's impugning what the member had reasonable to reasonable remarks to to make.

[Speaker Jill Krowinski]: Can I see members at the podium, please? The house of standard deed. Will the house please come to order and members kindly take their seats? Will the house please come to order? Member from Moll? Member from Moll, I find your point of order well taken. Members can't indulge in personalities in debate. Member from Burlington, the floor is yours.

[Representative Brian Cina (Burlington)]: Madam speaker, the words that we use in our debates have an impact, and I apologize to any members of the public harmed by any speech they hear in this chamber that triggers them and that escalates underlying medical conditions. Addiction is a medical condition, madam speaker, and an overdose prevention center is a venue to provide care to people without shame, a place to destigmatize their problem and connect them with resources. So I just want to remind members that our words may cause harm intended or not. And I hope that no one hears anything we say and that that doesn't drive their addiction and drive them to the point of an overdose because if that happens, the blood is on our hands. Thank you.

[Speaker Jill Krowinski]: The question is, shall the house adopt the report of the committee of conference on its part? Are you ready for the question? Member from Waterbury.

[Representative Theresa Wood (Waterbury)]: Thank you, madam speaker. I want to acknowledge that there are many strongly held opinions about an overdose prevention center. I also want to acknowledge that the establishment of a pilot project for this overdose prevention center was established by a previous legislature. It is not being debated in this bill, madam speaker. This bill makes appropriations from the Opioid Abatement Special Fund. There is no appropriation for the Overdose Prevention Center in this bill. What the bill acknowledges is the prior commitment of a previous legislature that if funding is needed, that the city of Burlington through the Department of Health may apply for funding and then this body will make that decision at that time. I also want to speak to the fact that we are seeing a reduction in overdose deaths. We are seeing a reduction in overdose deaths because of the variety of resources and techniques that the state has employed largely through the collaboration with the Department of Health, with our community providers, and with this body, Madam Speaker, to focus on not only treatment and prevention, but on harm reduction in our society and in our communities. And I make the argument that each life saved is valuable. And I hope that the body stands with the committee of conference as again that was a unanimous report from the committee of conference. Thank you.

[Speaker Jill Krowinski]: The question is shall the house adopt the report of the committee of conference on its part member from Burlington?

[Unknown Representative (Burlington)]: Madam speaker, overdose prevention centers have one simple goal, and that is to prevent Vermonters from dying. They are not meant to get someone through the process recovery. They are meant to keep Vermonters who have substance use disorder alive one more day so they have one more day's chance to get into recovery. Madam speaker, may I quote from the National Institutes of Health?

[House Clerk (BetsyAnn Wrask)]: You may.

[Unknown Representative (Burlington)]: Extensive global and local research shows that overdose prevention centers do not increase drug use. Studies across North America, Australia, and Europe indicate they do not cause new people to start using drugs nor do they result in an increase in local crime or public disorder. Thank you.

[Speaker Jill Krowinski]: The question is, shall the house adopt the report of the committee of conference on its part? Are you ready for your question? Are you ready for the question? Member from Burlington.

[Representative Kate Logan (Burlington)]: Thank you, madam speaker. Madam speaker, a hundred seventy Vermonters died from overdose deaths last year. Overdose prevention centers have been demonstrated to increase access to treatment, health services, and most importantly, prevent deaths. I know that I I'm not entirely sure why we're relitigating this policy at this moment, but I I will stand to defend the work that we have done in prior sessions. I stood similarly in support of H-seventy two when we passed it in the prior session and spoke about my own personal experience as well. So, my sister had what is called a dual diagnosis suffering from both a substance use disorder and a severe mental health issue. And the NIH estimates that nearly forty percent of those suffering from substance use disorders also suffer from at least one serious mental health issue. Both of these health issues are deeply stigmatized. They're seen as a character issue or in my family's case, a spiritual defect. And this shows up in our communities as a lack of resources dedicated to these deadly diseases such as adequate health care as well as criminalization and disrespect. My sister suffered from the dual stigma of mental illness and drug use. She felt low self esteem, shame, hopelessness, and wouldn't openly talk about her struggles with my parents or with virtually anyone else. In October 2006, my parents lost one of their daughters, my children lost their aunt, and I lost my only sister. She died alone of an accidental overdose when she relapsed after nine months of sobriety. My mother found her. I support overdose prevention centers so that nobody has to die alone.

