House Dems force end to debate to pass speaker’s hospital bill

Delaware House of Representatives Democrats on Thursday forced an end to a floor debate so they could pass their speaker’s controversial bill to create a state board to oversee hospital budgets.

The move came after three hours of head-scratching gamesmanship in which Republicans essentially filibustered with multiple representatives questioning aspects of the bill and Speaker of the House Valerie Longhurst’s attempt to play Lady Beneficient failing because she frequently couldn’t keep the scorn out of her voice.

One reason for the hurry: The House and Senate are about to take a two-break so the Joint Finance Commission can conduct hearings on capital requests. Passing the bill now means it can move more quickly through the Senate and into law.

Moving hospital bill

The end started after a break, when the House came back into session at 9:30 p.m. to continue debating House Substitute 2 for House Bill 350.

Rep. Ronald Gray, R-Selbyville, took the floor. As he was waiting for David Bentz, a former representative who stepped down in 2022 to go to work for the Delaware Department of Health and Social Services, five Democrats rose.

Acting speaker William J. Carson, R-Smyrna, asked, “Does someone have something here?”

Rep. Madinah Wilson Anton, R-Newark moved to call the question and noted there were five members standing under House Rule 48 Seven.

Despite audible comments that Gray had the floor, Carson immediately responded, “Motion has been made and seconded and is a non debatable.” He trailed off to start again, “Mr. Chief Clerk” but was interrupted by House Minority Leader Mike Ramone, R-Newark/Pike Creek, who noted that Gray had the floor.

“It’s not debatable with the five-man rule,” Carson said. He started a roll call on the motion, which fell along party lines, except for Rep. Sean Lynn, D-Dover, who voted no for the motion and on the bill.

Lynn rose after the vote on the bill to say he was severely disappointed that his attempts to be heard in the last four hours had been ignored, especially because his children had been waiting in his office the entire time.

‘I’ve been up and I’ve been down and I was absolutely denied the opportunity to have my voice heard on behalf of my district,” he said. “Dover is significantly affected by this bill.  I’m significantly disappointed in both the tenor of the bill and 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.”

Lynn said he had significant questions about bond covenants and bonds that the hospitals had issued, which he thought would lead to significant pre-emption  issues and had not had the opportunity to be heard on that.

He threw a message bag over his shoulder as he ended his statement and walked out to the applause of Republicans.

Longest debate?

Rep. Jeff Spiegelman, R-Claymont, noted that the hospital debate had been the longest in his 12 years in office but it was also fascinating to get the different perspectives.

“I’d just like to point out that while, yes, it is in the rules for a majority of votes to be able to call for a vote in this matter,  I do think that in this way on a bill of such importance the state of Delaware that the minority of opinion, the minority political opinion was won by a vote simply because it had run long.”

House Majority Whip Melissa Minor-Brown, D-New Castle, immediately moved to put the House in recess. Ramone balked, “Whoa,” noting that people had been standing to be recognized.

“I’ve been standing,” she told Ramone.

“You’re going to shut it down, huh,” he said in response.

Carson immediately called on Rep. Danny Short, R-Seaford, who also had been standing. He said he’d been a member of the board of Nanticoke Hospital, which once had to ask the state to borrow $5 million to make payroll and keep the hospital open.

“I think the idea that our speaker has put forth is something to work on,” Short said. “I hope there will be some compromise and some effort to come to a conclusion that helps everybody reach a destination that they can live with.”

He pointed out that the state was asking hospitals to meet a benchmark when the legislature hadn’t met its own Delaware Economic and Financial Advisory Council benchmarks in the last four years.

Ramone ended the comments for the night, saying what the Democrats did was “despicable and disrespectful to the people of Delaware that we’re here to represent.”

He said he thought the bill may be unconstitutional and expected it to go to court.

One-vote margin

The Delaware Healthcare Association issued a statement Friday expressing its disappointment over the bill passing by a one-vote margin with four members absent.

It will slash $360 million from our healthcare systems, forcing hospitals to make budget cuts that will negatively impact healthcare services, healthcare providers and critical community social support programs, the statement said.

“The bill will also put paid political appointees in charge of the oversight and control of Delaware’s hospitals instead of local community leaders serving on our nonprofit hospital boards,” it said.

The statement maintained DHA came to the table with meaningful alternatives that address healthcare affordability, enhance transparency and establish a collaborative effort “to identify real solutions to our shared concerns.”

