As we come into the home stretch of aligning Senate and House budget and tax bills, some are beginning to reference this as the “Year of the Alligator.” There is finally recognition of the impact of multiple years of setting budgets that do not match our rate of economic growth.
When spending increases at a higher slope than revenue growth, it creates a graph shaped like an alligator’s open jaw, ready to eat us. An increase in taxes only helps for a single year if the growth rates don’t change.
The Senate has now voted on its versions of this year’s spending and tax bills, which means that the clock has begun ticking towards adjournment. The remaining decision-making will take place in the conference committees between the two bodies, and will return to us with only a straight yes or no option.
Unfortunately, the major bill that has not moved yet is the economic development bill.
The Health Care Bill
This past week, the House added $12 million to the budget to pay for health care costs that were left out of the general fund. This divide and conquer process was a disingenuous way of increasing the state budget as a whole. I voted against it.
It included some essential items, but the added taxes to cover it (taxing candy and soda; increasing tobacco taxes) are projected to have a zero growth rate. Thus we opened the alligator’s jaw a bit wider for future deficits.
This was a mega-bill. It rolled up multiple policy directives, spending priorities, and taxes into a single bill. Some parts were very, very good, such as ensuring a mechanism to drop development of the Vermont Health Exchange computer system and join a federal-based exchange if it is not functioning properly by this summer.
The Green Mountain Care Board is working on payment reform, including reform that brings rates from different payers in line for similar services, and I got floor support for adding two clauses to this part of the bill.
The first explicitly bans the Board from reducing or limiting any covered Medicare services in this process. The second asks the Board to assess the pros and cons of protecting independent practitioners in their ability to set their own rates for private patients.
The most controversial part of the bill was the addition of electronic cigarettes to our laws and taxes on tobacco products. E-cigarettes allow people to take in nicotine without burning tobacco. So they are just as addictive, but less damaging to health.
The vapors they emit still carry some toxins, but they disperse in the air more rapidly, unlike the long-lingering effects of tobacco smoke. The strongest objection to them has been the illusion of “safety” and the resulting potential allure to teens as a new vehicle for getting them hooked on nicotine. The counter-argument has been the value they offer to some people in quitting tobacco.
The jury is still out on how we should regulate them. Last year, my committee placed restrictions to block access by kids, but did not ban them as part of the “second hand smoke” protections related to public places.
This is the kind of issue that really needs to come through the work of a committee, with expert testimony and the time to weigh all the factors. I objected to trying to address it based purely on opinions of legislators on the House floor.
However, an effort to ask the Health Department to gather information first was defeated, 79-59. I asked for the vote to be divided solely on the additional tax, and it passed on an extraordinarily narrow vote (extraordinary partly in that it broke party lines) of 70-67.
The length of the debate, combined with multiple roll calls on segments of the bill, resulted in two 10-hour days on the floor. With all of its parts assembled, the health care budget and tax bill passed the House on an 86-57 vote.
I hardly dare say it, but my committee will be taking up the Senate initiative to attempt, again, to remove the “philosophical exemption” clause from the state’s mandatory child immunization law. “Hardly dare,” because I know how passionately people feel on both sides of this issue, and that I will be barraged with calls from around the state.
Parents can currently have their child exempted from the array of vaccinations required before entering school for medical, religious, or reasons of philosophical objection. The more children who are exempted, however, the more other children may be placed at risk.
The issue pits personal liberties against broader social protections. I cannot commit in advance to voting a particular way, but I can commit to being deeply attentive to the testimony about the risk of harm that could result from either position.
I will also fight against moving quickly on the matter. There is no need to pass this bill this year with only a cursory review. I also believe that it is essential to have a public hearing. We owe it to people to hear them out.
Very similar issues were at play when we debated repeal of the physician-assisted suicide bill last week. The personal liberty of having one’s doctor legally permitted to write a prescription to hasten one’s death during a terminal illness is pitted against the harm to society than can result if others are placed at risk of pressure or involuntary choices.
Two years ago, the law we enacted was very different from what even proponents had introduced. In a mucky process of concessions to win votes, many of the protections against potential abuse were stripped out.
In addition, the key data-gathering elements that have given many Oregonians comfort over the years that their law is not being abused were removed.
We believe -- data is not collected; it is anecdotal -- the law has been used twice thus far in Vermont.
One organization is aggressively marketing its support services for accessing such prescriptions, and reading its website reveals a frightening mind-frame. It tells patients that if a doctor says he or she does not support the law, it is a “red flag” that they may be unwilling to offer a terminally ill patient adequate pain relief or an early referral to hospice.
That would be unethical medical practice. The group is basically suggesting that a physician’s opposition to assisted suicide amounts to a risk that they practice medicine unethically.
Furthermore, our law (unlike any other) mandates that clinicians inform any patient with a terminal illness that a prescription to hasten death is among the array of options they have for addressing their illness – whether they want the information or not.
The result has extended to an apparent misinterpretation at some nursing homes that every patient (terminally ill or not) must be informed about this option repeatedly.
I raised these concerns on the floor in debate last week, because it is evidence that we are already seeing abuses in the law.
I also proposed an amendment to remove the clinician mandate. That issue goes to the heart of whether clinician participation is voluntary and whether we want to protect Vermonters from the perception that pressure is being placed on them. My proposal was ruled “not germane” to the bill.
Another amendment proposing to expand the data we gather and restore what the House voted to establish two years ago (but was stripped in the final compromise bill) was defeated. The final vote against repeal was 60-83.
Please keep sending me your thoughts and concerns – they are important to me. Contact me any time via messages at the state house (828-2228), home (485-6431) or by email: email@example.com. You can read my past updates on my blog site, www.representativeannedonahue.blogspot.com.