Rep. Anne Donahue, Legislative Update, January 10, 2014
There was no time wasted starting the 2014 session. On day two, we heard the governor call for response to a public health crisis of opiate addiction, and the next morning my committee (House Human Services) held a joint hearing with House Judiciary and our Senate counterparts on the administration’s new pretrial services proposal.
Other first week updates in this report: budget pressures, the House vote on campaign finance reform, and bills introduced to clarify the end-of-life by physician prescription bill that became law last spring.
Pretrial Addiction Services
The pretrial services proposal, already drafted as a Senate bill, would insert a risk assessment and needs screening after arrest but before a person’s first court appearance. Based on the outcome, a prosecutor could choose to allow diversion into a pre-charge drug treatment program, and if treatment is completed, no charge would be filed.
If the prosecutor did not offer diversion, the assessment would be used in deciding upon conditions of pre-trial release. That release could include a treatment referral, and if completed successfully, the prosecutor could choose to drop the charges. Alternatively, after a conviction, the treatment outcome could be used to inform sentencing decisions.
I think we will have to keep very close watch on two aspects:
The greater that any system allows for more personalized approaches and for using discretion to affect what happens to a person, the risk increases that there will be injustice resulting from benefits going to some persons and not others.
Under this proposal, how a person is treated could vary dramatically based upon the new risk assessment tool, and we are a long way from having fool-proof ways of predicting who will succeed or not.
Every time we use the words, “a prosecutor could choose,” we create the danger of personal biases entering the justice system. There is both potential for good and potential for bad.
Second is the question of cost. The math always looks good when we project future savings through current investments. Money spent on creating this new system could easily be regained and more, when we save on the costs of future increases in addiction and crime, as well as the cost of locking people up in prison.
It’s rare, though, that we can actually put a finger on those savings in later years. We say the same about investments in preventive health care, education, and early intervention with troubled families. But we can really only speculate about what the increased costs might otherwise have been, if we had not spent the up-front money.
These are all about educated gambles, not sure-fire returns on investment. While the social benefits are clearer, the cost-benefits are less so.
My committee began reviewing two other big money issues in our first week: emergency housing for the homeless, and how to increase successful outcomes for families on Reach-Up (support to needy families.) Testimony came with pleas for new investments for future savings.
In just the past few years, we have almost quadrupled the budget for emergency housing: from $1.4 to $2.4 million in fiscal year 2012, to $4.35 million in fy 13. This includes a cold weather policy, which allows for housing everyone who asks if it is under 32 degrees and snowing, or under 20 and dry. (That has been 28 of the 31 days in December.)
This relief, however, comes mostly in the form of hotel vouchers, which doesn’t make much sense as public policy.
Last year, we tried to address this by shifting two-thirds of the money into developing longer-term housing solutions, and authorizing a priority system for emergencies. The system that resulted drew fire over the people being turned away (having a child age 6 or under grants a pass in the door, but there is no guarantee for a 7-year-old).
Despite that, the program is still running at almost the same as last year (projected at about $4 million), and the administration is requesting a budget adjustment to fill the $2.5 million gap. Without the change that created limits by priority groups, we would be spending $6 million this year on emergency housing.
Advocates urged an expansion of rent subsidies to making housing more affordable and help prevent homelessness. That begs the question: who becomes eligible for a subsidy? Every low income family struggles with the cost of housing. How much “prevention” can we afford, and be fair to all?
Support for Needy Families
We also reviewed a Reach-Up work group report on ways to develop greater personal responsibility among recipients and more effective support from the state in getting off the program.
Last year we placed a 5-year cap on benefits, even if a family had been following its development plan. (It allows for continuing benefits for those unable to find jobs if they provide equivalent community service work.) There is no real money saved, but hopefully progress in overcoming the cycle of poverty.
The report came back with one core message: Caseworkers have such high caseloads that they often cannot even see the families that they are supposed to be supervising. Advocates are urging an increase in staff in order to achieve long term success.
Invest more now with the hope to save money and improve the quality of life for all, in the future? The War on Poverty celebrates its 50th birthday this year, and has yet to see that aim achieved.
In a year where we already face a projected $70 million budget shortfall if everything stays the same, all the talk of the need for new programs and program expansions should be enough to send a chill down any taxpayer’s spine.
