MONTPELIER, Vt. - Vermont lawmakers made clear Friday that recently enacted federal health care reform did not go far enough toward a public model, passing legislation that could bring to the state the "public option" health insurance rejected by Washington or even a Canadian-style single-payer system.
By a vote of 91-42, the Democratic controlled House passed its own version of legislation passed earlier by the Senate. Both bills call for designing a single-payer system, in which a government agency would administer and make all payments for health care.
The House version calls for that as well as a parallel design of a system with a public option for health insurance, meaning a system in which a health insurance program offered by the government would compete against those offered by private companies. The House's version also would expand previously enacted reform efforts.
Either system would require federal approval.
The Senate focuses on single-payer as the goal, but also calls for two alternative designs. Differences will have to be worked out in a conference committee of three members from each chamber, and it's not clear what Gov. Jim Douglas, a Republican, will do with the bill.
Heidi Tringe, the governor's deputy chief of staff, said Douglas likes parts of the bill but has "strong concerns" about others. He has not said if he would sign it, veto it or let it become law without his signature.
Douglas doesn't like the single-payer or public option ideas because the federal health care law blocks states from pursuing any such plan until at least 2017, Tringe said. "We'd spend $250,000 to design these options, but we couldn't hope to implement them until 2017 at the earliest," she said.
The governor likes provisions to expand existing efforts to control costs and slow hospital budget increases, Tringe said. He does not like a provision requiring drug companies to disclose to the attorney general when they provide free samples to doctors' for distribution to patients, she said.
The legislation has "the dual goals of providing affordable coverage to every Vermonter, with access to health care in the right time and in the right place, and secondly to contain the costs of health care over time," Rep. Steven Maier, a Middlebury Democrat and chairman of the House Health Care Committee, told his House colleagues.
What Democrats called a new effort by Vermont to act as a laboratory pushing health care in a more progressive direction, Republicans called a fool's errand.
"Rather than focusing our efforts on ensuring that we can take full advantage of all of the resources that will be provided to states through the new federal law, we are setting Vermont on a completely different course than the rest of the country," said House Republican Leader Patti Komline.
Part of the bill calls for setting up new teams of nurses and other health care professionals to manage individual patients' cases. It's modeled on the Vermont Blueprint for Health, a program that Douglas has touted, which began with a few teams managing treatment of diabetes, heart ailments and other chronic diseases.
House Republicans said the state can't afford to expand that effort now, given its current budget crunch.
Sen. Doug Racine, chairman of the Senate Health and Welfare Committee, said the Senate version of the bill focused mainly on designing a single-payer system, with the two still to be determined alternatives. "It's just a difference in emphasis" between the House and Senate versions, he said.
Vermont's efforts to create a public option or a single-payer insurance system could run into trouble because either would require the federal government's OK so the state could continue receiving Medicaid funding from Washington, Racine said.
But Racine, a Democratic candidate for governor, said inaction is not an option. He said the state's health care costs are expected to grow from about $5 billion in 2009 to $6 billion in 2012. That $1 billion difference about equals the state's entire general fund budget, he said.
"We need to make basic, structural reform if we're going to get costs under control," he said.