Legislative Update, February 22, 2014

Legislative Update

Rep. Anne Donahue

February 22, 2014

 

It was the calm before the storm, with almost no action on the House floor last week as committees worked to finish bills that will need to be in the Senate within the next several weeks if they are to have a change of passing this term. So I will focus this update on bills that my Human Services Committee is preparing to pass.

Smoking Bans

This bill as introduced had an extension of the workplace smoking ban to include “semi-enclosed” spaces. Semi-enclosed included anything with a roof and two sides. This part has been removed.

The rest has strong committee consensus. It creates a 25-foot no smoking area around state buildings to eliminate the “smoker gauntlet” the public sometimes faces to get inside, as well as to protect from smoke from entering windows and vents. It also places restrictions on child care facilities, on the grounds of the new state psychiatric hospital, and in all hotel/motel rooms, and enables state parks to create “smoke free” areas.

It does not touch the controversial subject of smoking inside a car with a child – controversial apparently because it is personal, instead of public, space. With what we know about the effects of second-hand today, I think that trapping a child inside a small, contained, smoke-filled area borders on child abuse. There may be an amendment on the House floor to add this to the bill for any child in a car seat, and I would welcome it.

Food Stamps

The state is being fined by the federal government because it far exceeded the error rate in processing food stamp applications for the past several years. The feds are also reclaiming the overpayments from those who received them unknowingly because of our errors. This bill will at least partially make those individuals whole. The challenge will be in coming up with almost a half million in state funds to pay for our errors.

Public Assistance

We have been working on a bill to address some of the financial barriers that result in families on the Reach Up program losing income if they begin working. This long-vexing problem is known as the “benefits cliff.” The bill is good public policy, but it is not an expenditure of tax revenue that I will be able to support unless funding can be found to be shifted from another program.

Developmental Disabilities

The longstanding way that funding for developmental services has been allocated by the administration has been to cut more people off altogether when there is less funding to go around. Currently, only about 20 percent of those who are eligible receive help, and the priority list keeps getting tighter. This bill looks at whether the legislature should have a greater policy role in determining how the resources are shared.

Substitute Medical Decisions

Vermont has a strong law on enforcement of advance directives, which enables someone to have an agent fulfil their wishes about treatment if they lose the ability to provide informed consent. Substitute consent can also occur through a guardianship. However, we are a minority state in having no other person authorized by law to provide consent if needed. (Message: fill out your advance directive.)

It now appears that Medicare may begin to require a legal surrogate for admission to hospice, which could create a barrier for care.

In addition, six years ago a new law that clarified the process for end-of-life “do not resuscitate” orders specified that substitute consent could be through an agent, a guardian, or “other individual” – unspecified. Our committee agreed to address that the next year, but hasn’t yet.

So I introduced a bill this year that created a family or close relationship criterion for hospice and DNR consent. It also clarified that agent or other substitutes cannot speak for a patient requesting a “Death with Dignity” prescription to end life early. Our committee decided this past week that we will address hospice, but on two straw polls, 6-4-1, decided to defer the DNR issue yet again, and to not clarify the intent of the Death with Dignity bill from last year.

Budget Policy Input

Our committee is also working on input for the Appropriations Committee regarding policy issues in the budget. The system redesign developed two years ago for mental health services was intended to put more money in community resources and reduce the need for, and costly use of, inpatient care.

Construction of the new hospital in Berlin is progressing beautifully, but we have now learned that its 25 beds will cost as much to run as the former Vermont State Hospital (54 beds), while we also pay additional costs for 20 high-level inpatient beds at the Brattleboro Retreat and in Rutland. The per-person per-day cost at the new Vermont Psychiatric Care Hospital will be $2,250 per day, or almost $20 million a year, compared to about $1,450 per day at the Retreat and Rutland. The cost difference adds $5m to the inpatient care budget.

Why so costly? First is the loss of economies of scale created by a 25-bed hospital. Some of us predicted that from the start. Secondly, according to the administration, a much higher staff-to-patient ratio is required by the design of the brand new hospital. (You read that right. Higher.) In my view, as someone who invested a great deal of time helping in that design, the budget is significantly over-staffing a facility that was designed to increase efficiency. However, it is hard for legislators to overrule the “experts” on a subject like this.

It will also be opening without a full electronic health record (due to false starts in planning) and without money set aside to implement one next year; it requires an addition to the budget because furniture costs had been left out; and it faces some likely insurmountable obstacles to fully opening on schedule.

There is no full-time person in the administration overseeing the project, and no one at all with significant experience in running a hospital. Last December I urged my colleagues to address this; we have not, so the process stumbles along. Our committee will be recommending close monitoring.

I look forward to seeing you and hearing from you during the town meeting week break. Thank you for your calls and messages, and please continue to keep me informed about your priorities. My email is counterp@tds.net; home phone, 485-6431; at the state house for messages, 828-2228; and my blog to review past updates is at http:// representativeannedonahue.blogspot.com.

Legislative Update, February 8, 2014

Legislative Update

February 8, 2014

Rep. Anne Donahue

 

This Thursday, February 13, there will be a public hearing on what may become one of the most contentious bills this session: how we respond to the federal mandate that we do more to clean up Lake Champlain.

