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.
Housing
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.
End-of-Life Law
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 counterp@tds.net, 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/
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