Legislation to create a hospital cost review board in Delaware passes in the House on a near party-line vote following a heated debate that was cut short by a procedural move from Democratic representatives.
The bill's sponsor, Speaker of the House Valerie Longhurst (D-Bear), says the creation of the board is an attempt to curb rising healthcare costs in the state by requiring hospital budgets to be reviewed in their compliance with spending benchmarks.
The spending benchmark has fluctuated between 3% and 4%, but she notes healthcare spending has surpassed that mark every year except for 2020, continuing a trend that was seen prior to 2018 when the benchmarks were established.
Longhurst says the board would review all hospital budgets annually, and when a hospital fails to meet spending benchmarks, it would be required to work with the board on a performance improvement plan.
Under the bill, when a hospital successfully meets its budget goals for three consecutive years, the hospital would no longer be required to participate in the budget approval process.
“This legislation is not about punishing hospitals, but rather ensuring our constituents are able to access quality and affordable health care and to put a system into place to slow down the skyrocketing costs that we have experienced in Delaware," she says.
Department of Health and Social Services Deputy Director of Healthcare Reform David Bentz says while other factors are involved, hospital costs are the largest driver behind rising healthcare expenditures in Delaware, although the specifics are unknown because of lack of budget transparency.
"The reasons why we chose this model is because there is evidence from other parts of the country that it works, and in those same states, they have better health quality than we do," Bentz says.
Delaware Healthcare Association President and CEO Brian Frazee argues this type of review board is unprecedented compared to other states.
"The act of having to turn over our entire budgets to the board upfront is where we believe that's a bridge too far because that's very detailed information," Frazee says
Throughout the debate, Republicans raised concerns over the Board being government overreach and that it would restrict hospitals’ ability to meet capital improvement needs, properly recruit staff and repay bond debts.
They also questioned why the bill did not address monitoring pharmaceutical or health insurance companies as cost drivers, to which Longhurst replied she would be open to legislation that addresses those entities.
There was also debate on the bill being assigned to the House Administration Committee instead of the Health and Human Development Committee, which Republicans argued could make the bill out of order.
Comments from both sides of the aisle to keep decorum were brought up repeatedly, along with a motion to table the bill that failed on a near party-line vote.
After roughly three hours of debate, the acting Speaker of the House Bill Carson (D-Smyrna) called for a ten minute recess, and when the House re-convened, Democratic representatives utilized a special procedure to call the previous question, meaning after a near party-line vote, debate on the bill promptly ended, and the legislation was brought to a vote.
The bill passed 21 to 16 with 4 members absent, with State Rep. Sean Matthews (D-Brandywine), State Rep. Stell Parker Selby (D-Milton) and State Rep. Sean Lynn (D-Dover) defecting from the otherwise party-line vote.
After the vote, Lynn expressed his disappointment with his inability to make comments during the debate.
"I've stood up. I've asked to be added to lists. I've been told I was on a list. I've been up, I've been down and I was absolutely denied the opportunity to have my voice heard on behalf of my district. Dover is significantly affected by this bill. I'm severely disappointed that we were deprived of the right," Lynn says. "I'm significantly disappointed in both the tenor of the bill, the way that was handled this evening, and lastly, that we were deprived of a right to have questions asked and to have statements heard."
"I do think that in this way, on a bill of such importance in the state of Delaware, that the minority opinion, the minority political opinion, was squashed by a vote today, simply because it had run long," State Rep. Jeff Spiegelman (R-Clayton) adds.
State Rep. Danny Short (R-Seaford) followed with data on the state's inability to meet its own budget benchmarks: "So we're imposing a benchmark on a private industry, yet we can't make our own benchmark? And part of what we're talking about is also the expense within our own issue. I think we're moving in the wrong direction, when we can't do what we're saying we want others to do."
"We were asked during the course of the meeting tonight to exercise decorum, and it seems like that request is often more asked when you want other people to do it, but you don't do it for yourself," House Minority Leader Mike Ramone (R-Pike Creek South) says. “It’s an embarrassing day. It’s a very sad day. And I’m very sad to be part of this legislature. I know you have more bills — I am asking my colleagues to call it a night — we are leaving. You don’t listen to our votes, so we can’t talk about our [constituents] anyway.”
State Rep. Paul Baumbach (D-Newark) made the final statement of the debate, responding to Ramone.
"I just would like to point out that I think there were actions that were done tonight, that were not encapsulated by our minority leader. I don't recall, during my 12 years, of seeing a three-hour rolling filibuster, where we had witnesses up, and we had people who were speaking, not asking questions," Baumbach says. "That, to me, is not a sign of good faith discourse and doing the best to represent your constituents. I'm not saying that we are all innocent on one side or the other, but I'm saying this is a legislature. Stuff happens. We've seen it on both sides of the aisle today, I think."
Following Baumbach's comments, House Majority Leader Melissa Minor Brown (D-New Castle) motioned to recess before all closing comments could be made.
Following the floor debate, State Rep. Bryan Shupe (R-Milford South) said, "The way that the majority party ended the night by forcing an end to debate, by finding some obscure rule, concerns me very much and should concern the healthcare industry because now, what makes them, and the people of Delaware, think that the healthcare industry will have any voice on this board where there are no voting members of healthcare professionals?"
According to the bill, the governor would appoint seven members of the board who must have "knowledge of healthcare policy, healthcare delivery, or business, finance, or accounting," with the eighth member being the president and CEO of the Delaware Healthcare Association, who will not have voting powers.
The bill now heads to the Senate for consideration.