H. 586 (“Improving the Quality of State Waters”) is under committee review in the House, and focuses on registering farms and strictly controlling manure runoff practices. It proposes to raise money through a fee placed on property taxes, graded based upon how much of your property is developed.

Both the Fish, Wildlife and Natural Resources Committee and the Agriculture Committee are taking testimony, and any tax or fee proposal will have to go to the Ways and Means Committee, all before coming to the House floor and then on to the Senate.

The hearing will be in the House Chamber from 7 to 9 p.m.

Looking at a bill on line used to be the only way the public could access pending legislation, and that isn’t always very helpful, since a bill goes through many changes on its way through the process. We have taken some big leaps into the age of technology, however, and anyone who wants to dig for detail can now get a great deal of it by looking on any committee’s web page.

Documents that are posted include updated bill drafts, related reports, and witness testimony. Both of the committees above have this kind of information available on their committee web pages about H.586. Documents can be sorted by bill number, subject, date, or witness name. (The starting point is always www.leg.state.vt.us, then go to the Standing Committee pages.)

I must confess to being pleasantly surprised by how quickly I have adapted to having all of this on an iPad for the first time this year. This past Friday, leaving my small committee room table, I was suddenly struck by the difference. No more towering piles of paper waiting to be sorted!

Human Services Committee

The policy bill my committee is reviewing is a further step in providing cigarette smoke-free air for the public and at worksites. The bill, H.217, covers a wide range of proposals, and I think some are better than others. It includes 50 foot zones around state buildings, adds “partially enclosed” areas in the restrictions for places of public access, expands to cover all hotel rooms, adds child care center grounds, and includes designated smoke-free areas in state parks and lands.

I support smoke-free entrance areas as a right of public entry to our state buildings, and a poll from the Department of Health found that public opinion is in sync on this: 72 percent of Vermonters (including smokers) agree; 21 percent are opposed. Even 54 percent of smokers favored a ban for such entrance areas.

A bill I introduced addressing the new Vermont Psychiatric Care Hospital under construction in Berlin is now being considered as part of the larger smoking bill.

As awareness of health risks have become more prominent, every single hospital in Vermont has adopted a “smoke-free campus.” It may not be fully enforceable, but it is a public health policy statement of importance.

I think it would be an embarrassment to the state, and a poor example, if our new state-of-the-art hospital broke ranks, and allowed health care staff and visitors to be smoking on the grounds. (Patients are already barred from smoking.)

Unfortunately, this comes up against a bargaining right of the Vermont State Employees Association. In initial testimony this past week, a union representative said the VSEA would likely oppose a smoke-free campus policy for the new hospital.

The hospital itself is on schedule with construction, but I have serious worries about whether staffing and operations planning will be able to keep pace to begin admitting patients by July 1. This is critical to address the crisis in emergency rooms, where patients are waiting for days for a bed.

Last week, I discovered that the hospital will open without a fully functioning electronic health record. After many months pursing a vendor who could not produce what was needed, the administration is only now drafting the documents to seek bids for the project. It is a discouraging prospect, and worse yet, no money has been built into the budget for a now higher-than-expected cost projection.

Budget Targets

We have relied for years on patching money into the budget for extra spending with one-time revenue sources, leaving ourselves without the money to maintain that spending the following year. That means we start each year with a deficit facing us just to stay even.

The governor has called upon school boards to hold spending to a three percent increase at the most, and the Green Mountain Care Board required hospitals to hold budget growth to three percent this year. We should hold ourselves to the same standard. The governor’s proposal is almost double that, and relies on a $14 million tax increase on our health insurance payments.

Keeping a tight budget is not an easy prospect, but it is the job we are here to do on behalf of our taxpayers. My committee has begun its review of the human services sections.

Flood Insurance

The House has passed a resolution I introduced urging Congress to delay implementation of a flood insurance law passed two years ago. The bill itself was sound in principle: it sought to make federal flood insurance self-sustaining (instead of taxpayer supported) by increasing rates to market values. It also required an economic impact study to protect against unanticipated consequences.

The study never happened, the bill is going into effect, and Vermonters are being hit with some unexpected and inequitable consequences. Part of this is caused by federal flood zone remapping. People who bought homes that were not in a flood zone (with a purchase price reflecting that) are now suddenly in a flood zone, and placed under mandates to purchase expensive insurance. The property is suddenly worth less as a result.

Congress is now considering a delay until the review actually occurs.

I have never thought we should put time into “feel good” resolutions that ask our Congressional delegation to do something. But by chance two weeks ago, Peter Welch was in the state house on a visit, and I mentioned the possible resolution.

“Oh, please do it,” he said. “We need it” – apparently to help gain support of other colleagues. So I hope the effort pays off.

Our Teacher of the Year

There was a stirring moment on the House floor when Luke Foley, teacher at the STAR program at Northfield Middle/High School and Vermont’s Teacher of the Year, was introduced and received a standing ovation. He was there for a reading of a resolution honoring his achievement.

I was able to also proudly introduce the students who accompanied him.

Congratulations!

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You can reach me to discuss this update, or any other subjects of concern, by calling me at home (485-6431) or by message at the legislature (828-2228), or by my home (counterp@tds.net) or legislative (adonahue@leg.state.vt.us) email. I welcome your input. This and past updates can be found at http://representativeannedonahue.blogspot.com.