first_imgby Anne Galloway, www.vtdigger.org(link is external) April 27, 2011 In a historic vote on Tuesday, the Vermont Legislature created the enabling legislation for a first-in-the-nation universal health care system. The state Senate approved the visionary plan for a single-payer system in a 21-9 vote after four hours of debate. The split was largely along party lines.Gov. Peter Shumlin, a Democrat, campaigned on a promise to create a single-payer system in Vermont that would contain health care costs and give all of the state’s residents universal access to medical care. On Tuesday, Shumlin made good on the first step toward fulfilling that promise, and just five hours after the Senate vote, he marked the legislative victory in an appearance on MSNBC’s ‘The Rachel Maddow Show.’Shumlin said in a statement to the Vermont press: ‘Today the Legislature took a huge step toward making Vermont the first state in the first in the nation to control skyrocketing health care costs and remove the burden of providing health care coverage from small business owners. This bill is good for Vermonters and Vermont businesses.Many Vermont businesses, however, believe otherwise. Though small employers have said they will benefit, some larger employers actively lobbied against the bill. Opponents of H.202 argued that the legislation would leave businesses in the lurch during the transition period between 2013 and 2014 when the state is required under federal law to participate in insurance exchanges. The opposition was led by insurance brokers (the Fleischer Jacobs Group, Business Resource Specialists), business associations (Vermont Chamber of Commerce, Vermont Grocers Association and Vermont Retailers Association), large employers (Dealer.com, Biotek, Rhino Foods and IBM). The Senate debate on Monday and Tuesday centered on changes to the legislation that would have made it more palatable to these groups.Sen. Vince Illuzzi, R/D-Essex Orleans, who proposed two amendments that would have made the bill more business friendly, said companies are afraid ‘we will end up with a plan most won’t be able to afford.’The legislation sets the state’s health care system on a new trajectory. Instead of continuing to use an insurance model for covering the cost of care, the bill moves the state toward an integrated payment system that would be controlled by a quasi judicial board and administered by a third party entity. The system would be funded through a broad-based tax.The universal health care system would be implemented in 2014, if it clears 10 very high hurdles, including the receipt of a federal waiver. Otherwise it wouldn’t kick in until 2017.Longtime single-payer advocate Dr. Deb Richter was ecstatic about the Senate passage of the bill.‘I’m absolutely thrilled,’ Richter said. ‘It’s one of the best days of my life. I’ve given 400 speeches over the last 10 years and it feels like the work was worth it. We have a ways to go, but this is a step in the right direction.’A universal health care system is the only way to cover everyone and contain costs, Richter said.The passage of H.202 marks the first time any state in the country has attempted to provide universal care and a cost containment system that addresses administrative costs, hospital budgeting and uniform payments to doctors, Richter said.Whether the federal government will give Vermont a waiver to adopt a universal health care system in 2014 is an open question. Richter said the state has a 50-50 chance of getting the exemption from the Affordable Care Act. Even so, she believes Vermont’s attempt to create a single-payer system is worthwhile.‘You go for what you want, not for what you think you might get ‘ that’s what the bill does,’ Richter said.The Senate debate focused on the state’s implementation of the insurance exchanges that are required under federal law. The Affordable Care Act has mandated that states provide an actuarial value for insurance products (the insurance equivalent of a per unit price mechanism that allows consumers to compare the cost of on the shelf grocery items). The federal government has set up very general guidelines for the actuarial levels for insurance products insurers must provide under the exchange. The idea is to create an easy system for comparison between health insurance benefit plans that offer a dizzying array of deductibles, co-insurance, co-pays and premiums. The products, under the federal requirements, range from bronze (60 percent actuarial value) to silver (70 percent), gold (80 percent) and platinum (90 percent). It also puts minimum requirements on the ‘qualifying plans.’ Many of these mandates are already in Vermont law. Insurers, for example, are not allowed to ‘cherry pick’ consumers who are healthy and create pools without a cross-section of the sick and healthy populations.Read this summary of the ACA requirements from Kaiser Foundation.The Affordable Care Act requires individuals without insurance to buy into the exchange or face a $695 fine. Families of four with incomes of less than $88,700 qualify for tax credits. Businesses with more than 50 employees that do not buy insurance face a penalty of $2,000 per worker.The fight between employers and proponents of H.202 was about the potential for mandatory inclusion of businesses that have between 50 and 100 workers in the exchange. Sen. Hinda Miller, D-Chittenden, and Illuzzi argued that requiring companies of that size to participate in the exchange could jeopardize their economic viability. Employers in that range tend not to self-insure and so are not protected under the Employee Retirement Income Security Act.The federal law allows states some flexibility. States can decide what benefit plan levels can be offered, for example. They can also determine the size of the businesses that must be included in the exchange. The Shumlin administration pushed for intent language in the bill that could have led to the inclusion of businesses with 50 to 100 employees into the exchange. Proponents of H.202 have said it’s important to include these 28,000 workers in the state’s insurance exchange in order to build toward a single-payer system.An amendment proposed by Sen. Diane Snelling, R-Chittenden, and approved by the Senate struck the intent language. The Green Mountain Care board, which will oversee the health care reform effort including the exchanges, is charged with producing a report that would outline the impact of excluding the 50-100 employee group on the exchange, which the Shumlin administration wants to use as a stepping stone toward the single-payer system.Illuzzi proposed two amendments that would have forced the state to include a broader array of insurance carriers in the exchange would have specifically allowed health savings accounts and high deductible plans under the exchange and would have allowed ‘nonqualified’ plans outside the exchange. H.202 allows for two carriers.‘Let’s not kid ourselves it will be more than one carrier,’ Illuzzi said on the Senate floor. ‘It will likely be Blue Cross Blue Shield. It will be two carriers in name only. Both will be required to offer same (plans). It will be a change without a difference.’Anya Rader Wallack, Shumlin’s special assistant on health care, said she was impressed by the Legislature.‘A lot of people worked very hard educating themselves in a short period of time,’ Wallack said. ‘This isn’t simple stuff. I was impressed with the amount of effort both bodies have put into this.’The Shumlin administration was heavily involved in drafting the bill, H.202, though by the time the legislation reached final passage it had changed somewhat from its original incarnation, which was based in part on recommendations from Professor William Hsiao, the renowned Harvard economist who created a single payer system for Taiwan.Over the next year, the Shumlin administration will hire a director of health care reform and the chair of a quasi-judicial board. The board would be in place by January of 2012 and would begin the arduous task of sorting through the maze of federal laws, waivers, benefits, provider reimbursements, system financing and cost containment options.H.202 will be read in the House Health Care Committee on Wednesday morning. Rep. Mark Larson, D-Burlington, said he expects the bill will go to conference committee in several days. He expects to have no major beefs with the Senate version.‘The core composition of the bill remains identical to what passed in the House,’ Larson said. ‘There are differences between the two bills but they are things we can work out.’Larson said those details include a change in the dynamic of the board. ‘We want to make sure it’s an independent board.’He also referred to the so-called ‘Mullin’ amendment, which set conditions for implementation of Green Mountain Care, the single-payer style system that would be created under H.202. Larson said he thinks the new criteria for the implementation standards need to be more clearly defined.‘It has to be clear what hurdle has to be overcome,’ Larson said.Anne Galloway is editor of vtdigger.orglast_img read more


first_imgUEFA have launched disciplinary proceedings against FC Schalke 04 after the play-off encounter with PAOK on Wednesday.The allegations against the Royal Blues concern the alleged display of political banners, crowd trouble and late submission of team sheets.FC Schalke 04 will seek legal advice and plead not guilty.last_img


