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.
***
Immunizations
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.
***
Physician-Assisted
Death
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:
counterp@tds.net. You can read my past updates on my blog site,
www.representativeannedonahue.blogspot.com.
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