“Unfortunately, we simply did not have adequate time to engage in a meaningful stakeholder process on a massive healthcare policy,” the statement said. “DHA calls on Governor Carney, Speaker Longhurst and Majority Leader Townsend to convene stakeholders and lead a process to find a solution that works well for the unique needs of Delaware.”

Board salaries

House Substitute 2 for House Bill 350 — the third iteration of the bill — would create a seven-person board to be named the Diamond State Hospital Review Board. It’s expected to cost about $1 million a year.

Board members, who would be expected to know something about the industry, would be appointed by the governor and confirmed by the Delaware Senate for four-year terms. The chair would be paid $40,000 a year and the members $35,000,

The bill would require six hospital systems to keep their budgets at the state benchmark for growth, which has ranged from 3% to 4% since it was created in 1918.

If the budget does not meet the benchmark, which is determined annually by a DEFAC subcommittee, the state board will be authorized to ask the hospitals to change their budgets.

Longhurst says the largest part of state costs for healthcare — 42% — are hospital costs and the state needs to move to protect its citizens from high costs that are sucking up government, business and private budgets.

Republicans in particular are horrified that the state wants to take control of the nonprofit systems, stopping just short of calling it socialism.

The hospitals don’t believe the state can find people who understand the workings of a hospital and its interwoven deals with various institutions. If the state is going to monitor budgets, the hospitals believe it should include insurance companies, pharmacies and more.

RELATED STORY: State moves to control hospital budgets to lower healthcare costs

Longhurst set the tone for the night when she introduced the bill.

“This legislation is not about punishing hospitals, but rather ensuring our constituents are able to access quality and affordable health care and put a system into place to slow down the skyrocketing costs that we have experienced in Delaware,” she said. “Our current system is not sustainable.”

She went on to paint hospitals as blagards who were not negotiating in good faith and said opponents had started a misinformation campaign.

The bill is based largely on Vermont’s Green Mountain Care Board. It was not true that hospitals were closing in that state, she said.

GOP questions

It was clear Longhurst expected Republicans to fight the bill, and many immediately stood.

Most questions were repetitive and seemed devised to be unclear so that the speaker could continue eating up minutes, and Democrats seemed to willfully misunderstand questions, apparently to throw shade on the asker.

RELATED STORY: Hospital board bill could threaten Medicaid’s $100 million new money

One focal point was why the bill had been introduced in the House Administrative Committee rather than the House Health and Human Development Committee. Finally, house attorney Karen Lantz was called as a witness. She said the speaker could put the bill in whatever committee she chose.

Of the Republicans who spoke, Rep. Valerie Jones Giltner, R-Georgetown, fared the best, largely because she really knew what she was talking about.

A nurse who worked for years as a healthcare consultant dealing with hospital budgets, federal demands and other issues, she asked a series of questions probing the language or lack of language in the bill.

Her point essentially was that the bill appeared to have been thrown together and that the sponsors and Bentz didn’t really understand the issues that hospital deal with well enough to write meaningful legislation or to oversee budgets.

She noted that a recent Becker’s Hospital Review report said that one-third of Vermont hospitals were in danger of closing in the next two years.

At one point, Dems demanded that witnesses — mostly Bentz, a former legislator who clearly understood the dynamics and was capable of handling himself — be treated with more decorum.

Racism reared its ugly head.

Minor-Brown heavily questioned Brian Frazee, executive director of the Delaware Healthcare Association, which represents hospitals and other healthcare institutions, about a ChristianaCare internal memo.

It said that if the bill was passed, the hospital would have to make drastic changes.

“This bill will have horrific consequences for Delaware’s most vulnerable populations, including Black people and Hispanic people,” Minor-Brown read.

She asked how the situation led directly to Black people and Hispanic people.

Frazee said he thought it would have consequences for all people.

Then, Minor-Brown demanded, why mention only Black and Hispanic people.

“I just want to make sure we’re not just, you know, prioritizing the non Black people and non gay people,” she said.

Minor-Brown said she thought the note was proof that others might need to be at the table when hospitals are planning services and outreach.

“We want everybody at the table figuring this out and certainly understand your point, representative,” Frazee said, “but that’s not our intent there.”

The bill now goes to the Senate for committee hearings and then a floor debate, but is guaranteed to pass because the Senate has a Democratic super majority and doesn’t need a Republican vote for it to pass.

Watch the whole debate here.