Meetings
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[Virginia "Ginny" Lyons (Chair)]: It's fine. It's all live. All right, Senate Health and Welfare, we're back live on January 13, and we've talked with most of the committee members about interest for bills and the bills of interest. Come back to Senator Cummings and your thoughts about bills that we have that you would like to look at or focus on and then or topical areas. Topical areas. I am very concerned about the impact of federal changes on people's ability to access health care. I'm also very concerned that hospital transformation seems to be moving at a snail's pace, and I don't think we have the luxury of doing that anymore. The Medicaid changes could put some of our small rural hospitals under financially. Decline, reduce the provider tax to increase our Medicaid reimbursement to hospitals with the loss of the gradual cutback in that provider tax, we are not we're gonna be minus that money. So it's just access. Yeah. Things have gone exceedingly the wrong direction since we left here in helping people have access. We were going in such a good direction. Were going And that built us and brought in general. So thank you for that. Let me go through some of the things that we shared together this morning and I'm going to give you the list that I use for sort of looking at what we have in committee and our interests, that is cost, increased access that you've mentioned significantly, and quality, looking at our workforce and how to improve that, maintain it, looking at how we can confine insurance so that there's an alignment for folks so that we don't have such a complicated system, and then fixing our previous legislation laws systems and that you brought that up with hospitals and trying to accelerate the pace. That's a good conversation we should have. I think it does link in with a couple of bills that we have. S-one 190, you mentioned the provider tax and S-one 190 is about outsourcing services and care and when that happens those contracts may, because of the way they're happening, limit provider tax. So we'll look at that bill with that in thought. Your committee's probably gonna have to look at it anyway. Oh yeah. Yeah, thought so. Once we fix education, we'll see. Yeah. And so other folks mentioned S one ninety as well. Senator Morley, Senator Benson, me, I think you and I think we could pull Senator people that belong into that. And then we also looked at some of the bills that we had from 2025 to bring those forward to complete work on those. We talked about some of the work that we did last session that took information from 2025 bills and put them into the budget or integrated them in bills, other bills, or there was redundancy with what the House did. So some of the work that looks like it's not done in 2025 was actually done. So we've asked Jen and Katie to begin looking at the PhD psychologist prescribing leftover from last year working with a house to look at the recovery residence bill and we'll have some recommendations from the administration on that. And then there was interest in the optometry bill. We'll get to that one. There was interest in primary care, which will help consolidate some of the transformation work we're doing by moving from hospitals to primary care, and Senator Gulick's interest and shifting less costly care from hospitals to primary care. And then there's the early childhood licensure bill. There are a lot of bills that we have that we can go through and we just got Senator Benson. Four. Five more. Is it four or five? Four.
[John Benson (Member)]: Are there four more than me? I brought them with me. So yeah. Alright. It's five.
[Virginia "Ginny" Lyons (Chair)]: Four. One, two, five. Five bills and I have a list of all the bills in our committee from Legis Council. So, I'm gonna go through those again and see if these bills are on it. Oh, some of these bills have house companions, are you? Yes, and I'm meeting with Representative Black to sort of coordinate how we're gonna work together on that. Okay. Yes, sir. You
[John Morley III (Member)]: guys have been doing this for a long time to be in and kinda racking my brain with it because
[Virginia "Ginny" Lyons (Chair)]: I remember dealing with it on
[John Morley III (Member)]: a four patient a few years ago. It's the provider tax. Mhmm. So
[Virginia "Ginny" Lyons (Chair)]: Yeah. You want someone to come in and talk about it? No.
[John Morley III (Member)]: I I just just I'm gonna lay it out and see some way if I'm way off base, but it seemed like to me there was a tax imposed upon certain entities, hospitals, like, I think ambulances is one. Nursing. Nursing homes is one. And so basically, and I can't remember how how it gets calculated, x amount of dollars is a tax on, it then falls back, and it goes into the general fund.
[Virginia "Ginny" Lyons (Chair)]: Yeah. Yeah.
[John Morley III (Member)]: And so it's in the governor's budget, it's in our budget, and it's a pretty big chunk of change as I recall. Mhmm. But it also puts upward pressure, unless I'm getting this wrong, on healthcare.