[Speaker Jill Krowinski]: The question is shall the house adopt the report of the committee of conference on its part? Are you ready for the question? If so, all those in favor please say aye. Aye. All those opposed, please say nay. Aye. Ayes appear to have it. The ayes do have it. And you have adopted the report of the committee of conference. Members at 03:04 today, the clerk emailed you the senate proposal of amendment on House Bill seven fifty seven which is an act relating to manufactured homes and limited equity cooperatives. The senate proposal of amendment is also posted on the house overview webpage and paper copies are available at the main table. Member from Pulte, can you please offer us a motion to suspend rules to take up House Bill seven fifty seven for immediate consideration pending its entry on the notice calendar?

[Representative Patricia McCoy (Poultney)]: Madam speaker, I make a motion to suspend rules in order to take up for immediate consideration pending notice on the pending its entry on the notice calendar H757.

[Speaker Jill Krowinski]: The member from Pultely moves that we suspend our rules to take up House Bill seven fifty seven for immediate consideration pending its entry on the notice calendar. Are you ready for the question?

[Representative V. L. Coffin IV (Cavendish)]: If

[Speaker Jill Krowinski]: so, all those in favor please say aye. Aye. All those opposed please say nay. The ayes appear to have it. The ayes do have it and you have suspended rules to take up House Bill seven fifty seven for immediate consideration. House Bill seven fifty seven is an act relating to manufactured homes and limited equity cooperatives. The bill passed the senate in concurrence with a proposal of amendment. Member from Colchester.

[Representative Lori Houghton (Essex Junction)]: You, madam speaker.

[Representative Wendy Critchlow (Colchester)]: H 57 modernizes our law concerning manufactured or mobile homes and communities. The house passed h seven fifty seven on 03/18/2025. The senate has now passed the bill with several instances of amendment. Your general and house committee has reviewed the amendments to h seven fifty seven proposed by the senate and recommends that the house concur with the senate amendments. Three of the senate amendments relate to provision in the house bill which makes it easier for manufactured home communities organized as limited equity cooperatives to apply for grants for infrastructure improvements. Such grants and loans are of major importance to most manufactured home communities and to address aging and deteriorate deteriorated infrastructure. The senate proposes a two phased approach instead. It lets the house provision stand for a year and in the interim, directs the Department of Housing and Community Development in consultation with the agency of administration, the agency of natural resources, and the agency of transportation to prepare a report identifying all the state grants and loans programs available to mobile home parks for infrastructure improvements and to analyze the eligibility regulatory barriers that may exist, especially the limited equity cooperatives. The report is due on 11/15/2026, and the senate proposes to then sunset the house provision on 07/01/2027. The house also contained sales and use tax exemptions for mobile homes effective 01/01/2027. The senate pushes that date one year to 01/01/2028. Your general and house committee reviewed these senate amendments and by a straw poll of nine zero two recommends to the house that we concur with the h seven fifty seven as amended by the senate.

[Speaker Jill Krowinski]: And now member from Barrie City.

[Unknown Representative (Barre City)]: Madam speaker, your house committee on ways and means reviewed the senate proposals of amendment to h seven fifty seven and on a vote of eleven zero zero recommends that the house concur with senate proposal of amendments and ask for your support.

[Speaker Jill Krowinski]: So the question is, shall the house concur in the senate proposal of amendment? Are you ready for the question?

[Representative Patricia McCoy (Poultney)]: If

[Speaker Jill Krowinski]: so, all those in favor please say aye. Aye. All those opposed please say nay. The ayes appear to have it. The ayes do have it and you have concurred in the senate proposal of amendment. Members at this time, we have one bill left for consideration which is house bill nine fifty four which is, the Stowe Charter change and I believe the committee may be hearing it now. So the house is gonna take a recess. So the house will stand in recess until the fall of the gavel at approximately 06:35. The house will stand in recess until the fall of the gavel at 06:35.