This would have been done by limiting the current power of the Green Mountain Care Board to regulate the rates that physicians can charge. Some doctors wish to practice independently, and their patients pay the fees and deal with any private insurance re-imbursement themselves. These physicians can reduce administrative burdens and spend more time with patients. They often set fees on a sliding scale, and may also provide free care, so they can serve all kinds of Vermonters. We should be able to choose to see such providers.
These practices are an important component of our health care capacity.
The problem is that the GMC Board has the power to set the rates even of doctors who are not participating in public programs. They could set the rates too low, and undermine the viability of these businesses, especially for specialists. The rates of re-imbursement Medicaid and Medicare are set so low that the cost is shifted onto private insurance, and many doctors are reluctant to take more public patients. Therefore this is potentially a real problem.
So I was just trying to ensure that doctors in private practice outside of public insurance could care for their patients without interference. The House Health Care Committee opposed this amendment on the grounds that it threatened the process of health reform. I had not previously understood that the GMC Board does not merely want to control doctors and patients within public systems, they want to be able to control all Vermont health care. This five person appointed board cannot know enough to regulate the entire industry effectively. And Vermonters like to have choice and independence.
My amendment failed.
H.510 is the Transportation Bill that allocates funding to different programs. This year there is also a complex increase in the gas tax. This year more money is needed to match Federal Transportation Funds. In the long run more revenue is needed to fund transportation because the current gasoline tax is applied as cents per gallon, so revenue does not go up when the price of gas goes up. Since prices have been higher, people drive less and buy more fuel efficient cars, and the cents per gallon tax brings in less. However, these justifications for the tax increase are undermined by the fact that revenue has been systematically diverted from the Transportation Fund for other state uses for years. No wonder there is a shortfall now. The net effect of all the changes will be a new sales tax of 4 percent of the price per gallon and the cents per gallon tax will be reduced to 13 cents from 19 cents but indexed to inflation.
So right when gas prices rise, putting pressure on working Vermonters' budgets, the gas tax will rise. Using a gas price of $4 per gallon, we would go from a current tax of 19 cents per gallon to 29 cents per gallon. (Four percent of $4 is 16 cents plus 13 cents.) If you buy 20 gallons of gas a week, that would be $104 in increased taxes a year. When inflation increases, putting on additional financial pressure, the cents per gallon tax would then increase as well.
I worked with other Legislators to amend this bill: 1) to make the tax increase temporary just to meet the Federal match, 2) to eliminate the inflation adjustment, 3) to require restoration of diverted funding streams quickly, and 4) to require a study of restoring the diverted funds to Transportation in the future. All amendments failed. I voted against the bill.
Cynthia Browning represents Arlington, Manchester, Sandgate, and Sunderland.