Next Year’s Budget
This coming week, we will hear the governor’s budget address on how the administration proposes to address the gap. There are many concerns that are less emotionally appealing that the needs of struggling Vermonters, but that create significant future burdens if they are not addressed now.
We heard a presentation last month about the ongoing problem with the annual underfunding of the state pension fund. We are not even close to putting enough money in the budget each year to meet the minimum amount required so that the fund can pay out its obligations in the future. If your bank allowed you to underpay your mortgage every year, interest would build and the amount you would have to pay in the future would be hugely increased.
In its most direct terms, every dollar that we continue to fail to put into the fund means three dollars more that we will have to pay in the future. That’s not just an educated gamble about return on current investments. It’s hard financial fact.
We are also facing an estimated seven cent increase in the education tax rate for the second year in a row, in part from spending and in part from flat property values.
Our reliance on federal funds increased from 30 to 35 percent of our $5.2 billion budget this year, at a time when federal funding amounts are facing great uncertainty. Federal cuts are an enormous risk to our general fund and state tax burden.
We “spend” another one billion (16 percent of the entire $6.23 billion ball of wax) on money that we exempt from taxes to support another purpose, for example, the income-sensitivity provisions and current use program of the property tax.
The biggest chunks of that entire sum are K-12 education (27 percent), health care (24 percent), tax expenditures (16 percent), and transportation (9 percent). All of the other categories, from social services to public safety to corrections to general government, have slices smaller than five percent.
The governor’s “State of the State” speech this week did not refer to any of these money issues, so it will bear careful listening in the budget address in the coming week.
Campaign Finance Reform
Last year, both the House and Senate had passed reform bills, and a conference committee was working out the differences. The final product came before the House this past week.
The bill will increase transparency – public access to the information on who is making contributions to whom – significantly. It also sets limits on how much money can be given to a candidate, varying based upon the different offices.
There were those who believe the limits are still too high for Vermont, and can still create undue influence on candidates by a single person or group. We have been to the United States Supreme Court and back on this issue, over a 1997 law that was deemed far too restrictive.
I think the most critical issue is the ability to know where the money is flowing, a point that Rep. Tom Koch of Barre made last year in his challenge to all of us to finally pass new reform legislation this year. The House passed the conference committee recommendation on a 124 to 15 roll call vote. Once passed by the Senate and signed by the governor, we will have finally achieved that.
In the final days of the 2013 session, we passed a law permitting a doctor to prescribe lethal medication to a person with a terminal diagnosis of six months of less who wants the ability to end life before the final stages of the disease.
In the final negotiations to win votes, the original bill was stripped down, dropping many parts that had been included from the beginning and that were the basis for assertions that it included all of the protections against abuse that Oregon has. (It has permitted this practice for years.)
Several bills have already been introduced to address some of the unresolved issues. The law only gives immunity to doctors who act in compliance with its protocols. Rep. George Till, himself a doctor, has introduced a bill that would include pharmacists and consulting doctors, who had been included until the final version that passed last year.
I do not support the far reaches of this new law. We could have addressed the final days of life in better ways, without sanctioning doctors to write a prescription intended to cause death.
But given what we now have, I have introduced two bills to restore two other elements that were removed – or left in doubt – when the final bill was revised.
One would make it explicit that the request for and use of such a prescription must be by the individual themselves, and not through a guardian, agent, or other surrogate decision-maker. Vermont law is explicit in recognizing agents, in particular, as having the right to make any medical decision once the individual has lost decision-making capacity.
I don’t think we intended that to include prescriptions to bring about death, but that clarification was removed from the bill last year.
Similarly, we have existing law that requires doctors to give full information to patients about the support options available to them when they are diagnosed with a terminal illness. It includes, for example, the right to hospice care and pain management. The new law includes a life-ending prescription as one of those support options.
That means doctors, even if not asked, must tell every such patient that a prescription to cause an early death is one of the options now available to them. It makes it sound like a suggestion.
Although this may have been intended by some proponents, I do not believe a majority in the legislature (or among Vermonters) would want that mandate placed on doctors. My bill would clarify that such information is mandated only if it has been requested.
Your comments and questions are welcome. Please keep in touch: email at email@example.com, phone (485-6431), or message at the statehouse (828-2228.) This and past issue discussions can be found on my blog, http://repannedonahue.blogspot.com/