first_imgEL SEGUNDO — An hour before the NBA trade deadline, Lakers All-Stars LeBron James and Anthony Davis were facing the media side-by-side.James was asked how he received news that Andre Iguodala had just been traded to, and agreed to an extension with, the Miami Heat – his former team that now appears to be gearing up to make a run at the title.“How do I handle that news?” he said. “I don’t know, I mean, I saw it and was like, ‘OK.’”As the NBA scrambled itself around them on deadline day, the Lakers sat back and watched, standing pat with the second-best record (38-11) in the league. There was noise but no moves, even as would-be contenders reshuffled their decks to try to solidify their title chances. “I mean, obviously everyone has the ESPN app and the NBA app, so it comes to your phone,” Davis said. “So we don’t go out, well, I don’t go out checking for it. We don’t, ‘Did you guys see this trade, this is happening.’ We haven’t done that.”There was plenty of smoke. Multiple reports cited that Kyle Kuzma was a potential trade chip in a deal for Morris, a transaction that would have required the Lakers to include several other player salaries to make the deal work. The Knicks reportedly wanted Danny Green and a pair of future second-round draft picks included in a deal for Morris. Yahoo Sports also mentioned that the Lakers had fielded calls for Alex Caruso.None of it came to pass as the noon PT deadline ticked by. All three players were at the morning shootaround when it was already anticipated the Lakers could stand pat.One of the biggest moves tangentially involving Kuzma was his agent, Leon Rose, accepting a reported offer to become the New York Knicks’ president of basketball operations. Kuzma, who hired Rose over the summer, is expected to remain with Creative Artists Agency.James and Davis, who acknowledged working hand-in-hand with General Manager Rob Pelinka during the summer when the team was being constructed, were more cagey when asked if they played a role in any of the deadline decisions: “I think that’s a Rob question,” James said.Pelinka was not available to speak to the media on Thursday afternoon following the deadline.Related Articles Lakers, Clippers schedules set for first round of NBA playoffs How athletes protesting the national anthem has evolved over 17 years AD Quality Auto 360p 720p 1080p Top articles1/5READ MOREUCLA alum Kenny Clark signs four-year contract extension with PackersThe Clippers traded for Marcus Morris out of New York. The Heat traded for Iguodala. The Lakers’ Thursday night opponent, the Rockets, made some of the most dramatic moves of all, sending out franchise center Clint Capela to add 6-foot-7 Robert Covington.James found himself mostly reacting to the outside moves: He liked Miami’s move for Iguodala, who he said “helps them right away” because he brings “championship DNA.” The Lakers will learn right away how they can handle the Rockets, who now are likely to play most of the time without a traditional center.“They’re already shooting 45, 50 (3-pointers) a game,” he said. “Now they’re going to go to 60, 65 threes. That creates challenges for everyone in the league because you have to be on your toes and guarding a guy who is averaging almost 40, and guarding a guy who has averaged triple-doubles in seasons before. So it creates a lot more space for (Russell Westbrook) and (James) Harden.”Having a morning shootaround on the day of the trade deadline might seem unusual, but Coach Frank Vogel said he thought it was most important to give the Lakers a day off on Wednesday, following an emotionally exhausting week-and-a-half. Even though the team has won two straight, earlier in the week multiple players reported to the medical staff that they were feeling “worn down.”So the Lakers took Wednesday off and decided to shoot around the morning before their next game. James said it wasn’t awkward or tense, even as players who were mentioned in rumors were mingling around. Davis said phone alerts had popped up, but they had not been the source of much discussion among the team. Lakers practice early hoping to answer all questions center_img The Lakers have a full 15 roster spots filled, but could look at the buyout market in the coming weeks. The New York Times reported that veteran J.R. Smith would receive a workout with the team, and the Lakers have been linked to a potential return of point guard Darren Collison, who abruptly retired over the summer.Until then, the Lakers were simply following along.“You know honestly, just like everybody else that follows the NBA,” Vogel said. “This team did that, that team did this. It’s interesting. What are they trying to do? What do they look like now? It’s not too different from what the best of the basketball world is doing.” Trail Blazers beat Grizzlies in play-in, earn first-round series with the Lakers Trail Blazers, Grizzlies advance to NBA play-in game; Suns, Spurs see playoff dreams dashed Newsroom GuidelinesNews TipsContact UsReport an Errorlast_img read more