Middle school teachers of literature often say that the first act of a play ends with a question mark, the second with an explanation point and the third with a period. Following this analogy, I would say we have reached the end of the second act with a resounding exclamation point coming from the chambers of the Senate.

The most interesting place to be right now is the Senate with the budget and the tax bill passing last week and the unified health care bill slated for this week. Parodying the voice of Hamlet: to tax dentists, or not to tax dentists; to increase taxes on the wealthiest Vermonters, or not to increase this tax; to increase the tax on cigarettes, (although “not to tax” was never considered) – by 27 cents as passed the House, or $1 as passed the Senate Finance Committee? Following seven amendments and heated debate, the tax bill passed, raising about $24.5 million in new taxes, which included a 53 cent tax hike on cigarettes and the dentists were, once again, spared.

In contrast, H.441, the appropriations bill, often referred to as “the big bill,” passed easily with only one dissenting vote, resolving the $176 million budget gap for 2012 with the largest cuts to human services.

These bills will return to the House this week where changes between the House and Senate-passed versions will be reconciled in the House Appropriations Committee for the budget bill and House Ways and Means for the tax bill. These committees will then have three or four options.

The first option is to concur with the Senate’s amended version and bring the bill back to the floor with a recommendation to pass the bill and send it on to the Governor for signature. The second option is to concur with further proposal of amendment. The bill goes back to the floor of the House where it must pass and then return to the Senate for approval.

The more likely option with bills that have undergone significant change would be that they do not concur with the version passed by the Senate. At this point, House Speaker Shap Smith and Senate Pro Tempore John Campbell will each appoint three members from their respective chambers to a “committee of conference.” A fourth option is to do nothing. As this is the first year of the biennium, the committee can hold the bill and pick it up again in January. In the second year, any bill that has not been sent to the governor dies. This is not true for the budget in either year, however. The Legislature cannot adjourn until a budget is passed and sent to the Governor.

I have found this process not to be for the faint of heart. This process is set either by the Constitution or by the Joint Rules of the House and Senate and I have not seen any other alternative to get this work completed in a timely fashion. Nonetheless, major decisions can be made by a small handful of legislators and if you don’t keep your eyes open, tricky things can happen. Even though these committee meetings are all public, it is challenging to be in several places at the same time, thus it is important to have a very good network of contacts who are closely watching the different conference committees.

The original adjournment date was slated for May 7th with the option to add Saturdays and Mondays to our schedule to meet this deadline. Although there is great pressure to complete the universal health care bill and many, many others, the only bill that could truly delay adjournment is the budget bill.

I have placed some links which you can find on the right side of this site under “Kate’s Links.” You will find the latest version of the bill which passed the Senate Health and Welfare Committee on a unanimous vote after some additional revisions. Anything that said “single payer” has been stripped from the bill and some of the charges and responsibilities of the board have been reduced. There is also a link to other documents including frequently asked questions.

Feel free to email questions to me: klwebb22[at}mac.com and if appropriate, I will post answers on this website as they come in. Send to my email rather than replying on this site. Messages left on this site get lost in the hundreds of spam that come in.

The standing-room-only presence at the evening health care forum last week is a testament to the community’s interest and concern about pending health care legislation.  After the meeting, several people came up to me with feedback.  While several people expressed relief when they saw the flow chart showing a multi-year process with check points along the way, a more vocal crowd expressed frustration that their questions had not been answered or did not feel that their concerns about the general principles were being heard.  I have shared this with our leadership and made some recommendations.

I am planning to put some links on my website (www.katewebbvt.com)  to help people get answers to their questions and follow the action unfolding in the Senate.  This should be up before the weekend.  In the meantime, I will field questions related to your situation by email: klwebb22@mac.com.  The more specific and focused the questions, the easier it will be for me to get back to you. Do remember that the only staff I have is myself.  There is extensive information and a list of frequently asked questions on this website: http://www.leg.state.vt.us/jfo/healthCareReform.aspx that I will also post on mine.

Of ongoing concern to everybody has been “how much will it cost” and “how will we pay for this?” We do not know what it will cost yet, but we do have a starting place.  We know what we are spending now ($4.7 billion) and we know where we are headed in the 2013 ($5.9 billion) so we do know that whatever we build needs cost less than this. Businesses know that if they are spending, perhaps $500 rising to $700 then  $1000 per employee per month with no sign of letting up, there must be a more efficient and effective use of these dollars that also allows them to focus on their own business and not the business of health care.

Throughout this process, there has always been a balance between the competing interests of accuracy and speed in developing a financing plan. The faster the plan is developed, the broader the assumptions must be.  To develop an accurate plan, to allow for public participation, and to build confidence in this plan, it is important that it not be rushed.  This is why a full picture of the financing is not expected to be in place for at least two years.  The future board will look at a variety of sources: payroll tax, income tax, consumption taxes, provider assessments or other new or existing options.  Nothing here is set as of yet.  How it will come about will be subject to a lengthy study and opportunities for continued participation.  Those of you frustrated by this, please stay engaged, keep asking questions and giving input.

Other more specific questions can be answered and here are a few I heard that night.  As the bill stands today, Medicare is untouched.  Those who are receiving retirement benefits would not be required to change. Union-negotiated benefits may continue to bargain benefits if they so choose.  Other questions need more time for thought such as what to do with students in Vermont colleges, adult children up to age 26 and out-of-state networks available to Vermonters.

I voted for and continue to support H.202, an act relating to a universal and unified health care system.  That said, I too am anxious to see how the details will be fleshed out and addressed.  I believe that within two years, we will have a better idea as to whether or not this will work as planned.  The bill is continuing to undergo change in the Senate and should a bill pass, we will likely be revisiting this legislation for years to come.  When we do, we will need to analyze the data and continue to question our underlying assumptions and adjust accordingly.  And in the end, “do no harm.”