[Virginia "Ginny" Lyons (Chair)]: When it first started, have we had Nolan just clean the We're gonna have Nolan come in and we'll do provider tax 101. Okay. And then we can learn and with the experience that Senator Cummings has had financed. Yeah. Some of our experiences in here, we can look at that provider tax and see what it does and then what it doesn't do and what happens if it disappears, all of those functions. The money is used to often get them in this Medicaid match. The deal was we tax you and then get it back.
[John Morley III (Member)]: Two minutes. So so we're hiring Medicaid premium. Yes.
[Virginia "Ginny" Lyons (Chair)]: But the feds did catch on after a number even so. We aren't allowed to keep it as a separate fund, and we aren't allowed to say it's tit for tat, but there will be that less, much less money to
[John Morley III (Member)]: Okay.
[Virginia "Ginny" Lyons (Chair)]: Put into Medicaid. Federal, for our state, Matt. Yeah. Correct. Yeah. Okay. Because it's curious. So, yeah, it's a rock and a hard place actually. So
[John Morley III (Member)]: I was just curious because I it seems like it comes up every year. It seems like I've heard
[Virginia "Ginny" Lyons (Chair)]: Of course it does. Well, the woman had found a state employee. She's she's an attorney, she figured it out, she's a friend. Before I understand what this will be.
[John Morley III (Member)]: Yeah. Just curious. Thank you.
[Virginia "Ginny" Lyons (Chair)]: Good. Nolan's coming in at 09:00 Thursday morning.
[John Morley III (Member)]: Okay.
[Virginia "Ginny" Lyons (Chair)]: And he's gonna talk provider tax. Alright. So it's a very timely question.
[John Morley III (Member)]: Thank you. Alright.
[Virginia "Ginny" Lyons (Chair)]: He's good. Yeah. Alright. Absolutely. Alright. Anything else? Any other quandary that we need to sort out? So it seems like the effect on the feds have had on us, particular Medicaid and QHPs are premiums for folks significant. We did have that testimony but we won't let it go and come back and look at it again, see where we are. I think the administration really, AHS, has the data that we need and they're, you know, when they, if they get to a good place, we'll have them back in and present. Yeah, because that's what I have in your opinion is it's been all, and this is going to happen, which is great, but I haven't heard what the actual rates are right now, how much they have actually gone up in Vermont. We don't know how many people have not signed up, so we don't know or how many people have moved to a different plan, you know, from gold or silver to bronze and or off, So we don't know what we're looking at and we also the AHS has shared with us that we haven't heard what the guidelines are, what the guardrails are, So it's still in a gray area. So the people we are at the end, right, of the sign up period. At the end of what? The annual enrollment period. Yes. You have to sign up, yes, where there's a significant penalty. And we could expand that. Expand or extend? Extend. Extend. But depending on people are here now and depending on if congress does something or doesn't do something. Well, the sign up period is over, so we'll know. But then what we don't know is that well, there's also the Medicare effects for advantage plans, which we won't That's right. You all get into that. They're Medicare advantage. Getting into that right now because that's actually out of our control. The other thing we don't know is associations. So, you can plans, well, we don't have those right now. I know there's an ask for it. Yes. And there was before, and it is a very painful discussion because you're balancing individuals and your small employers who all are getting burned. And the feds oh, yeah. The Affordable Care Act banned associations. Trump came in and said, no. We're gonna put them back along with several other things. And we spent several painful weeks working on it, and then the Fed said no and let us off the hook. Which is better. It it it is. But when so we need to find out what's do you know the the the timeline for? No. I don't know any big discussions. Lots of discussions. But I think it's critical that we keep federal as much as possible in a place until we know exactly. The speculation will only make us spin our wheels. All right, what I'm going to suggest now is that we take a break until 11:40, 11:35, let's make it 11:35, just in case somebody comes in early. And we have two folks coming in to testify. Before we go offline, I will say in my discussion with the House healthcare folks, I'm looking at an opportunity for us to have a joint meeting with House healthcare. And one of the things I think we would like to look at is what have we accomplished with the legislation that we passed? So having the hospitals come in and talk about reduction in costs, we'll have pre med care board and DFR. I know they'll want to talk about that very much because the work that we did last year really will make a difference including making a difference to the cost of healthcare premiums for educators. And that begins in 2027. That is important. Sounds good. Yeah. We'll just take a Oh, won't Come in. We will not stop right now. No. We're not gonna get
[John Morley III (Member)]: her back.
[Virginia "Ginny" Lyons (Chair)]: Maybe like five minutes.