"The way that they profit is to deny care"

2024-03-19

Dear friend,

How's your week going so far? I'm pretty excited. At halftime in the Vermont Legislature, we are on track to save lives and reduce healthcare costs.

For a bill to become a law, it must pass both the House of Representatives and the Senate, and then be signed by the Governor.

By the rules of the Legislature, we set a deadline at the midpoint of the session -- Crossover. For bills to be considered by the Senate this year, they have to pass out of the House by that deadline, and vice versa. Although there are wrinkles and workarounds, Crossover is key.

Crossover is key, not Crossing Over. Sorry fans of John Edward's 2001–2004 TV show about a medium.

What's making Crossover this session? Here's a link to today's House calendar. Bills under the "Action Calendar" are ones that we voted on today. Bills on the "Notice Calendar" are coming down the pike. By rule, bills must appear on the Notice Calendar for a couple of days so that legislators have a chance to review them.

In this very hectic time, I want to share something special that happened last week. I voted "Yes" on an important bill, passed in time to cross over to the Senate, to help Vermonters get the medical care they need in a timely way.

To put several faces on this bill, you might enjoy taking 10 minutes and watching this Opinion piece that was featured last week on the New York Times: ‘What’s My Life Worth?’: The Big Business of Denying Medical Care. It highlights the stories of individuals whose essential healthcare was denied by this bureaucratic process.

Prior authorizations are a practice where doctors have to get expensive procedures cleared by insurance companies. While intended to control costs, there's a lot of evidence that this practice does the opposite. Prior authorizations:

• require multiple staff members even at small medical practices

• delay timely and life-saving care

• may not even make a difference

It's a hoop you have to jump through. If you are persistent and stick with the process, you often get your care approved. But plenty of people don't make it. Money is saved by insurance not because they delivered a better outcome, but because someone's illness progressed so that the treatment became obsolete.

As the video puts it, "The way that they profit is to deny care."

With the passage of H.766: An act relating to prior authorization and step therapy requirements, health insurance claims, and provider contracts, I joined the House Healthcare committee in supporting:

• modifying the time frames within which health plans must respond to prior authorization requests;

• limiting the occasions on which reauthorization is necessary for a previously approved treatment, service, or course of medication;

• prohibiting prior authorization requirements for generic medications and for items and services with low variation and low denial rates across health care providers

We want to see a balanced approach where the benefits of the second opinion offered by "prior auths" remains available. I am confident from the work on this bill that we have struck a good balance, and that this topic will be reviewed by the Legislature to see how the field responds.

While Americans have a perception that our politics is very "divided," many bills in fact pass the House unanimously by voice vote. Roll call votes, where each Representative goes on record as "Yea" or "Nay," are usually only called for on close or controversial measures.

H.766 was a special bird, one in we held a roll call vote, and all 137 Reps present voted "Yes," with 0 in the "No" column. (See full results.)

H.766 passed the House on a 137–0 vote

Your Legislature is hard at work trying to control healthcare costs. I am happy with the strong signal that this roll-call vote sends to the Senate and to the Governor that the House really supports this bill.

Do you support it? Please contact your Senator to let them know.

***
Thank you to everyone who celebrated K-9 Veterans Day in Vermont last Wednesday! It was a very special day in the State House.

Rep. Roberts presents H.C.R. 152 to Corporal Dave Robinson, honoring the service of K-9 veterans.

Corporal Dave Robinson of Brattleboro offered a beautiful Devotional in honor of our four-legged warriors. It takes up the first three or so minutes on this playback. Stick around for about 10 minutes on the video for the ceremonial reading of H.C.R.152 and a standing ovation for Dave.

Have a great rest of your day! As always, I'd love to hear your feedback and thoughts.

warm regards,

Rep. Tristan Roberts
Vermont House of Representatives

P.S. One more photo of on K-9 Veterans Day. I am very grateful to know Corporal Robinson and everything he's taught me.