Call Gov. Scott for healthcare reform - 802-828-3345
2024-05-07
Dear friend,
What do you consider sacred? For an upcoming column I'm writing about what's sacred to me, and I'd love to reflect on anything you want to send my way.
What do I mean by "sacred"? The dictionary defines it as "connected with God (or the gods) or dedicated to a religious purpose and so deserving veneration."
I'll go ahead and give you my thesis in case you want to poke holes in it. First, I'm setting aside in this conversation of whether and how God or gods exist. The question I'm interested in is how humans discover a relationship with the sacred, and when and how they gravitate toward it. By sacred, I mean beyond reproach. Something in your life that's greater and wiser than oneself, that you feel connected to, but that is not you. That way you can measure yourself up against it, and access its wisdom when you need it.
I feel as though it is human to have a relationship with the sacred. For some people, this might be nature. I love how our National Parks are set aside with the idea that there's something so special there on Earth, that we shouldn't try to improve on it. When I'm going through something that requires reflection, being out in nature never fails to give me some insight. I never get to see the whole picture (like gods do), but I see a step forward.
I don't consider the workings of government to be sacred. I mean -- look at how a bill becomes a law in Vermont.
It's not exactly poetry in motion!
How a bill becomes a law - from Bill Introduction to Bill Enactment
The process of making and changing and interpreting and enforcing our laws is a hodge-podge that often feels intended to make change hard to happen (see No to excuses, yes to second chances). But throughout the law, we find moments where humans are asked to think, not for themselves, but to hold themselves to a higher duty. To me, the duty of being responsible to over 4,200 direct constituents and 647,064 Vermonters is so much bigger than myself that it inspires my deepest respect, if not a sacred awe.
That's why I'm writing to you from Montpelier on the Monday of the last week of the 2024 session. Even as the session winds down, I remain focused on fulfilling my oath of office (as I wrote about the day after taking it in January 2023 -- The buck has a new place to stop.)
We don't normally legislate on Mondays, but Speaker Krowinski gaveled us in at 1 p.m. today (Monday), and the floor session today went almost to 6 p.m.
Why so serious? Being counted for S.220: An act relating to Vermont’s public libraries, and which passed 97–20
We are in the midst of debating and voting on so many bills this week covering so many topics, I don't know where to start. To see what we're up to, visit the Legislature's homepage, and then look for the link to the Current House Calendar. Here's the House Calendar for today, Monday, May 6th.
In the spirit of this newsletter's focus on how a bill becomes a law, I'm going to focus today on H.766. Remember H.766? It's a bill that I last discussed here when the House approved it on a rare 137–0 roll-call vote. H.766 would reform the process of insurance companies using "prior authorizations" to deny treatment prescribed by your physician.
I asked you then to ask your Senator to support H.766, and they did support it. The bill passed the Senate, with amendment, and now the House has approved the amended bill and sent it to the Governor's desk.
Have you had a procedure ordered by your doctor denied by your insurance company? I have, and I've since become aware that it's one of the biggest tools that insurance companies use to trim costs. For more on why I support H.766, please see the commentary below that was published in the Deerfield Valley News.
If you support asking insurance companies to reduce their reliance on "prior authorizations," please call Governor Scott’s office at 802-828-3345 and ask him to sign H.766 into law.
This bill was subject to a last-minute lobbying attack from the insurance industry. Will the Governor veto it? I hope not.
If you agree, please let Phil Scott know at 802-828-3345, or email him here. Tell him your story and why you support H.766.
warm regards,
Rep. Tristan Roberts
Vermont House of Representatives
P.S. Here's my full commentary on H.766 that ran recently.
Denied care by a “prior auth”? H.766 is smart reform.
By Rep. Tristan Roberts
Healthcare, as you know, is a mess.
Take my right foot—please.
It all started when I wore this one pair of dress shoes to Alison’s cousin’s wedding in N.C. a couple years ago. I was on my feet all day, and the band was hot! By the end of the night I had an excruciating pain in the ball of my right foot. It subsided the next day, but came back that summer when I went door-knocking for a week straight in those same shoes.
The whole thing is a mystery. My podiatrist, poking around sharply with her thumb, could not find any sore or inflamed areas. The only thing that has worked is to adapt. I wear wide-sole shoes or sandals. If I do experience pain, resting and going barefoot help. Barefoot worked on my son’s 6th-grade hike up Gap Mountain this fall, but I don’t think it would be appreciated in the hallowed halls of Vermont’s State House.
After P.T. didn’t do anything, my podiatrist ordered an MRI. I was reluctant– due to my high deductible, I know I’ll be paying for it out of pocket . Maybe I should skip the procedure and save up for property taxes this fall. But she insisted. “This isn’t getting better. We need to see what’s going on in there,” she told me.
My doctor told me that I’d be notified when I was approved for the MRI and that I could call the hospital for an appointment then. Instead, I got a letter from a company whose name I didn’t recognize and didn’t have a relationship with, but that said it was working with my insurer.
The letter told me that my doctor’s request for an MRI had been denied, because I first needed to get an ultrasound. Or was it ultrasound therapy? It seemed like it was written to be confusing. It didn’t speak to my underlying condition and it wasn’t written by a medical professional who knew my case. It was written by a for-profit company hired by my insurer to look for excuses to deny care.
Prior authorizations are a practice where doctors have to get expensive procedures cleared by insurance companies, which use the practice to pad their bottom line.
What happened next? As with everything about healthcare in 2024 in America, it’s an ongoing war of attrition. Within a week or so I found a quiet minute between two other errands to call my podiatrist to ask about this ultrasound thing—should I get that? Why hadn’t she mentioned it?
Of course, I had to leave a message because she works in the nursing home that day. I’m waiting now for her to follow up. Maybe I should double-check that letter to see if there was more to it. Now, where did I put it? Adulting can be hard, even for this state legislator.
I’m trying to keep my sense of humor about it, but it was no laughing matter for Representative Kari Dolan of Waitsfield. Speaking on the House floor in support of H.766, Rep. Dolan said, “My own daughter, at age 16, was denied cancer treatment. We worked with her oncologist to fight that decision.”
Imagine Kari’s stress. Not only are you coping with your daughter’s having cancer, you’ve got to fight the obstacle course of the healthcare system.
I was happy to learn later from Rep. Dolan that her daughter is alive and well today in her late twenties. The messed-up thing about “prior auths” is that they truly only function as a “hoop” to jump through, to add friction to the system.
Insurance companies look for excuses to deny care to keep their immediate costs down, but doctors and patients know that if they persist, they can often get the care authorized. But that’s if you’re lucky. And to get that care approved, healthcare providers employ dozens of people just to submit and fight for prior authorizations.
For a portion of cases, the timely and life-saving care is denied. The treatment becomes obsolete because the patient dies, or their condition progresses and they lose their sight. Such cases were included in a recent documentary, “What’s My Life Worth?’: The Big Business of Denying Medical Care,” shown on The New York Times website. "The way that they profit is to deny care," states the film.
I’m proud not only to have voted “Yes” on H.766, but to hear every Representative agree, in a 137–0 roll-call vote, that this practice needs to be radically reformed.
H.766 is a bill that’s off on the right foot. It’s smart regulatory reform that limits some prior authorizations and kicks others to the curb. If the Senate approves and the Governor signs H.786 (ask him to at 802-828-3345, or email him here), we’ll be writing a prescription to both insurers and hospitals—cut your administrative costs and focus on patient care.